JustCare

Tag: Dementia

  • What to do if someone you love struggles to use a computer

    What to do if someone you love struggles to use a computer

    Modern technology can be a godsend for handling affairs speedily. But, there often comes a time when older adults struggle to use their smart phones, computers and tablets, and caregivers need to step in. What should you do if someone you love starts having difficulty using a computer?

    Judy Graham reports for Kaiser Health News that millions of older adults (nearly three in four) depend on computers to pay their bills, access their bank statements, and connect with their families and friends. Blocking their use of a computer may disconnect them from things they care deeply about. More than four in ten (42 percent) of them own smartphones.

    We all know how easy it is to forget a password and not be able to access online accounts. It can be particularly difficult for older adults. Problems could be related to people’s vision, coordination or cognition. When struggling to use a computer stems from loss of mental function or dementia, it’s likely time for caregivers to act.

    Learn what’s confusing: Ask about what’s confusing on the computer and smart phone. And, if possible, sit down at the computer with the people you love to see what they can and cannot do.

    Share passwords: It’s wise to create shared passwords so that you too have access to the programs your loved ones use. If you want to check their accounts online, make sure you have power of attorney or, at the very least, their written agreement to do so. Otherwise, it’s a federal crime!

    Reduce confusion: One easy fix is to delete any apps that are confusing older adults. In fact, the fewer the apps, likely the better. Why should they struggle?

    Minimize scamming: Make sure that the older adults whom you care for know not to give anyone their Social Security, Medicare or credit card information. Scams abound. Scammers are pros at pretending to be a relative or a government agency staffer in order to obtain this information.

    Manage purchases: Get permission to unsubscribe your loved ones from marketing emails. If appropriate, ask to install a parental control app that can block use of online devices at certain times.

    Replace a credit card with a stored value care: A stored value card limits the amount of money that can be spent. Or, reduce the credit amount on the credit card.

    Notify credit bureaus not to open new accounts in the name of your loved ones.

    —————————————————-

    Here’s more from Just Care:

  • Assisted living facilities present serious risks for some people

    Assisted living facilities present serious risks for some people

    In a New York Times op-ed, Geeta Ananad warns against expecting assisted living facilities to meet the needs of aging parents once they lose their independence. Rather, she explains that assisted living facilities can present serious risks to older adults who are not able to function independently.

    To be sure, most people have no desire to end up in a nursing home, even if they offer 24-hour care. Ananad argues that an assisted living facility is not a substitute. Most of us will not be self-reliant until the day we die. And, if we cannot care for ourselves, we likely should not be in an assisted living facility.

    Don’t believe the marketing hype about assisted living facilities. They appear to be a good financial investment–with close to 15 percent annual returns, of late. But, assisted living facilities likely are not where you want your parents, or for that matter yourself and the people you love, to live out their lives.

    Assisted living facilities have the advantage of offering older adults companionship, activities and social interactions that they often cannot get at home. As you need more care, however, it becomes harder to rely on an assisted living facility, as much as you might like to. Once you need help walking or toiletting, or become mentally impaired, assisted living facilities are generally ill-equipped to meet your individual needs.

    Half of assisted living facility residents are over 85 and more than four in ten have dementia; they need fulltime attention, which is generally not available to them. For most people who are not independent, the “24-hour” monitoring an assisted living facility offers is not enough to provide needed assistance and to ensure people are safe. According to Eric Carlson, the directing attorney for Justice in Aging, the assisted living facility system is broken.

    Unlike with nursing homes, the federal government neither licenses nor oversees assisted living facilities. And, states do a poor job of regulating them. Assisted living facilities often do not have adequate staffing or properly trained staff and generally are not even required to have medical directors to review care for patients. (NB: Nursing homes must be licensed and meet strict regulatory standards and still they too often do not deliver the care people need.)

    The average cost of staying in an assisted living facility is nearly $6,000 a month. The cost will only increase if regulations require more staffing and more trained staff.

    Ananad proposes a Japanese model for paying for long-term care–a mandatory national long-term care insurance system, which the government helps pay for and is also supported by payroll taxes and premiums. Better still, Medicare for All, a single-payer cost-effective universal health care system, would spread the cost of long-term care across the entire population.

    Here’s more from Just Care:

  • Keeping mentally and physically healthy and engaged may prevent dementia

    Keeping mentally and physically healthy and engaged may prevent dementia

    A 2017 study by a worldwide team of dementia experts, published in Lancet, lays out the latest research findings on dementia, and the news is better than you might expect. There are a range of proven ways, particularly through mental and physical stimulation, to prevent or delay dementia.

