Determining what Elder care is needed & considerations for placement

Caring for an aging parent, spouse, partner or close friend presents difficult challenges – especially when a crisis hits and you are suddenly faced with the responsibilities of elder care. Perhaps your  mother fell, is hospitalized with a broken hip and needs to go to a skilled nursing facility to recover.

Caregiving can also begin as a result of unsettling warning signs that indicate a need for some sort of intervention.   Perhaps your elderly spouse has wandered off and gotten lost. Or a friend has lost a lot of weight and rarely leaves home. You may be the only person to step in and become the caregiver. Or, you may be the key in a network of family members and friends willing to help. Whatever the situation, you may not be sure of the next step to take.
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What kind of help does your loved one need? Perhaps there are underlying undiagnosed causes that can be corrected.  For example, prescription drugs interactions/side effects, Vitamin B12 deficiency, dehydration, low thyroid, urinary infection and other treatable problems are often mistaken for Alzheimers  or  dementia. According to Consumer Reports on Health, "Any new health problem in an older person should be considered drug induced until proven otherwise." A visit to the primary care physician is critical to rule out any underlying causes and determine the best approach to care.

If the problem is not correctable, what living arrangements are available for your loved one? What nursing care plans are most appropriate? If they are able to remain in their own home, what kind of services can be arranged? Is assisted living preferred over a nursing home? What challenges does your loved one's condition pose? How will both parents get their needs met when they both need different levels of care?  What community resources are available? How will you manage it all – and still maintain a life of your own? Who will make all these decisions? 

Hopefully, the individual has made good life preparations by having a POLST and durable power of attorney for healthcare and financial matters already established.  If not, these documents should be formulated as soon as possible.  The primary care physician will assist in obtaining the POLST form which indicates the person's personal preference for resuscitate or Do Not resuscitate.  Family members often self-designate one responsible person to make the financial and healthcare decisions, or, they may utilize group consensus. 

Of course, each elder care situation is unique. Your loved one's medical condition, financial resources, personality, personal wishes, relationships with potential caregivers, geographic proximity to services and other factors all determine what best approach to take. There is no place like home or maintaining one's usual routine, but when a change of medical condition occurs compromises must be made in order to provide optimal care within your loved one's financial constraints.  If the condition has potential to improve, it is wise to consider temporary measures that can easily transition to permanent if needed.  Conditions requiring daily skilled nursing and/or therapies should be cared for in a Skilled Nursing Facility.  If nursing and therapy is required on an intermittent or several days/week basis, then return to home with home health support services could be considered. 

Meeting one's daily needs at home despite not needing a nurse or therapist can be challenging.  There are meals to prepare, housekeeping, bills to pay, medicine to refill and dispense, personal care to manage and transportation to arrange.  Those who are alone could be monitored with safety monitors or periodic visits and phone calls, but often times isolation becomes problematic.  If care and supervision needs are overwhelming for family/ friends or other providers to safely accomplish within your loved one's budget, then placement out of the home should be considered.

 RCFE's (Residential Care Facilities for the Elderly) can be large communities, or small 6 bed homes; many offer dementia and hospice care.  Those key people who are involved in placement decisions should weigh future needs (depending on the disease process) to minimize the trauma of any future transfers.  Physical and mental needs as well as compatibility with others are important when looking at any communal living situation.  Look closely to the daily program, menu and services to determine if there is enough structure and flexibility to meet your loved one's current and future needs.  Meet the administrator and staff; are they loving, caring, patient, consistent and communicative?  Don't be tempted to make your decision based solely on the look of the room or the building.  Ask how your loved one will get to medical appointments or receive hair/nail care.  Will the program satisfy all the physical, mental, social, emotional and spiritual needs?

Minimizing the institutional nature of a facility while maximizing dignity, choices and quality individualized care can be challenging when caring for those with complex medical conditions including dementia.  When your loved one's condition requires a higher level of care that cannot be safely or appropriately managed in an RCFE, placement in a skilled nursing facility will be necessary.  Another close look at the daily program, menu, services and staff in addition to the environment and activities will help you decide if the facility will be compatible for the patient as well as the family.  Make sure the location is convenient for family and fiends to easily visit, and that your preferred physician will be able to continue providing care.

