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  • Homecaresandiego

    Homecaresandiego

    The “Triple Witch Hour” at a Home Care Agency  

    The Triple Witching Hour

    Borrowed from the stock market, the term “triple witch hour” became part of our vernacular at the Agency; and unlike the stock market, which had a triple witch hour on one Friday afternoon every three months (a point at which futures and options contracts expired, bringing about heightened volatility and excitement), we had a triple witch hour –several hours really- every Friday afternoon. Thus we prepared all week for the dreaded hours on Friday afternoons.

    The Agency’s “responsibility”

    Mrs. Mullen lives on her own, cared for by our live-in caregiver, Juanita. She is wheelchair-ridden, paralyzed from the waist down as a result of a stroke she had almost a year back. She has a loving and capable daughter, Linda, who is an attorney. Linda would have been the perfect person for Mrs. Mullen to live with, except that Linda lives in Delaware, miles and miles away.

    We’ve had this relation with Mrs. Mullen ever since she came out of the hospital following her stroke. A short time later, Juanita became the primary caregiver, and every time Juanita wanted to take the weekend off, usually every other week, we would send another caregiver to fill-in, also as a live-in. We thus provided services at the Mullen residence on a continuous basis, without interruption.

    Relieving the primary caregivers

    On Friday afternoons, our weekenders would be showing up to replace weekday caregivers at client homes throughout the area. Since most of our clients were like Mrs. Mullen in the “may-not-be-left-unattended” category, we were thus assigned to provide uninterrupted services at many of our clients’ homes. We therefore had many “Juanitas” who had worked day and night from Sunday to Friday and who were, on Friday afternoons, looking for their fill-in relief caregivers to arrive and take over for the weekend.

    Not only were we to provide for the safety and wellbeing of our clients, but we also had to –simply had to- relieve the weekday primary caregivers who, having worked hard all week, would have made rigid plans for the Friday night –plans that we better not upset. For if the relief worker didn’t show, they would have to stay on the job until we could find someone else to relieve them, and that might take several hours at best.
    That set the tone for the “witching” factor: caregivers calling in late at the last minute or, worse, no shows on the part of the weekend relief caregivers.

    Care Coordinators on their knees

    The task of scheduling caregivers to be at certain homes by no later than set time falls on the Care Coordinators, or Care Managers as they are at times referred to. At our agency, we had three Coordinators, and it wasn’t rare that we overheard a Coordinator “begging” a caregiver to drop what she had and rush to a certain patient’s home. And that wasn’t because the Coordinator didn’t have other caregivers who could go to that patient, it was because only that particular caregiver had the requisite knowhow to meet the needs of a certain patient. Besides, she would have typically been to that patient before, with good knowledge of how to get to the patient’s home and how to provide good care and companionship once she is there.

    Thus if wheelchair-ridden Mrs. Mullen was also say over 200 lbs in weight, we couldn’t just send any caregiver there. It had to be someone who could execute smart transfers for a person of that weight, apart from the patient’s other needs. To relieve Juanita at Mrs. Mullen, of the dozens of caregivers we had, perhaps only a handful a) lived within commuting distance from the Mullen residence, b) could do that kind of lifting, and c) happened to be available at the last minute for a 48-hour live-in assignment.

    Our clients’ needs

    Short term forgetfulness, cognitive impairments, Alzheimer’s, paraplegics, advanced Parkinson’s, and people who were very frail, those were some of the folks in our charge, their sons and daughters at work and living separately, frequently in other states. They represented the ultimate in responsibility to all of us the agency -care recipients who could not be left unattended –not even for 10 minutes. Thus by Friday afternoon of every week we worried mostly about them and, in particular, about those whose next of kin, or “responsible party” as we referred to them, were out of town. And even among those, there were always a handful who could not be staffed by just any caregiver –they required attention by the very special only.

    We prepared all week for the witching afternoon

    Over time, we learned how to “attack” the Friday witches: we prepared well. We prepared all week, and we had contingency plans for all eventualities. Most weeks, we were able to go home on Friday evenings by 7 or 8 PM, having tucked in everyone with their rightful caregiver. Lisa would be squarely booked for Ms. Francis who loved her and who would throw a tantrum –at 92 years of age- if we sent anyone else. Mrs. Kulowski, who fussed and cussed whomever we sent for the weekend, would finally get exhausted and go to sleep, only to wake up altered and easy going the following morning. I remember one fateful Friday afternoon though when I felt like the Oxygen had been sucked out of my lungs –out of our whole office.