    Dementia literally translates from the Latin to mean “out of mind.” It is a brain disorder that affects memory and the ability of people to process information. In 2015, 47 million people around the world, mostly people over 65, were living with dementia at a cost of $818 billion. By 2050, there are expected to be almost 150 million people living with dementia. Today, one in three older people die with dementia.

    Though there is no cure for dementia, people’s daily activities may delay or prevent its onset. And, for people diagnosed with dementia, there are ways to slow down the course of the disease and improve quality of life. The data suggest that people who are better educated, as well as more mentally and physically active and socially engaged, are less likely to be diagnosed with dementia.

    Not surprisingly, social isolation, not having friends or family to talk to and spend time with, and poor education, increases the risk of dementia. In addition, people with hearing loss who are not managing that condition are prone to getting dementia.

    Here are a few ways that have been found to delay or prevent dementia:

    • Treatment for hypertension or high blood pressure is important since high blood pressure has been found to cause dementia.
    • It is possible that more than one in three cases of dementia can be delayed or prevented through exercise, having a social network, and engaging your mind.
    • Smoking less.
    • Managing hearing loss,
    • Keeping your blood sugar level under control if you have diabetes.
    • Maintaining a healthy weight; and,
    • Treating depression.

    Getting a diagnosis of dementia in its early stages can allow for treatment interventions that maximize memory and cognition, and reduce stress and depression. There are many people living with dementia who are able to drive and function independently. You can learn more about the living with dementia movement, here.

    Here are ways to help people living with dementia remain independent. And, here are best practices for communicating with a person with dementia.

    Here’s more from Just Care:

  • Earwax can cause hearing loss, if left untreated

    Earwax can cause hearing loss, if left untreated

    If you have a problem hearing, it may stem from excess earwax. Kaiser Health News reports that earwax can cause hearing loss in older adults, if left untreated. Excess earwax is more common in older people than in younger people.

    In addition to conductive hearing loss–preventing sound waves to reach your inner ear–excess earwax can cause tinnitus or ringing in your ears, because earwax blocks the ear canal. It can also cause vertigo, and even cognitive decline. And, it can increase your risk of falling.

    What is earwax? It is a sticky substance that mixes with dirt and dust in the air, which protects your ears. For about three in ten older adults, however, it can block the ear canal, posing serious risks. People in nursing homes are particularly likely to suffer from this blockage or impaction.

    Many people try to remove excess earwax on their own. That can can bigger problems, pushing the wax deeper into the ear canal. Experts suggest leaving the earwax alone. The National Institute on Aging recommends mild treatments, such as mineral oil, baby oil, glycerin, or commercial ear drops to soften earwax.

    Here’s more from Just Care:

  • Safety at home for people with dementia

    Safety at home for people with dementia

    People with Alzheimer’s disease and other forms of dementia can live at home safely as long as precautions are taken. Needed precautions will change as problems progress for each individual. When it comes to safety for someone with an impaired memory, the first thing that often comes to mind is the hazard of leaving a pot on the stove and starting a fire. Later in the illness, people with dementia can do unpredictable things like hide objects under burners, or try to cook with plastic containers. I’ll highlight three key safety concerns and what to do about them. I list additional resources at the end.

    1. Fire –

    • To keep someone from cooking who shouldn’t, you can remove knobs from stovetops, or install switches so that the appliances can be completely turned off. Place switches inside cabinets or somewhere you’re sure the person with dementia can’t or won’t access them. Don’t forget the microwave; it can catch fire too.
    • For someone who still cooks, but there is a worry about walking away, you can install timers that will signal stoves and other appliances to turn off after a set period of time, or after a motion sensor detects that a person is no longer standing in front of the cooking area.
    • Take special care. You’d be surprised at how easy it can be for things to go wrong even when you think you have covered the bases. When it was no longer safe for my parents to be cooking in their apartment, I initially thought that throwing the circuit breaker to the oven and stove would take care of it. On my next visit though, my mother was heating soup. She had thrown the circuit breaker back. People with early dementia remember well-engrained lessons, such as, if an appliance doesn’t work, first check the circuit breaker. So I called the maintenance department for their building, explained the situation and asked them to unplug my parents’ appliances. They did so, but a few days later I noticed the clock on the oven was on. My mother had called maintenance, complained that her stove and oven weren’t working and asked them to fix them. Again, they did so. Finally I called the social worker for my parents’ Continuing Care Community, and she shored up all lines of communication; we unplugged the stove and oven for good.
    • Obviously keep matches out of the home or in a secured drawer or cabinet. Fortunately fewer people smoke these days, but people with a memory problem should do so only under supervision. Smoke detectors and fire extinguishers should all be checked and in working order.