Please note that referral agencies may be timesaving and helpful in narrowing your choices, but they do not guarantee personal knowledge of the properties and may engage in unfair commission practices or have a conflict of interest with preferred properties.  Facility or healthcare insurance social workers may be more fair and accurate in their suggestions; asking local agencies on aging or recommendations from other friends/family members can also assist in guiding you. Take your time, tour more than three facilities and meet with as many staff and administrators before making your decision; you will be establishing a new relationship with the facility & staff that will hopefully last for many years. 

Please feel free to visit my website to compare what RCFE small 6 bed facilities can provide for your loved one.  www.VillaCareHomes.com  We provide service with personal attention and dignity, loving caring staff and the facility is managed with program structure/customized approach to aging in a home environment.  We cultivate an atmosphere of friendship, comfort and consideration of our residents, visitors and neighbors.  We encourage an independent lifestyle for those with even complex medical conditions so that our residents can maintain their independence while leaving the difficult tasks of daily living to our dedicated and competent staff.  This is the standard you should seek when determining what care is needed for your own loved one.

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WHAT IS SUNDOWNING AND WHAT CAN BE DONE?

Anyone with acute or chronic confusion may become more confused, restless, agitated and anxious in the late afternoon and especially after dark when the sun goes down or seasonally when there are fewer hours of sunlight.  This may happen whether the person is living at home ore in a facility.  The sundowning behavior can worsen following a move or change in routine.  Individuals with sundowning behavior become more demanding, upset, suspicious, disoriented and see, hear, believe things that aren't real or pace/wander.

Those with Alzheimer's Disease act as if their biological clocks are "reset."  These individuals may stay up all night alert and full of energy despite all interventions to encourage them to sleep in bed; then, they will continually doze on/off during the day.  The reasons for these changes in the sleep-wake cycle in Alzheimer's Disease is not known.

The reason for sundowning behavior is also not known. One theory is that there are fewer environmental clues at night when daylight and eyesight is diminished.  Some scientists believe it may be related to the biological clock in the brain which regulate the amount of hormones and other chemicals important for brain function.  If the biological clock is not properly functioning, the brain itself may not be able to properly function as well.

What can be done for those with abnormalities to the sleep-wake cycle?  It can be a very frustrating problem to deal with, but the following suggestions may be worth a try:

1) ACCOMODATE TO THEM.  Granted, this may be the most difficult and costly approach.  Accommodating to the person's new routine must include keeping them in a locked/secured environment and awake night staff for full supervision as well as ongoing stimulation during their awake periods. They could rest and snooze throughout the day to insure they are adequately rested.

2) MEDICATIONS.  It may be appropriate for the doctor to review all medications to consider discontinuing any non-essential medications which may have an effect on sleep.  Other medications that may reduce anxiety, relax muscles or induce sleep may be considered.

3) ASSESS PAIN.  Pain keeps people from sleeping, or may wake them up from sleep.  With some forms of dementia, communicating or expressing one's pain may be impaired.  Those with complex medical problems in addition to dementia may also be affected by musculoskeletal or other source of pain.  In some cases, a trial of a relatively benign pain medication such as Tylenol may be justified.  If sleep problems are in part due to arthritic pain, aspirin or Tylenol may decrease musculoskeletal pain so that the person can sleep more comfortably.

4) ADDRESS NIGHT TIME TOILETING.  Many older persons awaken many times a night to urinate and then are unable to return back to sleep.  Identify if there might be a urinary infection, provide a bedside urinal or commode to minimize walking through the house activity.  With less physical activity involved to manage night time urination, individuals may fall back to sleep more easily.

5) UTILIZE NIGHT LIGHTS.  Elderly individuals may also have low vision which is exacerbated at night.  A small night light helps to orient and minimize agitation if the individual wakes up and becomes frightened by strange surroundings.  Night lights can also be placed to mark the pathway to the bathroom.

6) KEEP A STANDARD, DAILY ROUTINE.  While caregivers may change from day to day, it is helpful to keep a standard daily routine for any individual with dementia.  A standard daily program for wake-up time, meals, medications, toileting and bedtime routines should be followed by all caregivers to provide consistency.  The daily routine should also include physical activity and other mentally stimulating activities which will help to reset the awake-sleep cycle as well as maintain optimal function. A consistent program reduces anxiety so that an individual will also learn to anticipate what will happen next rather than begin to worry or become anxious wondering when they will eat, get their meds, toilet or go to bed.  Make a written program which is followed by all caregivers 7 days/week.

Dementia: When to worry

Have you ever gone to the pantry to get something then can't remember why you went there?  Can't remember where you put your phone or keys?  Have trouble remembering someone's name?  Are you worried about your memory?  Then join the crowd and perhaps worry less.  The type of memory problems described above are entirely consistent with normal brain function in someone over 55 (or younger) and are in no way indicative of dementia.  Many people consult doctors about their poor memory and are concerned they may be in the early stages of dementia.  If YOU ALONE are concerned about your memory, there is most likely less concern about dementia than if close family members are concerned.

True dementia does involve short term memory loss with retention of long term memories, but it's more than just that.  In general it can be said that dementia involves memory impairment PLUS some inability to function independently in one's daily routine, social activities, or relationships.  These independent functions might include:

• Impairment of complex tasks such as balancing a checkbook
• Impairment of reasoning such as difficulty dealing with new and unfamiliar situations
• Impaired spatial functions (Dementia testing often will involve asking the subject to draw a clock face with a given time on it, or copy a pattern on paper)
• Impaired language such as using the wrong words to describe things

Of those who have  dementia, about 70% have Alzheimer's disease, 10-20% have Vascular (stroke related) dementia and 10-15% have Lewy body dementia (an accelerated form of Alzheimer's).  Other diseases such as Parkinson's or brain tumors can also result in related dementias.

Dementia-like symptoms that can appear to be similar in behavior (but are not) can include age related mild cognitive impairment (MCI), delirium or depression.  Those with simple age related cognitive impairment may have some memory difficulty and they may think a little more slowly, but the ability to function with day to day activities remains intact.  Patients with delirium have a sudden onset of new mentation symptoms and this is usually reversible. On the contrary, the onset of dementia is gradual and will worsen with time.   Depression can also mimic dementia-like symptoms.  Depressed individuals may perform poorly on standardized dementia tests due to lack of motivation and/or poor effort.  Medications can also create brain function changes that simulate dementia; alcohol, antihistamines, psychiatric medications, sedatives and others can impair memory and cognitive function.

Getting evaluated for dementia first involves talking to your primary care physician about your symptoms.  Then a brief brain function screening test can be administered.  If the screening test score results in a cause for concern, then blood testing for reversible causes like vitamin B12 deficiency or thyroid deficiency can be performed.  The value of brain imaging in diagnosing early dementia is controversial since the most common causes of Alzheimer's disease and Lewy Body disease will show no abnormality on imaging tests.  Neuropsychological testing is frequently valuable in anyone who is having a new brain function problem.  This testing involves several standardized cognitive skills tests administered by a neuropsychologist. 

At best, medication treatment for dementia can provide a modest improvement in symptoms and can slow down the rate at which dementia progresses.  Dementia is frequently accompanied by depression so antidepressant medication can be beneficial as well as other stimulating activities such as Physical, Occupational and Recreational therapies aimed at cognitive rehabilitation, exercise and mental stimulation. 

The benefits of social support for all individuals, families and caregivers affected by dementia related disease cannot be emphasized enough.  The prognosis from early symptoms to morbidity may last as long as ten years or more.  Joining support groups, dividing up caregiving duties and finding proper medical care or placement is imperative for the well-being of the affected individual as well as their loved ones.

Staying at home with support, placement in Skilled Nursing, Dementia Care Units or Board and Care facilities are all choices families may make for their loved ones.  Please visit the Villa Care Homes website to see how small board and care facilities can manage residents with dementia with a regimented daily program and high level of care/supervision. www.VillaCareHomes.com

Vitamin D deficiency ages bones

A recent study conducted by American and German scientists found that vitamin D deficiency not only inhibits the formation of new bone but also accelerates aging of existing bone, according to an article in Medical News Today. The study appears in the journal Science Translational Medicine.
Robert Ritchie, leader of the American team from the University of California, Berkeley, said, “The assumption has been that the main problem with vitamin D deficiency is reduced mineralization for the creation of new bone mass, but we’ve shown that low levels of vitamin D also induce premature aging of existing bone.”
Vitamin D helps the body absorb calcium. When a person becomes vitamin D deficient, his or her body takes calcium from the bone to replenish blood calcium levels, which can lead to rickets (in children), osteomalacia, or osteoporosis. According to Björn Busse, leader of the German team and a scientist at the University Medical Center in Hamburg, “Unraveling the complexity of human bone structure may provide some insight into more effective ways to prevent or treat fractures in patients with vitamin D deficiency.”
The study highlights the importance of continually monitoring and maintaining vitamin D levels in patients who are at risk for vitamin D deficiency. The article suggests that vitamin D deficiency is a growing problem in the United States.
It is not too late to start adding vitamin D to your daily regimen. Patients 65 and older stand to benefit from everyday vitamin D supplementation. In 2012, the U.S. Preventive Services Task Force suggested that supplemental vitamin D combined with exercise can reduce the risk of falls in individuals who are at an increased risk. To reap the benefits, it is crucial that patients take a high enough dose as determined by a physician. The American Geriatrics Society recommends that patients with proven vitamin D deficiency take at least 800 IUs a day.

Please visit us at VillaCareHomes.com   We care about the physical, social, mental and emotional needs of our residents.

Brain Power/Brain Boosting habits

Living to an old age isn’t much fun if you can’t remember anything. No matter what your age, you can protect your memory and keep your mind sharp with one habit: practice a mental exercise every day. Practice consistently, and by the end of the month, you will have a new brain-boosting habit that will pave the way for a long and memorable life!

This comes from habits found in the 2011 Longevity Program, a yearlong plan of monthly activities that come from the habits of centenarians from around the world. The idea of this program is that by choosing a simple activity and doing it every day, you will gradually develop 12 new healthy habits by the end of the year. Would you like to do the whole year program?

This Month's Habit: Practice a brain-boosting exercise each day
Here’s why: While you may not be able to teach an old dog new tricks, you can certainly teach your brain some new tricks. Scientists have found that the human brain has an amazing ability to adapt and change--an ability called neuroplasticity. With the right stimulation, your brain can form new neural pathways, helping increase your cognitive capabilities, improve your ability to learn new information, and give your memory a boost.
By the time you are an adult, your brain has developed millions of neural pathways that help you solve problems you have come across before and process information at a rapid pace. But sticking to these well-worn pathways does not give your brain the stimulation it needs to keep developing. Mental brain puzzles performed on a daily basis help strengthen your brain by activating new neural pathways. One thing to keep in mind: the activity you choose should be a little out of your comfort zone. If you choose something you are already good at, even if it’s intellectually demanding, it isn’t an optimal choice for exercising your brain. Also, try to practice around the same time every day, because consistent cycles aid in the development of new neural pathways.
Brain-Boosting Exercises
These brain exercises help improve brain capacity in younger people and restore mental faculties that are declining in older people.
1. Use it or lose it with a cognitive workout: Memorize a poem, play chess, enjoy a challenging crossword puzzle, learn phone numbers by heart, add numbers without a calculator, learn the words to a new song, or memorize a shopping list--as long as it’s something new to you. Keep challenging yourself with new tasks.
2. Use your non-dominant hand: If you’re right-handed, use your left hand to eat, comb your hair, brush your teeth, write your name, or try putting your mouse pad on the other side of the keyboard. This practice of non-dominant hand use stimulates communication between the two hemispheres of the brain, helping to improve mental capacity as well as physical balance. Another idea: tai chi and yoga are physical activities that coach people to use the right and left side of the body equally.
Reward yourself
If you stick to the plan nearly every day, think of a way to reward yourself. You will be more likely to follow through with your goal when there is a bonus at the finish line.
Stay on track
To stay on course, ask yourself these questions each day. Keeping a written record of daily answers will help you stick to the plan and may offer insights to keep you inspired.
• Are you practicing one brain-boosting exercise every day? What has the experience been like?
• How do you feel today compared to the previous day? How about to one week ago? You may notice that you are processing new information more quickly and you may feel more alert.
• What obstacles are keeping you from practicing your mental exercise every day? What can you do to remove the obstacle?
Make it happen! An answer for every excuse
• Miss a day? Sometimes, when things get busy, you might miss a day or two. But, you are not a failure! Let it go and consider the reasons for missing a few days. What will you do differently for more successful results? Simply recommit, make adjustments, and continue where you left off. Don’t ever give up!
• Too boring. Keep your mental activity fun. If none of the above examples work for you, try any appealing activity that requires some mental effort and expands your knowledge. Some examples are learning a new language, instrument, or technological device. Try a sport or other physical activity you have never tried before, like qi gong or a zumba dance class.
• Forget to practice. Start simply. If you can’t remember to do a brain exercise every day, try building off of the daily habits you already have. Brush your teeth with your non-dominant hand. On your commute, memorize the signs around you and then recall them to memory. In an empty moment, try to remember each birthday of the people you know.
At the end of the month: If you have been practicing one mental exercise a day, it is likely that you have created a new brain-boosting habit.

Let us be part of your loved one's mental stimulation and well-being.  If you are considering board and care placement, please check out my website: VillaCareHomes.com

May you live long, live strong, and live happy!

Spinal Fluid Test predicts Alzheimer's Disease

Researchers report that a spinal fluid test can be 100 percent accurate in identifying patients with significant memory loss who are on their way to developing Alzheimer’s disease.  Although there has been increasing

evidence of the value of this and other tests in finding signs of Alzheimer’s, the study, which will appear Tuesday in the Archives of Neurology, shows how accurate they can be. The new result is one of a number of remarkable recent findings about Alzheimer’s. 

 

After decades when nothing much seemed to be happening, when this progressive brain disease seemed untreatable and when its diagnosis could be confirmed only at autopsy, the field has suddenly woken up.
Alzheimer’s, medical experts now agree, starts a decade or more before people have symptoms. And by the time there are symptoms, it may be too late to save the brain. So the hope is to find good ways to identify people who are getting the disease, and use those people as subjects in studies to see how long it takes for symptoms to occur and in studies of drugs that may slow or stop the disease.

Researchers are finding simple and accurate ways to detect Alzheimer’s long before there are definite symptoms. In addition to spinal fluid tests they also have new PET scans of the brain that show the telltale amyloid plaques that are a unique feature of the disease. And they are testing hundreds of new drugs that, they hope, might change the course of the relentless brain cell death that robs people of their memories and abilities to think and reason. “This is what everyone is looking for, the bull’s-eye of perfect predictive accuracy,” Dr. Steven DeKosky, dean of the University of Virginia medical school, who is not connected to the new research, said about the spinal tap study.

Dr. John Morris, a professor of neurology at Washington University, said the new study “establishes that there is a signature of Alzheimer’s and that it means something. It is very powerful.” A lot of work lies ahead, researchers say — making sure the tests are reliable if they are used in doctors’ offices, making sure the research findings hold up in real-life situations, getting doctors and patients comfortable with the notion of spinal taps, the method used to get spinal fluid. But they see a bright future.

