Tag: Dementia

How to communicate with a person with dementia
In part two of a four-part series on caregiving and dementia, Julie Potyraj, community manager for the online master of public health at The George Washington University, explores strategies that caregivers can utilize while communicating with someone who has dementia.

Alzheimer’s disease and other types of dementia can negatively affect a person’s ability to communicate effectively, particularly during the later stages of the disease. People may begin to speak less frequently and, when they do speak, they may lose their train of thought or have difficulty organizing words in a logical way. Some people may revert back to their native language or use “made up” words to describe familiar objects.

Communicating with someone who has dementia requires skill, patience, and understanding. Below are some strategies from the Alzheimer’s Society that caregivers can employ to keep exchanges flowing smoothly.
- Speak slowly and use simple words and sentences. This will make it easier for a person with dementia to understand what you are saying.
- Maintain eye contact. This helps the person with dementia stay focused on you and what you’re saying.
- Offer continual reassurance. Be comforting. Tell the individual that it’s okay to take their time in trying to explain their thoughts or emotions.
- Avoid overcorrecting. Do not criticize or always attempt to correct what the person says. Instead, try repeating their words back to help them clarify their thoughts. Avoid arguing.
- Encourage body language. When words are ineffective in relaying the person’s message, ask them to gesture with their hands.
- Limit surrounding distractions. Turn off the TV or move to a quieter area before attempting to communicate or understand what the person is saying.
- Do not stand too close. Standing too close to someone with dementia may make the person feel overwhelmed and intimidated.
- Look for—and focus on—the emotions at play. In some cases, the feelings being expressed are more significant than the words being used. Try to identify what the person is feeling by paying attention to tone of voice and gestures.
Lastly, be aware of your own attitude and body language and how they affect the individual with dementia. Be sure to maintain a relaxed demeanor and friendly facial expressions. When you do, the person with dementia will feel more at ease.

Here’s more from Just Care:
August 31, 2016
Caregiving: Understanding the emotional impact of dementia
In part one of a four-part series on caregiving and dementia, Julie Potyraj, community manager for the online master of public health at The George Washington University, looks into the emotional symptoms many dementia patients experience and what caregivers can do to help.

It’s understood that dementia can impair a person’s ability to remember, communicate, think, and reason. But beyond the practical aspects of the disease, dementia has emotional consequences as well. Below are some common behavioral and psychiatric symptoms that can occur in many dementia patients.

Depression or anxiety after diagnosis. A dementia or Alzheimer’s disease diagnosis can trigger intense emotions in many people. The person diagnosed may experience feelings ranging from shock and disbelief to grief and fear. For people with lasting feelings of sadness or anxiety, talk therapy can be helpful, or, in some cases, medication.

Changes in emotional responses. People with dementia may have less control over how they’re feeling and their emotional expressions. They may have volatile mood swings, irritability, or become inappropriately agitated in certain situations. Some people may appear to be distant or disinterested in what’s going on around them.

Anger and agitation. In later stages of the disease, a person may have physical or emotional outbursts, visible emotional distress, or periods of agitation. Feelings of anger can be exacerbated by new places and people, loud noise, or a lot of activity.

Lower self-esteem. People with dementia may feel “out of control” and lose confidence in themselves or their ability to perform basic functions. They may also feel the impact of the social stigma of dementia and perceive a real or imagined difference in the way people treat them. All of this can have a devastating effect on someone’s sense of self-worth.

What Caregivers Can Do

Fortunately, there are things caregivers can do to help lessen the brunt of emotional changes in their loved one with dementia. These include:
- Validating the patient’s worries instead of dismissing them.
- Giving the person adequate time to calm down after an outburst.
- Trying not to take emotional responses personally.
- Employing a healthy sense of humor, when appropriate.
Caregivers are also encouraged to involve their loved one in everyday tasks—for example, asking what they would like for dinner. This can give the patient a sense of control during a time when they feel they have no say in what’s happening around them. Empathy and patience go a long way in helping to preserve the dignity of those struggling with dementia.

Here’s more from Just Care:
August 23, 2016
Value-based insurance design coming to Medicare
In January 2017, the Centers for Medicare and Medicaid Services, CMS, will launch a new initiative for some older adults and people with disabilities enrolled in Medicare Advantage plans. People in some states with certain chronic conditions will be able to choose a Medicare Advantage plan–a commercial insurance plan that contracts with the government to offer Medicare benefits–that has “value-based insurance design,” with the goal of providing them better care at lower cost. How good the care will be is still a big question mark.

Just to say it, the vast majority of people with Medicare are enrolled in traditional Medicare because it gives them easy access to care and predictable costs almost anywhere in the country. Medicare Advantage plans appear less costly, but they generally come with very little choice of doctors and hospitals and high out-of-pocket costs, particularly for people with costly and complex conditions. While there is a limit of $6850 on out-of-pocket costs in 2016, on top of that you usually must pay the full cost of your care, or a large chunk of the cost, if you use doctors or hospitals outside the health plan’s network. And, your copays and deductibles may not be included in the out-of-pocket limit.