    2. Hazardous materials –

    • Remove or lock away electrical appliances such as hairdryers and curling irons that might accidentally be dropped or even put into water, as a person’s dementia becomes severe and the person forgets how to use objects.
    • Secure other objects that might be hazardous if misused, such as tools or knives, as well as insecticides, solvents or cleaning supplies..
    • Don’t forget to keep medicine bottles in a safe place, especially for people who may be used to taking their own pills. They may forget they had already taken a dose or that someone else administers them now and take too much if bottles are out.

    3. Falls – Along with memory loss, people with Alzheimer’s disease and other forms of dementia often have visual-spatial problems. This affects their perception and their ability to navigate and move around safely.

    • It’s especially important for people with dementia to have their home free of tripping hazards like loose rugs, low furniture, and electrical cords,. Try to de-clutter.
    • Keep the home well-lit, with night lights in hallways. Motion detectors can bewired to turn bathroom and hall lights on at night.
    • Take extra care with stairs and consider blocking them off completely when confusion, balance, and physical issues compound to make them extremely hazardous.

    Here’s more from Just Care:

    Resources:

    How to Care for Aging Parents by Virginia Morris (2014), the third edition of this excellent book on medical, financial, housing, and emotional issues is thorough and easy to read.

    http://www.thiscaringhome.org/ Home Safety A project of Weill Cornell Medical College, with information pulled together from a wide variety of professionals. Contains lots of specifics.

    The 36-Hour Day by Nancy L. Mace and Peter V. Rabins, now in it 5th edition (2011) is a classic on dealing with many issues in caring for a loved one with dementia, including home safety.

  • Living well with dementia: The benefits of early diagnosis

    Living well with dementia: The benefits of early diagnosis

    Are you concerned that you or someone you love is showing signs of dementia? If so, the benefits of early diagnosis of dementia are significant. There are some treatments for dementia, including medications and psychosocial interventions. Without a diagnosis, there’s no way to benefit from them.

    The thought of getting a dementia diagnosis can be intimidating. Many people fear the idea of losing their independence if they are diagnosed with dementia or facing increased caregiving responsibilities if they suspect it in someone they care for.

    Dementia affects not only people with dementia, but also their families and the people who care for them. In many cases, certain lifestyle and environmental adaptations are needed at some point along the disease journey. About 3.4 million adults over 71 have dementia, almost 14 percent of that population.  

    The good news is that there are ways to maximize wellbeing while living with dementia, and no one should have to face the challenges of dementia alone.

    The benefits of early diagnosis of dementia should not be underestimated. Evidence suggests that when families feel well prepared and supported, initial feelings of grief are replaced with ones of reassurance and empowerment.

    Getting a diagnosis at early stages of the disease has three significant benefits:

    1. Enabling people with dementia and those who care for them to prepare for disease progression,
    2. Giving people with dementia the opportunity to make legal and financial decisions while they are still able to, and
    3. Giving people with dementia a better chance to benefit from drug and non-drug treatments that may delay disease progression and enhance their quality of life.

    Dementia is increasingly gaining attention at the national and international levels as an important health care issue, and there are now many resources and supports available for both people with dementia and their caregivers, including these from the National Institutes on Aging. You should also contact your local area agency on aging to learn about community supports and services. With proper planning and knowledge about the resources available, it is possible to help yourself or a loved one maximize happiness and independence while living well with dementia.

    Here’s more from Just Care:

  • Tips for driving safely

    Tips for driving safely

    As you get older, it can become increasingly challenging to drive. A variety of health conditions can affect your ability to drive. If you are concerned about whether you or someone you love is a safe driver, talk to your doctor. Don’t risk hurting yourself or others. Here are tips for driving safely from the National Institutes of Health.

    If your joint and muscles are stiff, you may have difficulty turning your head to see oncoming cars or responding to a situation where you need to turn the steering wheel or brake quickly. In these situations, you are likely better off driving an automatic car with power steering and brakes and big mirrors. And, you should exercise so that you are as strong and flexible as possible.