Although the latest PET scans for Alzheimer’s are not commercially available, the spinal fluid tests are.
So the new results also give rise to a difficult question: Should doctors offer, or patients accept, commercially available spinal tap tests to find a disease that is yet untreatable? In the research studies, patients are often not told they may have the disease, but in practice in the real world, many may be told.
Some medical experts say it should be up to doctors and their patients. Others say doctors should refrain from using the spinal fluid test in their practices. They note that it is not reliable enough — results can vary by lab — and has been studied only in research settings where patients are carefully selected to have no other conditions, like strokes or depression, that could affect their memories. “This is literally on the cutting edge of where the field is,” Dr. DeKosky said. “The field is moving fast. You can get a test that is approved by the F.D.A., and cutting edge doctors will use it.”

But, Dr. John Trojanowski, a University of Pennsylvania researcher and senior author of the paper, said that given that people can get the test now, “How early do we want to label people?” Some, like Dr. John Growdon, a neurology professor at Massachusetts General Hospital who wrote an editorial accompanying the paper, said that decision was up to doctors and their patients.  Sometimes patients with severe memory loss do not have the disease. Doctors might want to use the test in cases where they want to be sure of the diagnosis. And they might want to offer the test to people with milder symptoms who want to know whether they are developing the devastating brain disease.

One drawback is that spinal fluid is obtained with a spinal tap, and that procedure, with its reputation for pain and headaches, makes most doctors and many patients nervous. The procedure involves putting a needle in the spinal space and withdrawing a small amount of fluid.  Dr. Growdon and others say spinal taps are safe and not particularly painful for most people. But, he said, there needs to be an education campaign to make people feel more comfortable about having them. He suggested that, because most family doctors and internists are not experienced with the test, there could be special spinal tap centers where they could send patients.

The new study included more than 300 patients in their 70s, 114 with normal memories, 200 with memory problems and 102 with Alzheimer’s disease. Their spinal fluid was analyzed for amyloid beta, a protein fragment that forms plaques in the brain, and for tau, a protein that accumulates in dead and dying nerve cells in the brain. To avoid bias, the researchers analyzing the data did not know anything about the clinical status of the subjects. Also, the subjects were not told what the tests showed.  Nearly every person with Alzheimer’s had the characteristic spinal fluid protein levels. Nearly three quarters of people with mild cognitive impairment, a memory impediment that can precede Alzheimer’s, had Alzheimer’s-like spinal fluid proteins. And every one of those patients with the proteins developed Alzheimer’s within five years. And about a third of people with normal memories had spinal fluid indicating Alzheimer’s. Researchers suspect that those people will develop memory problems.

The prevailing hypothesis about Alzheimer’s says that amyloid and tau accumulation are necessary for the disease and that stopping the proteins could stop the disease. But it is not yet known what happens when these proteins accumulate in the brains of people with normal memories. They might be a risk factor like high cholesterol levels. Many people with high cholesterol levels never have heart attacks. Or it might mean that Alzheimer’s has already started and if the person lives long enough he or she will with absolute certainty get symptoms like memory loss.

Many, like Dr. DeKosky, believe that when PET scans for amyloid become available, they will be used instead of spinal taps, in part because doctors and patients are more comfortable with brain scans.
And when — researchers optimistically are saying “when” these days — drugs are shown to slow or prevent the disease, the thought is that people will start having brain scans or spinal taps for Alzheimer’s as routinely as they might have colonoscopies or mammograms today.  For now, Dr. DeKosky said, the days when Alzheimer’s could be confirmed only at autopsy are almost over. And the time when Alzheimer’s could be detected only after most of the brain damage was done seem to be ending, too.
“The new biomarkers in CSF have made the difference,” Dr. DeKosky said, referring to cerebral spinal fluid. “This confirms their accuracy in a very big way.”

Excerpt from NY Times article

Let Villa Care Homes assist you with your family member who may have Alzheimer's.  We have trained staff capable to handle complex medical conditions, including dementia and Alzheimer's.  We are located in Antioch, Martinez and Alamo, California.       www.VillaCareHomes.com