Medicare Advantage health plans are supposed to provide the same benefits as traditional Medicare, but they often have a narrower view than traditional Medicare of when those benefits are reasonable and necessary, further limiting people’s access to care. The Medicare Advantage Value-Based Insurance Design Model (VBID), launching in 2017 is intended to benefit people with diabetes, Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure (CHF), past stroke, hypertension, coronary artery disease, mood disorders, rheumatoid arthritis (starting in 2018) and dementia (starting in 2018).

How does VBID work? The goal is to make out-of-pocket costs for people with these chronic conditions low enough to encourage them to take advantage of Medicare Advantage plan “high-value clinical services” that help manage and improve their care. CMS is encouraging plans to help members with these chronic conditions. Health plans have the flexibility to lower their members’ out-of-pocket costs if they use particular doctors, services or disease management programs; health plans can also offer extra benefits to meet their needs.

Historically, Medicare Advantage plans have tried to avoid enrolling members with costly and complex conditions in order to maximize their profits, so presumably CMS is giving them a financial incentive to participate in this pilot. That said, CMS says that another goal of this pilot is to reduce Medicare spending.

Medicare Advantage plans in seven states–Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee–may be able to test the VBID model. CMS will announce in September which plans will be offering VBID. In January, 2018, CMS will expand the model to three more states–Alabama, Michigan, and Texas.

Here’s more from Just Care:
August 23, 2016
Delirium common for older adults in hospital
According to the American Delirium Society, seven million hospitalized adults experience delirium each year. They become confused and disoriented. And, according to the National Institute on Aging, they become at increased risk for dementia, loss of independence and death.

Delirium and dementia have similar symptoms so it can be hard to distinguish them. But, delirium usually comes suddenly and often causes hallucinations. Moreover, people often do recover entirely from delirium once it is treated. In contrast, dementia develops slowly, does not cause hallucinations and cannot be reversed.

Research is underway to identify the causes of delirium in hospital in order to prevent its onset. Allowing hospital patients to sleep uninterrupted for eight hours may help prevent delirium. Not using physical restraints on patients could also help, along with ensuring that patients are walking around in hospital as soon as possible and opening blinds to allow sunlight in the room.

Here are a few other posts on delirium from Just Care:
April 5, 2016
Dementia declining as life expectancy grows

We don’t understand the causes of most dementia, but we know that people with dementia generally lose their memory, reasoning, speech and other cognitive functions. Experts thought that as life expectancy grows longer, the incidence of dementia would grow as well. But, new research reveals that the incidence of dementia is declining as life expectancy grows. No one yet knows why.

The New England Journal of Medicine reports that decades of data from the Framingham Heart Study show declines in dementia from one decade to the next since the late 70’s and up to the early 2010’s. The study results apply to people with at least a high school education living in high-income countries.

The researchers found two people in 100 with dementia in the period between the late 2000’s and the early 2010’s–a significant decrease from 2.2 people in 100 during the period from the late 90’s into the early 2000’s. During the period just before that, from the late 80’s to the early 90’s, the incidence of depression was at 2.8 people in 100. And in the late 70’s to early 80’s, the incidence was up at 3.6 people in 100.

Over forty years, the incidence of dementia declined 44 percent. Great news. Now we need to understand why.

Of note, new observational research suggests that there may be a link between proton pump inhibitors, such as Prilosec and Nexium, used to treat heartburn and GERD and dementia. But, more research needs to be undertaken to determine whether there really is a link. For now, you might talk to your doctor about whether you can stop taking PPIs. There are ways to avoid heartburn without drugs.

Click here for the signs of dementia and here for how to live well with dementia and find out about community resources for people with dementia.

March 2, 2016
Do Prilosec and other PPIs increase people’s risk of dementia?

Millions of people take proton pump inhibitor drugs (PPIs) such as omeprazole (Prilosec), esomeprazole (Nexium), and lansoprazole (Prevacid) for heartburn or gastro-esophageal reflux disease (GERD). This week, news outlets reported a link between these drugs, which many people stay on for years or even decades, and the risk of dementia.

Researchers in Germany examined an insurance claims database that included over 73,000 people, 75 and older, and free of dementia at the study’s start. They found that over seven years those who took PPIs had a 44% increased probability of receiving a diagnosis of dementia.

Since this finding comes from an observational study, and not a clinical trial, the researchers can’t say whether the drugs actually cause dementia, although they discuss some plausible reasons why they may.

Nothing is known about long-term side effects of drugs when they are approved by the FDA. (See this Just Care post about FDA-approved cancer drugs that don’t work.) So, observational studies are an important way to gather this information.

This is the second study indicating that PPIs may contribute to dementia risk. More evidence needs to accumulate though, such as showing that those who take higher doses have a higher probability of dementia, before a more definitive causal link can be established.

For those interested in a more in-depth discussion of the findings, click here.

To learn about ways to avoid heartburn or GERD without drugs, see this Just Care post.

To understand the signs of dementia, see this Just Care post. To learn about safety at home for people with dementia, see this Just Care post. And, for some tips on the benefits of early diagnosis of dementia, click here.

February 25, 2016