    If your vision is not what it used to be, you may have trouble seeing people and things in front of you as you drive. You also might struggle to see at night. Visit the eye doctor to ensure your vision is as good as possible. You also might consider stopping driving at night.

    If your hearing is failing, you may not hear horns and sirens and may not be warned when you need to get out of the way. Make sure to have your doctor check your hearing. Also, consider keeping the radio off while you are driving so that you are better able to hear outside noises.

    If you have mild dementia, you may continue to drive. But, you want to stop when your memory weakens and you are unable to remember where you need to go. You may not appreciate the challenges of driving.

    As your reflexes slow down, you may not be able to respond as quickly as needed while you are driving. Try to not to get too close to the car in front of you, brake sooner, and, if possible, stay out of rush-hour traffic. If you need to drive when the roads are busy, try to keep to the right lane.

    If you are taking medicines, be sure to note whether the warning label includes side effects like drowsiness or lightheadedness.  If so, driving can be unsafe, and you should not be driving. Be sure to check the warning labels on your medicines and discuss them with your doctor to see whether you should be driving while taking them.

    To be safe, try not to drive when the weather is bad and at night and avoid highways, if possible. Here are helpful tips on how to help someone you love decide when to stop driving.

    Here’s more from Just Care:

  • This is your brain on exercise

    This is your brain on exercise

    To support brain health, we know many things that people should not do, such as smoke, drink alcohol heavily, use most recreational drugs, and engage in activities associated with frequent head trauma. But other than getting adequate sleep, there isn’t much that we know people should do to promote brain health, sharp cognition, and good mental health. Of course, we recommend eating a healthy, well-balanced diet, but very few individual foods or nutritional supplements have been proven to be good for the brain. The same goes for “brain teaser” activities and “cognitive skills training” programs. Contrary to logic, they haven’t been shown to produce sustained benefits. However, time and again, one activity has been connected to robust improvements in brain health and prevention of brain diseases and mental health problems: exercise. And the encouraging results keep rolling in.

    Regular aerobic exercise has been linked to reduced risk of developing dementia, such as Alzheimer’s disease. This type of exercise has also been repeatedly shown to prevent depression, and has even been proven to be an effective treatment for depressive and anxiety disorders, with effect sizes roughly equivalent to medications. These benefits have been consistently demonstrated in both human studies and in studies examining animal models of mental illness. More recently, non-aerobic weight training has also been definitively associated with positive effects on brain and mental health outcomes.

    As if this news wasn’t good enough, the amount or “dose” of exercise that people need to promote brain health is not as high as you may think. Minimal amounts of exercise such as 20-30 minutes of walking or gardening a day – not even enough to lose weight – may be enough to boost cognitive functioning and lower the risk of mental health problems. So, it should be possible to fit into all but the very busiest schedules.

    Exactly how exercise helps the brain is unclear, and there are many theories, multiple of which may be simultaneously true. Exercise may increase blood flow and oxygen supply to the brain. It may also increase the production and activity of “neurotrophic” (literally “brain feeding”) factors, such as brain-derived neurotrophic factor (BDNF) []. BDNF in critical brain areas such as a memory center called the hippocampus promotes brain health and mental resilience through stimulating the growth of new neurons and connections between them. Exercise causes chemicals to be released from muscles and bones that may be essential to sustaining proper brain functioning. In addition, physical activity causes the release of several “feel good” substances, such as endorphins and endocannabinoids, which have been implicated in the feeling of general well-being and relaxation after a workout often referred to as a “runner’s high.” Finally, exercise may benefit your brain for the same reasons that it is good for the rest of your body – it lowers blood pressure and inflammation levels and enhances proper blood flow and heart functioning.

    Regardless of the exact reasons why it’s so healthy, we know that exercise is a relatively easy-to-do, inexpensive, and fun way to improve brain health and reduce the risk of mental illness and cognitive decline. So, do your brain a favor and grab those running shoes or that bicycle and head outside!

    Here’s more from Just Care:

  • What’s a psychiatric advance directive?

    What’s a psychiatric advance directive?

    We all need advance directives—living wills and health care proxies that enable us to identify a trusted friend or family member who can help ensure that our care wishes are honored if we cannot speak for ourselves. As more people come to recognize the value of advance directives, experts are seeking to expand upon them. Some have begun to promote dementia directives, and now others are promoting psychiatric advance directives.

