KATU - Nearly 15 million caregivers – most of them family members but also friends – provide care for people with dementia, says a report being released Tuesday by the Alzheimer’s Association.

An estimated 5.4 million Americans have the mind-destroying disease. That it takes so many more people to care for them reflects the burden of an illness that not only robs its sufferers of the ability to do the simplest activities of daily life – but that patients can survive in that increasingly incapacitated state for years, even a decade or two.

Those caregivers provide 17 billion hours of unpaid care, valued at more than $202 billion. Previously, experts had used a count about a decade ago to estimate that about 10 million caregivers provided 8.5 billion hours of unpaid care for Alzheimer’s patients.

Moreover, the time and stress of caring for an Alzheimer’s patient takes a physical toll, translating into nearly $8 billion worth of extra health care costs for caregivers, the report says.

What staggering numbers.  Two things stick out most notably to me:

First of all the ratio of caregivers to Alzheimer’s and Dementia patients, most of whom are of the senior and elderly population, is nearly 3:1.  What speaks loudest to me about this ratio is how many caregivers, who tend to be family and close friends, an average Alzheimer’s patient requires to be watched after.  In many cases, these Alzheimer’s and Dementia patients live at home and prefer to stay there.  And for the patients who live at home, want to stay there, and don’t have close family and friends to provide the necessary caregiver tasks, finding in home care is necessary whether you live in the Portland-metro area or a suburb like Beaverton, Lake Oswego, Newberg, or McMinnville.

The second thing is the amount of hours spent by family caregivers watching over seniors and elderly with Alzheimer’s and Dementia.  By the report’s estimates, caregivers spend about 8 hours per day with the patient, which in my eyes is a conservative estimate for someone with any sort of advanced Dementia or Alzheimer’s.  That amount of hours certainly could be much higher in reality, simply adding to the need for caregivers who can assist with these diseases.

Studies have linked poor health literacy, which disproportionately affects the elderly, the poor and recent immigrants, to higher rates of hospital readmission, expensive and unnecessary complications, and even death. A 2007 study estimated the problem cost the U.S. economy as much as $238 billion annually. This problem will become even more severe in 2014 when tens of millions become insured.

A 2006 study by the U.S. Department of Education found that 36 percent of adults have only basic or below-basic skills for dealing with health material. This means that 90 million Americans can understand discharge instructions written only at a fifth-grade level or lower. About 52 percent had intermediate skills: They could figure out what time a medication should be taken if the label says “take two hours after eating,” while the remaining 12 percent were deemed proficient because they could search a complex document and find the information necessary to define a medical term.

The Joint Commission, which accredits hospitals, is requiring them to use plain-language materials and to “communicate in a manner that meets the patients oral and written communication needs” in providing care. For example, instead of “myocardial infarction”, use heart attack; instead of “febrile”, use fever; replace “hyperlipidemia” with high cholesterol. Doctors are also encouraged to replace “diet” with food; many folks when they hear diet believe doctors want them to go on a diet. It is also recommended replacing “exercise” with walking.

-Kevinmd.com

Lot and lots…and lots of blame to go around for poor health literacy in the US.  I want to start by saying this is somewhat circumstantial as much of the medical terminology used in the US is derived from Latin.  Not Spanish, French, or Italian, languages with many commonalities in sentence structure and words.  But Latin, a language understood by few in this country.

The next step is to consider the two categories of people involved: healthcare professionals and the patients.  From the healthcare professionals point of view, they are working with what they are taught in their years, and sometimes decades, of studies.  It only makes sense that if you are taught a certain way to obtain a license to practice, you would use said education in your profession.

From the patients perspective, society as a whole does not speak using medical terminology, so how can you be expected to learn these terms?  Americans call the clavicle the collar bone, a myocardial infarction a heart attack, and hydrocodone vicodin.

Healthcare professionals and patients are speaking a different language.  The most frustrating part for patients is they know healthcare professionals can communicate in plain English because it is a basic requirement on all job descriptions for healthcare professionals!  And of course the opposite side is the professionals themselves are required to use medical terminology in their practice.

The solution?  Well, a partial solution is for both sides to be more aware.  Patients must not leave their doctor’s office, hospital, or pharmacist without a clear understanding of what is being communicated to them.  If you are not persistent and don’t ask questions you have nobody to blame but yourself.  Likewise, the purpose of being in the healthcare industry is to help others and communicating their diagnosis and treatment plan is of utmost importance.  It should not be up to the average person to understand the language it took a doctor years of hard work and studying to master.