    Because of a lot of flu going around, we had what came close to being a tsunami of call-outs: one caregiver after the other calling out sick. We worked our database, tapped our short lists, made a hundred calls and, after all that, we were left with two caregivers that we simply could not find reliefs for.  We decided that people from the office staff would fill-in. Nothing else we could do. We would go ourselves because the caregivers in attendance there had both done two weeks in a row non-stop, so we simply had to relieve them. At the very last minute however, one of our Coordinators pulled the hare from the hat and produced first the one, then both of the needed caregivers. The point nevertheless was that if all else failed, and it never did, we, the office personnel, would have to fill the gap.

     

  • Baby Boomers

    Baby Boomers In a Classic “Double Whammy” 

    The secret was out by the turn of the millennium

    People mostly referred to it as the “double whammy”, although I’ve also heard it called the “vortex”.  If you combine a whirlwind with a large, twirling funnel, you get a vortex into which people get sucked. Thus, by the turn of the millennium, boomers born in the late 1940s were turning into their early 50’s in large numbers. They were typically at or near the peak of their careers, with dual, real-time responsibilities to parents as well as children. I was in at-home eldercare at the time, a vantage point from which I was privy to the unraveling of many a family who suddenly found themselves grappling with the whirlwind.

    By Jennifer N. Brok in The Evolution of the Aging Population: “10,000 baby boomers entering the Medicare age every day, heralding a seismic shift in demographics worldwide. By 2020, there will be 115 million seniors in America.”

    The women usually ended up with the heavy lifting
    Thus Jennifer Huxley received me at her door one afternoon and promptly broke down in tears. We had spoken on the phone the day earlier when she recounted a story I was only too familiar with. Her father-in-law had died unexpectedly, leaving behind a mentally impaired wife he had been looking after. From that point on, it was the daughter-in-law, not the son, who had to put a hold on all facets of her life to take care of this 80-year old who could not be left unattended –not even for 10 minutes.

    By Laura Carstensen, director of the Stanford Center on Longevity: “The norms that told us when to get an education, when to marry, when to retire evolved when we lived half as long as now; In those norms, we’re raising kids, reaching the peak of our careers, and taking care of aging parents, all at the same time.”

    The Huxleys in the clutch of the vortex
    “She was suddenly in my lap the same day he died,” Jennifer said. “When I called you yesterday, I had no idea what to do.” Then she continued, “She’s here now, with the caregiver you sent, but there is no way we’re going to be able to afford a full-time caregiver.” With two daughters of college age, and with Jennifer’s in-laws having –not uncharacteristically- outlived their resources, Jennifer and her teacher husband found themselves suddenly staring at the prospect of having to spend down from paltry savings. And while most families manage to cope with the added responsibility, the hands-on caregivers –usually the women- suffer from stress and often neglect their own health, according to experts.

    By Ken Dychtwald Ph.D. Gerontologist and public speaker: “…for others, this “longevity bonus” will be fraught with pain and suffering. Large numbers of tomorrow’s elders could wind up impoverished, left stranded by an absence of financial preparedness and dwindling old age entitlements.”

    The path ahead for baby boomers (born between 1946 and 1964)
    Experts say the number of adult children taking care of their parents will increase as people live longer. According to a 2011 study done by MetLife Mature Market Institute, there are nearly 10 million children over the age of 50 who care for their parents. That figure has more than tripled over the past 15 years. And, according to the U.S. Department of Health and Human Services, the demand for informal caregivers – family, friends and neighbours – is expected to grow by more than 20 percent in the next 15 years as baby boomers age.
    Long term care (LTC) insurance
    “Life expectancy is going up. The National Institute of Aging says that by 2040 life expectancy for men will be 86 and for women 91.”

    Medicare, Medicaid, and an individual’s health care insurance do not reimburse for long term care. To avoid a crisis, the adult children of seniors and their parents had better have a plan that assumes life beyond the mid 80’s for the seniors. Long term care insurance is definitely a vehicle to look into. If the parent is still in their 50’s or 60’s, the premium for a policy can be thought of in terms of a monthly car instalment. When that parent later begins to need care at home or at a facility, the policy kicks in. How much the policy covers will depend on the type purchased. For example, a policy could be for 5 years only, or for life; it can be for up to 8 hours a day, or up to a daily dollar value, with a policy cap. There are hundreds of LTC insurers, and the policy for each family needs to be shopped much like a car is.

    Choices and costs for eldercare in 2012

    • For an 80-year old who is semi-independent, count on $16/hour for an agency caregiver, perhaps $10/hour if hired privately, and let us say help for 6 hours/day, 7 days/week; the annual costs would be approximately $35,000 for an agency hire, or $22,000 for a private hire; add to that the cost of maintaining a home and living expenses.
    • For an 80-year old who is totally dependent, count on a 7-day live-in caregiver, at $160/day from an agency, and $90/day if hired privately; this comes to $58,000/year for an agency hire, or $33,000/year for a private hire, plus the above referenced home and living expenses.
    • For an 80-year old at a middle class assisted living facility, count on at least $4,500 a month, inclusive of all the add-ons, for a total of $54,000/year.
    • For a person of any age, the national average daily rate for a private room in a nursing home is $250, or $90,000+ a year.
  • Seniors In Their Homes

    Meals On Wheels Service Can Keep Many Seniors In Their Homes

    Many older adults need only a little support to stay in their homes, but when that isn’t available they can end up in an expensive nursing home where they don’t need most of the available services. According to a new study, states that invest more in delivering meals to seniors’ homes have lower rates of such “low-care” seniors in nursing homes, after adjusting for several other factors.

    The more states spend on home-delivered meals under the Older Americans Act, the more likely they are to help people who don’t need nursing home care to stay in their homes, according to a newly published Brown University statistical analysis of a decade of spending and nursing home resident data.

    “Despite efforts to rebalance long-term care, there are still many nursing home residents who have the functional capacity to live in a less restrictive environment,” wrote gerontology researchers Kali Thomas and Vincent Mor in the journal Health Services Research. “States that have invested in their community-based service networks, particularly home-delivered meals, have proportionally fewer of these people than do those states that have not.”

    Nationwide in 2009, 12.6 percent of nursing home residents were considered “low-care,” meaning they did not need much of the suite of services that a nursing home provides. That proportion had declined from 17.9 percent in 2000 because of a variety of efforts, including OAA programs as well as Medicaid-sponsored home- and community-based services (HCBS).

    But the percentages every year vary widely between the states. A major reason for that state-to-state variation turns out to be the difference that home-delivered meals can make. The researchers wrote that their analysis boils down to this ratio: For every $25 per year per older adult above the national average that states spend on home-delivered meals, they could reduce their percentage of low-care nursing home residents compared to the national average by 1 percentage point.

    Thomas and Mor’s calculations didn’t merely associate each state’s meals spending with its percentage of low-care residents in nursing homes. They also statistically controlled for the overall decline over time and a wide variety of factors that might also have affected the rates. Those factors included state spending on Medicaid HCBS, as well as a variety of long-term care market pressures, such as excess capacity or nursing home reimbursement rates, that could create incentives for nursing homes in different states to pursue or forgo relatively profitable low-care residents.

    The data included state spending on OAA programs and performance information from each state between 2000 and 2009 as well as variety of public health and nursing home data sources compiled by Brown University’s Shaping Long-Term Care in America Project. In all, 16,030 nursing homes were included in the research.

    After all the analysis, home-based meals, which served more than 868,000 people in fiscal 2010, emerged as the only statistically significant factor among OAA programs that affected state-to-state differences in low-care nursing home population. Home-delivered meals account for the bulk of OAA spending.

    Other factors keeping low-care residents out of nursing homes in some states included a high proportion of residents receiving skilled nursing care, which provides nursing homes with higher revenues. Factors that drove more low-care residents of some states into homes included high nursing home capacity and a high percentage of residents with not-so-lucrative Medicaid funding.

    Meals mean a lot

    Lead author Thomas said that as a Rhode Island Meals on Wheels volunteer and the granddaughter of a Meals on Wheels beneficiary, she was not surprised to see that the program has such a significant impact.

    Until her grandmother died in October, she was able to live at home despite suffering from macular degeneration that made it impossible for her to cook.

    “My 98-year-old granny was able to remain at home, independent in her house until she died, and we have always, even before I did this research, attributed that to Meals on Wheels,” Thomas said. “She lived four hours away from any family and refused to leave her house. We had comfort in knowing that every day someone was in her house to see how things are.”

    Drivers, after all, not only bring food every day but also observe the condition of their clients. If the elderly beneficiary doesn’t answer a delivery, drivers report that. The volunteers therefore provide food and a “safety check” for many older adults.

    For retired journalist and state worker Bill McNamara, 90, of Warwick, R.I., Meals on Wheels helps because he and his wife Catherine, also 90, have developed arthritis in recent years that makes food preparation too difficult. Since 2009 they have lived in an in-law unit of their son’s house, but because his son and daughter-in-law both work, McNamara said, asking them to prepare all their meals would be a significant burden.

    Instead, Meals on Wheels of Rhode Island provides that service, McNamara said. The food is great and the drivers work hard to ensure consistent and timely delivery, he said. They even faithfully worked around the recent obstacle of the road being closed for a time.

    “We feel it’s even better than we would have anticipated,” McNamara said. “We look forward to hearing the bell ring.”

    For many seniors, especially those who don’t live with such a supportive family like the McNamaras, research shows that meal delivery is what allows them to remain where the ring of the doorbell is for their own door.

    Source: www.medicalnewstoday.com

  • What Is Alzheimer’s Disease?

    What Is Alzheimer’s Disease? What Causes Alzheimer’s Disease?

    Alzheimer’s disease is a progressive neurologic disease of the brain leading to the irreversible loss of neurons and the loss of intellectual abilities, including memory and reasoning, which become severe enough to impede social or occupational functioning. Alzheimer’s disease is also known as simplyAlzheimer’s, and Senile Dementia of the Alzheimer Type (SDAT) .

    During the course of the disease plaquesand tangles develop within the structure of the brain. This causes brain cells to die. Patients with Alzheimer’s also have a deficiency in the levels of some vital brain chemicals which are involved with the transmission of messages in the brain – neurotransmitters.

    Alzheimer’s disease is the most common form of dementia. The disease gets worse as it develops – it is a progressive disease. There is no current cure for Alzheimer’s, although there are ways of slowing down its advance and helping patients with some of the symptoms. Alzheimer’s is also a terminal disease – it is incurable and causes death.

    According the National Institute on Aging, there are estimated to be between 2.4 million and 4.5 million Americans who have Alzheimer’s. There are approximately 417,000 people in the UK with Alzheimer’s, according to the Alzheimer’s Society.

    People who lead active lifestyles are more likely to slow down the progression of Alzheimer’s disease, while active people who are Alzheimer’s free have a lower risk of developing the disease or any kind of dementia, researchers from the University of California reported at the annual meeting of RSNA (the Radiological Society of North America) in November 2012.

    Lifestyle factors that help ward off or slow down Alzheimer’s include yard work, gardening, dancing, riding an exercise bike, and any type of aerobic exercise.

    Why the name Alzheimer’s disease?

    Aloysius Alzheimer was a German neuropathologist and psychiatrist. He is credited with identifying the first published case of “presenile dementia” in 1906, which Kraepelin later identified as Alzheimer’s disease – naming it after his colleague.

    In 1901, while he worked at the city mental asylum in Frankfurt am Main, Germany, Dr. Alzheimer had a 51 year old patient called Mrs. Auguste Deter. The patient had distinct behavioral symptoms which did not fit any existing diagnoses – she had rapidly failing memory, disorientation, confusion, had trouble expressing her thoughts, and was suspicious about her family members and the hospital staff. Her symptoms progressed relentlessly. Dr. Alzheimer wrote that she once said to him “I have lost myself.”

    Over the coming years Auguste Deter would take up more and more of Dr. Alzheimer’s time, to the point of almost becoming an obsession for him. The lady died in 1906 and Dr. Alzheimer, who was working at Kraepelin’s lab in Munich, had her patient records and brain sent there.

    Along with two Italian doctors, Dr. Alzheimer performed an autopsy. The autopsy revealed that her brain had shrunken dramatically, but there was no evidence of atherosclerosis (thickening and hardening of the walls of the arteries). He used a silver staining technique he had learnt from ex-colleague Franz Nissl which identified amyloid plaques and neurofribrillary tangles in the brain – two hallmarks of the disease.
    In November, 1906 Dr. Alzheimer gave the first lecture ever that presented the pathology and the clinical symptoms of presenile dementia together. Kraepelin started using the term Alzheimer’s disease, which by 1911 was being used throughout Europe and by European doctors when diagnosing patients in the USA.

    Fairly recently, Dr. Alzheimer’s findings were reevaluated when his original microscope preparations on which he based his description of the disease were rediscovered in Munich.

    A researcher from Prague, Oskar Fischer, and a contemporary of Dr. Alzheimer’s, may have described the pathology of dementia in greater depth than did Alzheimer himself, say Czech scientists who have been digging through historical archives in Prague.

    What are the symptoms of Alzheimer’s disease?

    Doctors say Alzheimer’s disease can sometimes be tricky to diagnose because each patient has unique signs and symptoms. Several of the signs and symptoms present in Alzheimer’s disease also exist in other conditions and diseases.

    Alzheimer’s disease is classified into several stages. Some doctors use a 7-stage framework, while others may use a 4, 5 or 6-stage one.

    A common framework includes 1. Pre-Dementia Stage. 2. Mild Alzheimer’s Stage. 3. Moderate Alzheimer’s Stage. 4. Severe Alzheimer’s Stage. The example below is of a 7-stage framework.

    The 7 stages of diagnostic framework

    Most patients take from 8 to 10 years to progress through all the seven stages. However, some may live for 20 years after neuron changes first occur.

    Stage 1 – No impairment 

    Memory and cognitive abilities seem to be normal. During a medical interview a health care professional identifies no evidence of memory or cognitive problems.

    Stage 2 – Minimal Impairment (Very Mild Cognitive Decline) 

    Could be normal age-related changes, or the earliest signs of Alzheimer’s.

    Friends, family and health care professionals hardly notice any memory lapses. Approximately 50% of people aged 65 and over start experiencing slight difficulties with recalling the occasional word and concentration. The person may feel there are occasional memory lapses, such as forgetting familiar words or the names, and perhaps where they left their keys, glasses or some other everyday object.

    Stage 3 – Early Confusional (Mild Cognitive Decline). Duration – 2 to 7 years. 

    Early-stage Alzheimer’s is sometimes diagnosed at this stage.

      • The patient has slight difficulties which have some impact on certain everyday functions. In many cases the patient will try to conceal the problems.

     

      • Problems include difficulties with word recall, organization, planning, mislaying things, failing to remember recently learned data which may cause problems at work and at home – family members and close associates become aware.

     

      • Problem reading a passage and retaining information from it.

     

      • The ability to learn new things may be affected.

     

      • Problems with organization.

     

    Stage 4 – Moderate Cognitive Decline. (Mild or Early Stage Alzheimer’s Disease). Duration – about 2 years

    With these symptoms diagnosis is easy to confirm.

      • Still identifies familiar people and is aware of self.

     

      • Reduced memory of personal history.

     

      • Problems with numbers which impact on family finance – managing bills, checkbooks, etc. Previously doable numerical exercises, such as counting backwards from 88 in lots of 6s become too difficult.

     

      • Knowledge of recent occasions or current events is decreased.

     

      • Sequential tasks become more difficult, including driving, cooking, planning dinner for guests, many domestic chores, shopping alone, and reading and then selecting what is in a menu at the restaurant.

     

      • Withdraws from conversations, social situations, and mentally challenging situations.

     

      • Denies there is a problem and becomes defensive.

     

    • Requires help with some of the more complicated aspects of independent living.

    Stage 5 – Moderately Severe Cognitive Decline (Moderate or Mid-stage Alzheimer’s Disease). Duration – about 18 months

      • Cognitive deterioration is more serious.

     

      • Cannot survive independently in the community and requires some assistance with day-to-day activities.

     

      • Cannot remember details about personal history, such as name of where they went to school, telephone numbers, personal address, etc.

     

      • Confused about what day it is, month, year.

     

      • Confused about where they are or where things are.

     

      • Problems with numbers; mathematical abilities get worse.

     

      • Easy prey for scammers.

     

      • Require supervision and sometimes help when dressing, including selecting right clothing for the season or occasion.

     

      • Require help carrying out some daily living tasks.

     

      • Can still eat and go to the toilet unaided.

     

      • Unable to recall current information consistently.

     

    • Usually remember substantial amounts about themselves, such as their name, name of spouse and children.

    Stage 6 – Severe Cognitive Decline (Moderately Severe Mid-stage Alzheimer’s Disease). Duration – about 2½ years. 

    Memory continues to deteriorate. There is a considerable change in personality. Require all-round help with daily activities.

      • Virtually totally unaware of present and most recent experiences.

     

      • Cannot recall personal history very well.

     

      • Can still usually recall their own name.

     

      • Know family members are familiar but cannot recall their names.

     

      • Can communicate pleasure and pain nonverbally.

     

      • Ability to dress progressively deteriorates. Need help dressing and undressing.

     

      • Ability to bathe and wash self progressively deteriorates.

     

     

      • Need help when going to the toilet – flushing, wiping, disposing of tissues.

     

      • Disruption of sleep patterns.

     

      • Wander off and become lost.

     

      • Suspicious, paranoid, aggressive. May believe caregiver is an impostor, devious, scheming, cunning, dishonest.

     

      • Repeat words, phrases or repetitively utters sounds.

     

      • Repetitive/compulsive behavior, such as tearing up tissues or wringing hands.

     

      • Disturbed, agitated, especially later on in the day.

     

      • Hallucinations, also more common later on in the day. May hear, smell or see things that are not there.

     

    • Eventually need care and supervision, but can respond to non-verbal stimuli.

    Stage 7 – Very Severe Cognitive Decline (Severe or Late-stage Alzheimer’s Disease). Duration – 1 to 2½ years

    During the last stage of Alzheimer’s disease patients lose the ability to respond to their environment, they cannot speak, and eventually cannot control movement. The duration of this stage may depend on the quality of care the patient receives.

      • Severely limited cognitive ability.

     

      • Patients lose their ability to recognize speech, but may utter short words or moans to communicate.

     

      • Usually the ability to walk unaided is lost first, then the ability to sit unaided, plus the ability to smile, and eventually the ability to hold the head up.

     

      • Body systems start to fail and health deteriorates.

     

      • Swallowing becomes increasingly more difficult. Chocking when eating/drinking becomes more common.

     

      • Reflexes become abnormal.

     

      • Seizures are possible.

     

      • Muscles grow rigid.

     

      • Generally bedridden.

     

      • Spends more time asleep.

     

    • Require round-the-clock care.

    Loss of sense of smell - researchers from the Perelman School of Medicine at the University of Pennsylvania reported in PloS One that when a person begins losing their sense of smell, it may be one of the first signs of Alzheimer’s disease, Parkinson’s, or some other neurodegenerative disorder.

    Alzheimer’s disease and life expectancy

    The main reason Alzheimer’s disease shortens people’s life expectancy is not usually the disease itself, but complications that result from it. As patients become less able to look after themselves, any illnesses they develop, such as an infection, are more likely to rapidly get worse. Caregivers will find it harder and harder to identify complications because the patient becomes progressively less able to tell if he/she is unwell, uncomfortable, or in pain.Pneumonia and pressure ulcers are examples of common complications which may lead to death for people with severe Alzheimer’s disease.

    What are the causes or risk factors of Alzheimer’s Disease?

    Although a great deal of research has been done and is currently being done on the possible causes of Alzheimer’s, experts are still not sure why the brain cells deteriorate. However, there are several factors which are known to be linked to a higher risk of developing the disease. These include:

      • AgeAfter the age of 65 the risk of developing Alzheimer’s doubles every five years. Although Alzheimer’s is predominantly a disease that develops during old age, some younger people may also develop the condition. According to the Canadian Medical Association Journal the risk of developing Alzheimer’s is as follows:
        • Ages 65-74, 1 in 100
        • Ages 75-84, 1 in 14
        • Age over 85, 1 in 4.
      • Family historyPeople who have a close family member who developed Alzheimer’s have a slightly higher risk of developing it themselves – just a slightly higher risk, not a significantly higher risk. Only about 7% of all cases are associated with genes that cause the early onset inherited familial form of the disease. Among those who do inherit the condition, it may start at an earlier age.

     

      • Down’s syndromePeople with Down’s syndrome have an extra copy of chromosome 21, which contains a protein that exists in the brain of people with Alzheimer’s. As people with Down’s syndrome have a larger amount of this protein than others, their risk of developing the disease is greater.

     

      • Whiplash and head injuriesSome studies have identified a link between whiplash and head injuries and a higher risk of developing Alzheimer’s.

     

      • Aluminum (UK/Ireland/Australia: Aluminium) The link here is a theory which most scientists have discarded. Aluminum exists in the plaques and tangles in the brains of Alzheimer’s patients. Some have suggested that aluminum absorption by humans could increase the risk. However, studies have failed to find a link. Aluminum exists in some foods and plants. It is found in some cooking pans, medications and packaging. Scientists doubt there is a link because our bodies absorb minimum amounts and our bodies eliminate it through the urine.

     

      • GenderA higher percentage of women develop Alzheimer’s than men. As women live longer than men, and Alzheimer’s risk grows with age, this may partly explain the reason.

     

      • Mild cognitive impairmentA person who has just mild cognitive impairment has memory problems but not Alzheimer’s. His/her memory is worse than other healthy people’s of the same age. A higher percentage of people with mild cognitive impairment develop Alzheimer’s, compared to other people. Some people say that this is not a risk factor, because those with mild cognitive impairment just had a very, very early Alzheimer’s stage which was not diagnosed. Others disagree with this. Surprisingly, a UK study showed that people with mild cognitive impairment are less at risk of developing dementia than previously thought.

     

     

      • Heart disease risk-factorsPeople with the risk factors of heart disease - high blood pressure (hypertension), highcholesterol, and poorly controlled diabetes - also have a higher risk of developing Alzheimer’s. If your high-blood pressure, high cholesterol, and or poorly controlled diabetes type 2 is a result of lifestyle, it is called a lifestyle factor. Eating a well balanced diet, doing plenty of exercise, aiming for your ideal bodyweight, and sleeping between 7 to 8 hours each night will probably eliminate these factors. If you cannot eliminate your diabetes 2, good diabetes control will help.Sometimes these factors have nothing to do with lifestyle, i.e. if you have high blood pressure for another reason, have diabetes type 1, or are susceptible to high blood cholesterol despite being the right weight, exercising, etc., good control and treatment of the condition helps minimize the risk of developing Alzheimer’s (and heart disease).

     

      • Academic levelThere is some data showing a higher risk of developing Alzheimer’s among people with lower educational qualifications, compared to highly qualified individuals . However, nobody really knows why.

     

     

    • Some other diseases and conditionsThe following diseases and conditions have been linked to a higher risk of developing Alzheimer’s.
      • Some chronic inflammatory conditions
      • A history of episodes of clinical depression
      • Strokes and/or ministrokes
      • Obesity

    In October 2012, researchers from Drexel University College of Medicine in Philadelphia reported in PLoS ONE that they discovered a natural anti-cancer mechanism in the human body that may encourage the development of Alzheimer’s disease.

    How is Alzheimer’s diagnosed?

    A doctor can diagnose most cases of Alzheimer’s. However, nobody can be 100% sure until after death, when a microscopic examination of the brain detects plaques and tangles. There is no basic testing, such as a blood test, urine test, biopsy, or image scan for diagnosing Alzheimer’s disease. A brain scan may help identify changes in the brain.

    Ruling out other conditions

    Doctors will usually carry out some tests to rule out other conditions which typically have symptoms that are also present in Alzheimer’s. Below are some examples of diseases and conditions that need to be ruled out:

    • Anxiety
    • Brain tumor
    • Depression
    • Infection
    • Thyroid problems
    • Vitamin deficiency

    The following tests may be ordered:

      • Blood tests - to see if the patient has a thyroid disorder or vitamin deficiency.

     

      • Neuropsychological testing - this involves an extensive assessment of cognitive (thinking) and memory skills. It can take several hours. These types of tests are extremely useful in detecting Alzheimer’s as well as other dementias early on.

     

      • MRI (magnetic resonance imaging) scan - A powerful magnetic field is created by passing an electric current through the wire loops. Meanwhile, other coils in the magnet send and receive radio waves. This triggers protons in the body to align themselves. Once aligned, radio waves are absorbed by the protons, which stimulate spinning. Energy is released after “exciting” the molecules, which in turn emits energy signals that are picked up by the coil. This information is then sent to a computer which processes all the signals and generates it into an image. The final product is a 3-D image representation of the area being examined; which in this case would be the brain.

     

      • PET (positron emission tomography) scan - uses radiation, or nuclear medicine imaging, to produce 3-dimensional, color images of the functional processes within the human body. It is very useful in helping the doctor diagnose Alzheimer’s disease. A PET scan that measures uptake of sugar in the brain significantly improves the accuracy of diagnosing a type of dementia often mistaken for Alzheimer’s disease, a study revealed.

     

      • CT (computerized tomography) scan - this device uses digital geometry processing to generate a 3-dimensional (3-D) image of the inside of an object. The 3-D image is made after many 2-dimensional X-ray images are taken around a single axis of rotation – in other words, many pictures of the same area are taken from many angles and then placed together to produce a 3-D image.

     

    • What is difference between a PET, CT or MRI scan? A CT or MRI scan can assess the size and shape of body organs and tissue. However, they cannot assess function. A PET scan looks at function. In other words, MRI or CT scans tell you what it looks like, while a PET scan can tell you how it is working.

    Detecting Alzheimer signs over 20 years before symptoms appear

    American and Colombian scientists found a way of detecting Alzheimer’s disease signs over twenty years before the onset of symptoms. Their study involved participants with a very rare, inherited form of the disease. They reported their findings in The Lancet Neurology (November 6th, 2012 issue).

    The researchers believe their findings could pave the way to a much deeper understanding on how and why Alzheimer’s progresses, which in turn may lead to much earlier detection of the disease, as well as more effective clinical trials.

    Clinical trials for Alzheimer’s disease are extremely difficult to set up in a meaningful way, because the disease is only diagnosed when extensive damage to the nervous system has already occurred. For a new compound to be tested comprehensively, ideally the participants should be in the early stages of a disease, because it is then that most drugs have the greatest benefit. Being able to identify people more than twenty years before the onset of symptoms should make it easier to set up effective human studies, the researchers explained.

    What is the treatment for Alzheimer’s disease?

    Alzheimer’s is a terminal disease. This means it has no cure and will end in death. However, there are various medications which can help slow down the progression of the disease, and others that can improve the signs and symptoms, such as sleeplessness, wandering, depression, anxiety and agitation.

    The doctor may prescribe the following medications to help slow down the disease:

    Neurotransmitters – A neurotransmitter is a chemical that transmits neurologic information from one cell to another. Without neurotransmitters our nervous system, which includes the brain, would not work. We would be paralyzed, blind, with no thoughts, no movement – we would be dead.

      • Cholinesterase inhibitorsThese improve the levels of neurotransmitters in the brain. The medication contains a chemical that inhibits the cholinesterase enzyme from breaking down the neurotransmitter acetylcholine – resulting in an increase in both the neurotransmitter’s level and duration of action.Cholinesterase inhibitors are prescribed to treat problems related to memory, thinking, language, judgment and other thought processes.

        Clinical trials showed that about half of all patients did not get any benefit from this type of drug. Experts believe cholinesterase inhibitors may delay or slow worsening symptoms by about six to twelve months. However, some patients experience longer periods of delay.

        Examples of cholinesterase inhibitors include:

        • donepezil (Aricept) – approved in the USA to treat all stages.
        • galantamine (Razadyne) – approved in the USA to treat mild to moderate stages.
        • rivastigmine (Exelon) – approved in the USA to treat mild to moderate stages.

        Cholinesterase inhibitors are generally well tolerated (side effects minimal).

        Side effects may include:

        • Diarrhea
        • Nausea
        • Vomiting
        • Loss of appetite

     

      • MemantineThis medication protects brain cells from damage caused by glutamate, a chemical messenger. It is used to treat moderate to severe stages of Alzheimer’s. Some doctors prescribe memantine along with a cholinesterase inhibitor. Examples include Axura, Akatinol, Namenda, Ebixa and Abixa, and Memox.Memantine is prescribed to improve memory, language, reason, attention, and the ability to carry out simple tasks.

        A clinical trial showed that patients taking memantine showed a small, but statistically significant improvement in mental function and their ability to carry out daily activities.

        Memantine is generally well tolerated (minimal side effects)

        Side effects include:

     

     

     

    What are the complications of Alzheimer’s disease?

    People with Alzheimer’s disease progressively lose the ability to care for themselves. This makes them more susceptible to accidents and health problems:

      • Pneumonia - this becomes a significant risk when patients start losing their ability to swallow properly. Food and drink often go down the wrong way – down the air passages into the lungs, rather than into the digestive system. If food or drink gets into the lung there is a risk of pneumonia.

     

      • Urinary tract infection - when the patient becomes incontinent it may be necessary to place a urinary catheter. This increases the risk of urinary tract infections. Urinary tract infections can become very serious and life threatening.

     

    • Injuries - disorientation and wandering are common symptoms of Alzheimer’s. Patients are much more likely to fall and fracture a bone or sustain a head injury. The risk is greater if they have sleeping problems and get up in the night and wander about while others are asleep.

    Source: www.medicalnewstoday.com

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  • Homecaresandiego

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