    The idea behind a psychiatric advance directive (PAD or mental health advance directive) is to best ensure that the wishes of someone living with a mental illness are honored if they are suffering from a mental disorder that prevents them from making medical decisions for themselves. Jennifer Adaeze Okwerekwu writes in StatNews that her patient with catatonia could “barely move or speak.” He did not want food or water, let alone medical treatment.

    Because Dr. Okwerekwu’s patient did not have a psychiatric advance directive–a legal document outlining the patient’s treatment preferences should he not be able to state them–the doctor could not insist he receive treatment until he was in physical danger. His mental crisis without any physical crisis prevented any medical intervention. Had the patient had a psychiatric directive, he could have set forth in advance the medications he would have wanted, along with other information to ensure his care wishes were met.

    Today, only some states allow patients to write psychiatric advance directives. New York is among them. In Virginia, psychiatric advance directives are only honored if signed by two witnesses, excluding the health care proxy. Massachusetts does not allow psychiatric advance directives but does allow a health care proxy the authority to direct the care of a patient when he or she is incapacitated. The Massachusetts law burdens psychiatric patients with having to speak with their proxies about their care wishes, when they are incapacitated, which can be challenging. To learn more about the law in your state, click here.

    Here’s more from Just Care:

  • Beware of medical advice from the mainstream media

    Beware of medical advice from the mainstream media

    Kevin Lomangino of Health News Review explains how you and the rest of America may end up duped by medical advice from the mainstream media. Even the medical correspondents in the big media outlets are often not delivering evidence-based advice. And, while they may be spinning an interesting story based on a study of one sort or another, question what you learn before taking action.

    Medical studies abound to support the value of all kinds of treatments. And, it seems worthwhile to let people know when a study shows that a treatment works. What’s the downside, especially when the treatment sounds benign. Unfortunately, if the sample of people studied is small, the length of the study is short, or the design of the study is flawed, the value of the study is questionable. And, in some cases, the proposed treatment may have harmful side effects.

    At Just Care, where possible, before reporting on a study, in addition to speaking with medical experts, we check with Cochrane, an independent non-profit that does meta-studies, before we offer health advice. Cochrane’s meta-studies dig deep into as much of the research as possible to determine whether a particular finding can be trusted; and, if so, to what degree. But, Cochrane does not always have an answer, so what to do?

    If the proposed treatment is based on independent peer-reviewed evidence and there is no harm in trying it–such as “exercise” or “eat green leafy vegetables”–there are likely only benefits to trying it. And, Just Care might write about it as we did with one study on exercise and memory. It could be another reason to take a brisk walk or eat a Mediterranean diet or not eat foods with processed sugar.

    But, if the proposed treatment is any type of supplement or complementary medicine, it is potentially unsafe. And, you should likely avoid it. You certainly should not take it without first consulting with your doctor. Much like new drugs and medical devices approved by the FDA, the treatment may not be worth the risks, as less in known about it.

    Health News Review reports, for example, that ABC News’ Good Morning America’s medical correspondent advised viewers to take “complementary natural” remedies for the flu without any compelling evidence that they work. Without evidence on benefits and toxicities, the ABC News medical correspondent has no business recommending to viewers a cocktail of supplements to treat the flu and how to take them. The medical correspondent even acknowledges that there is no evidence that these “remedies” work and no data on their toxicity. What is she and ABC’s Good Morning America thinking?

    Similarly, Sharon Begley at StatNews writes about a rash of media reports on the value of aerobics and other exercise to help the brain. But, as Begley explains, experts disagree on the value of the studies underlying these reports. Even when advice is evidence-based, there is generally more to the story.

    The American College of Neurology recently began recommending aerobics to patients with mild cognitive impairments as a way to help their memory, thinking and judgment and to prevent dementia as they age. And, there is evidence to support this recommendation. But, the National Academy of Sciences (NAS) has completed a meta-study of 262 studies, and it did not find a link between exercise and dementia prevention.

    Interestingly, the studies showing a link between exercise and dementia prevention were randomized-controlled studies that were peer-reviewed. But, the NAS found that many of them were flawed in one way or another.

    Of course, lots of us want to learn about ways to stave off the flu, forestall dementia and live longer healthier lives. So, we are sure to continue to read and hear about new findings as to what we can do. If the recommendations are exercise and good nutrition, following them will most likely help you. But before buying and taking a pill, an oil or some complementary medicine remedy, look deeper into the research and talk to your doctor.

    Here’s more from Just Care: