Honest Communication with Seriously ill Patients

It is not easy to tell patients they are going to die.  Despite the fact that chemotherapy delivered to cancer patients with a poor prognosis is intended only to provide palliation, not a cure, a majority of patients with metastatic cancer have false expectations regarding the curative potential of the treatment.

This raises the question of whether the needed patient-physician conversations about palliative and end-of-life care are even taking place.  Patients who do not know whether a treatment offers any possibility of cure may be compromised in their ability to make informed treatment decisions that are consonant with their preferences.  This misunderstanding could represent an obstacle to optimal end- of-life planning and care.

If patients have unrealistic expectations of a cure from a therapy that is administered with palliative intent, there is a serious miscommunication that needs to be addressed.  Studies have shown that two-thirds of doctors tell patients at the initial visit that they have an incurable disease, but only about a third actually state the prognosis.   It is not easy to tell patients that they are going to die and many physicians choose not to do this.  It might explain why two months before death, many patients with cancer have not heard any of their doctors use the word "Hospice."

Most patients want to know whether or not they can be cured, and physicians can provide them with the information they need in order to plan for their remaining life.  If patients are offered truthful information on what is going to happen to them, they can choose wisely and physicians can help them make these difficult decisions. 

Helping seriously ill patients and their families to become proactive in understanding and seeking the services of palliative medicine and Hospice care is the focus of a new educational campaign from The Joint Commission. "Speak Up: What You Need to Know about Your Serious Illness and Palliative Care," the program offers free downloadable brochures, videos and posters.  Topics addressed in the brochure include how and when to get palliative care, questions palliative care specialists may ask patients, questions for patients to ask their palliative care providers and where to get more information.  www.jointcommission.org/topics/speakup_brochures.aspx

The Villas in Antioch, Martinez and Alamo work together with families, residents, physicians and Hospice or Palliative care agencies to insure there is clear and honest communication with patients living with serious illnesses.  We are proud to assist guiding residents and their families through one of life's most challenging times with clinical expertise and compassion.  Please contact us if we can assist you with placement of a loved one, or just information regarding eldercare services.
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.

Ten Early Warning Signs of Alzheimer's:

1. Recent memory loss that affects job skills
It's normal to occasionally forget phone numbers and remember them later.  Those with dementia, such as Alzheimer's disease may forget things more often.

2. Difficulty performing familiar tasks
Those affected with Alzheimer's disease could prepare a meal and not only forget to serve it, but also forget they made it.

3. Problems with language
They may forget simple words or substitute inappropriate words, making their sentence incomprehensible.

4. Disorientation of time and place.
Those with Alzheimer's disease can become lost on their own street, not knowing where they are, how they got there or how to get back home.

5. Poor or decreased judgement
The disease can cause people to forget entirely the clild under their care; they may also dress inappropriately, wearing several shirts or blouses.

6. Problems with abstract thinking
Forgetting completely what number or words are and what needs to be done with them.

7. Misplacing things
Putting things in inappropriate places: an iron in the freezer, or a wristwatch in the sugar bowl.

8. changes in mood or behavior
Rapid mood swings from calm to tears to anger for no apparent reason.

9. Changes in personality
People's personalities ordinarily change somewhat with age, but a person with Alzheimer's disease can change drastically, becoming extremely confused, suspicious, or fearful.

10.  Loss of initiative
Becoming very passive and requires cues and/or prompting to become involved.

At Villa Care Homes, we can monitor behavior and provide a safe environment for your loved ones.  Stimulating a person mentally and physically to the best of their abilities to maintain independence is critical for quality of life.  Please visit the Villa Website at: VillaCareHomes.com

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

STROKE WARNING SIGNS

A stroke occurs when the flow of blood to a part of the brain is cut off. This can be due to something (usually a blood clot) blocking the flow of blood to the brain (ischemic stroke). It can also be caused by a burst blood vessel bleeding into the brain (hemorrhagic stroke). About 80% of strokes are ischemic and 20% are hemorrhagic. Without a blood supply, the brain cells in the affected area start to die.
The effects of a stroke depend on which part of the brain is affected and how severe the damage is. A stroke may affect your ability to move, your ability to speak and understand speech, your memory and problem-solving abilities, your emotions, and your senses of touch, hearing, sight, smell, and taste. In some cases, a stroke can be fatal.
It's important to recognize the warning signs of stroke, because quick treatment can reduce the risk of brain injury and death. A stroke usually comes on suddenly, over a few minutes or hours. The warning signs of stroke include:

• sudden weakness, numbness, or tingling of the face, arm, or leg (often on only one side of the body)
• sudden confusion, trouble speaking, or trouble understanding speech
• sudden vision loss (often in one eye only) or double vision
• sudden trouble walking, dizziness, loss of balance or coordination, or falls
• sudden severe headache (often described as "the worst headache of my life") with no known cause

If you notice these symptoms, call 911 (or your emergency medical number if you do not have 911 service) immediately. Stroke is a medical emergency.

Elderly are Easy Targets of Financial Scams

Senior Safety is an important issue, including financial safety.  More than ever, the elderly have become targets of financial fraud, and surprisingly the scammers are of retirement age themselves! “One out of five Americans over the age of 65 has been the victim of a financial scam, according to the Washington-based Investor Protection Trust, a nonprofit that promotes shareholder education. That means more than 7.3 million seniors have been taken advantage of financially through inappropriate investments, high fees, or fraud, which insurer MetLife says comes at a cost of more than $2.6 billion a year. “Older people are being targeted because, as 1930s robber Willie Sutton said when asked why he robs banks, ‘that’s where the money is,’” says Kathleen Quinn, executive director of the National Adult Protective Services Assn. in Springfield, Ill.”
“Many of today’s scammers have a particularly good understanding of their victims–because the fraudsters themselves are of retirement age, if not exactly retired. More elderly con artists than ever seem to be preying on retirees, perhaps because senior citizens put more confidence in someone their age, says Denise Voigt Crawford, president of the North American Securities Administrators Assn. “It’s astounding that you can’t even trust older people anymore,” Crawford says.” (Bloomberg Business Week-Scams:  A Sucker Retires Every Minute, July 15 2010)

The primary way that seniors are taken advantage of is by purchasing financial products that are inappropriate, unsuitable and at times down right fraudulent.   Seniors, including veterans, who are isolated are likely to become targets, and their retirement assets are at great risk.  If you are the caretaker of an aging senior, please take the time to make sure that their retirement savings are secure, and that any changes are truly in their best interest.  If you are have an aging parent living alone, or are a long distance caregiver, reach out for professional care giving help to insure the overall safety of your aging family member.  For help with an aging loved one in the California San Francisco Bay Area, visit VillaCareHomes.com