Has your family member/friend:

1. Neglected personal hygiene resulting in wearing dirty clothes, body odor, bad breath, neglected nails and teeth, sores on the skin?
2. Neglected their home so it is not as clean or sanitary as you remember growing up?
3. Exhibited inappropriate behavior by being unusually loud or quiet, paranoid, agitated, making phone calls at all hours?
4. Changed eating habits within the last year resulting in weight loss, having no appetite, or missed meals?
5. Decreased or stopped participating in activities that were previously important to them such as bridge or a book club, dining with friends, or attending religious services?
6. Exhibited forgetfulness resulting in unopened mail, piling newspapers, not filling their prescriptions, or missed appointments?
7. Changed relationship patterns such that friends and neighbors have expressed concerns?
8. Had physical problems such as burns or injury marks resulting from general weakness, forgetfulness, or possible misuse of alcohol or prescribed medications?
9. Mishandled finances such as not paying bills, losing money, paying bills twice or more, or hiding money?
10. Made unusual purchases such as buying more than one magazine subscription of the same magazine, entered an unusual amount of contests, increased usage of purchasing from television advertisements?

The key is to identify a legitimate warning sign or a developed pattern of these behaviors. Everyone has a ‘senior moment’ from time to time, so pointing out a small mishap may unnecessarily cause problems.  Communication with the elder’s care providers (physicians, therapists, caregivers, etc…) is also a good idea to compare behavioral patterns – and could be easier to take action when the time calls for it.

Here are a few blurbs I found worth noting:

Work is “medicine” — even better than medicine for many. In addition to providing economic security and often wider access to healthcare options, work enhances well-being, promotes social interaction, increases the variety and quality of life, and provides many people with a sense of accomplishment and achievement.

An active an engaged person is generally a healthier one.  No doubt.

Work provides accountability for many; an absence from work may serve as the first sign to warn distant family that something is wrong with a loved one. Emerging evidence also suggests that work may improve brain health, sustain healthy cognition, and protect memory.

Have you heard that physical and mental activity slows memory loss and possibly the development of Dementia and Alzheimer’s? If not it is a very widely discussed topic.

Remind yourself that chronological age matters little. One 75-year-old can differ markedly from another. When it comes to work, what matters is functional ability, not the number of candles on a birthday cake.

Employers increasingly see the value that older workers bring to the job. Older workers have greater institutional knowledge and usually more experience. They often possess more productive work habits than their younger counterparts.

As I read the article, these points hit me the most because they really say to evaluate each person individually, not to label someone a certain way because of his or her age.

The one thing I wished the article addressed a little more is alternatives for those who deteriorate – mentally or physically – faster than others and therefore don’t have the opportunity to work.  My suggestion for an alternative is to get involved with volunteer work and other community groups that are not profit-driven.  Of course this does not satisfy the need of extra income, however it is an excellent way to stay connected socially.

1. Associate hard-to-remember facts with some familiar space
One trick, known as the journey method or “memory palace,” is to conjure up a familiar space in the mind’s eye, and then populate it with images of whatever it is you want to remember.

2. Use “chunking” to remember numbers, such as passwords, credit cards or bank accounts
Chunking is a way to decrease the number of items you have to remember by increasing the size of each item.

3. Conquering the OK plateau
The “OK Plateau” is that place we all get to where we just stop getting better at something. Take typing, for example. You might type and type and type all day long, but once you reach a certain level, you just don’t get appreciably faster.

4. Pay attention
We’ve forgotten how to remember, and just as importantly, we’ve forgotten how to pay attention.  So, instead of using your smartphone to jot down crucial notes, or googling an elusive fact, use every opportunity to practice your memory skills. Memory is a muscle, to be exercised and improved.

If you have done any research on memory loss, dementia, or Alzheimer’s, you have inevitably heard that exercising your mind is one of the top ways to slow the process of memory loss.  Often times aging people will use crossword puzzles, card games, reading, and discussing current events as methods to keep a sharp mind.  All are excellent ways of doing so, however we should not forget these same methods for better memory that are taught to people of all ages.

Medscape Medical News – In a population of elderly male veterans in a primary care setting, brief counseling improved participation in home-based walking and strength and flexibility exercise, according to the results of a study reported in the May 12 issue of the Archives of Internal Medicine.

“Although walking is a popular and safe endurance exercise, strength building exercises are also an important component of the exercise recommendation for older adults,” write Patricia M. Dubbert, PhD, from the Montgomery Veterans Affairs Medical Center, University of Mississippi School of Medicine in Jackson, and colleagues. “There have been few studies of interventions to promote adoption of home-based strength-building exercise, and a recent review found the results of the existing trials to be inconclusive.”

In this study, 224 male veterans aged 60 to 85 years with physical function limitations were randomly assigned to receive either counseling for home-based walking and strength exercise (EXC) or discussion of their choice of health education topics (EDUC) with a nurse. These interventions took place at baseline, 1 month, and 5 months. During the 10-month trial, all participants received bimonthly newsletters, and the EXC participants recorded exercise on monthly calendars and received brief follow-up telephone calls from the nurse. Analyses used the last observation carried forward approach.

“The results suggest that health benefits can be obtained with relatively modest and safe home-based regimens that include walking and strength training,” the study authors conclude. “We are encouraged by the positive findings of this trial but note that many study participants were still exercising below recommended guidelines. Additional studies will be needed to examine strategies to secure more robust outcomes and successful long-term adherence to these types of interventions.”

The preceding 4 paragraphs are merely highlights of the study.  The study showed those in the EXC group continued to exercise and walk more as time passed.  The EDUC group was given the opportunity to select their own healthcare topic to discuss.  Initially I thought with the EDUC group given a choice, it would increase the men’s interest in continuing with the exercise program.  After all, nobody enjoys to be told what to do.

However, the results showed otherwise.  With education/counseling directly related to walking at home and strength exercise, elderly men showed the strength and interest in walking later into the study.  Perhaps the difference was the consistency of information on that one topic.  It is also possible the elderly men applied the counseling to their walking habits.

Part of the Patient Protection and Affordable Care Act, these assessments are part of final regulations for implementing the new wellness visits, which were announced November 3 by the Centers for Medicare and Medicaid Services (CMS).

Dr William H. Thies noted that he thinks the new assessment system will be either a series of tests or some sort of criteria for tests that the clinician can select, plus suggestions for a follow-up system to put into place.

“Identifying that someone is beginning to have cognitive difficulties will be just the beginning. Ideally they would then go on to further evaluation that would either confirm or not confirm the diagnosis of dementia and be as specific as possible for Alzheimer’s or not Alzheimer’s. And then that diagnosis would be taken into consideration as the rest of the care of that patient is considered,” said Dr. Thies.

After the workgroup comes to a consensus, Dr. Thies said that the fate of their decisions is open to a number of possibilities. “It could go as far as becoming official rules for CMS, if they so choose, or it may simply become advice for physicians who are trying to implement this type of yearly visit and the cognitive evaluation that’s part of it.”

According to the Alzheimer’s Association, the purpose of the workgroup is to build consensus around appropriate methods and processes that can be used in the primary care setting to detect possible cognitive impairment during the wellness visits.

Perhaps we don’t all agree on the decisions our government makes pertaining to senior healthcare, but we should be able to come to terms that the implementation of cognitive testing has to help in the fight for earlier detection of Alzheimer’s.  This article, and the implementation of the testing, did not lay out the exact plan to solve the unsolvable.  But I can’t help but think the early stages of this testing program is a positive sign for future early detection.

HDE is seeking a physical therapist with home health experience – ASAP!!  The home health PT’s coverage zone would span the SW Portland area to include Beaverton, Tualatin, Lake Oswego, Tigard and Wilsonville.  This is a 40 hour/week position.

If you are out-of-state, we are also considering travel PTs as well! 

To learn more about the position, call us right away at 503-686-9079 or send your resume and qualifications to donny@hde-home-care.com or fax to 503-715-5786.

If you know someone who has home health physical therapy experience or a travel PT besides yourself, call and ask about our referral bonuses!

Begin the conversation today We have tremendous cultural resistance to the recognition of aging, disability and death. Just as the first few steps uphill are the hardest, so, too, you may meet the greatest resistance simply starting the conversation about their possible need for care.

Gather cost-savings tips This might mean something as simple as ordering generic medication or regularly inquiring about senior discounts. But, most cost savings opportunities aren’t as obvious.

Create a plan Talk with your parents about their ideal plan if they are no longer able to care for themselves. Then, start to work toward that proactively. Investigate long-term care insurance. Draw up the appropriate legal documents.

Use personal and community resources Make caregiving a family job to which each member contributes. Even children can make grandma’s life special with drawings and phone calls. Identify services that make your job as a caregiver easier.

Take care of yourself You will be able to provide the best care as a caregiver when you’re at your best. Get good nutrition, enough sleep and regular exercise. Manage your stress and do a little something every day to nurture your soul.

Money, money, money.  It really does effect most every decision you make on a daily, and long-term, basis.  No difference when Mom and/or Dad’s health and future residence are in question.

From a more broad perspective, Dr Rackner is simply telling us to make a plan, do our research, use our resources, and make decisions based on that information.  Of course, the trick is to find the right – and credible – information.

Where do you find out if in home care is right for Mom and Dad?  How can you tell if the things you are doing make you a well-prepared family caregiver?  Or if you should find someone else to care for your elderly parent?

The honest answer is find an industry expert you trust.  Case managers, social workers, assisted living administrators, in home care agency administrators, and many of the like must know more about senior care than simply what they have to offer.  Often times if a senior care industry expert cannot give you an immediate answer, someone in their network will be able to help.

There are many, many different companies and programs who can help.  And for you to feel good about the information you receive, it is important to find someone you know and trust first.

From Yahoo – Dad always balanced his checkbook to the penny, and he took few chances with his nest egg. Now he’s forgetting to pay bills, and he’s lost thousands of dollars to fraudsters who’ve called with get-rich-quick schemes.

If that sounds like your parent or spouse, don’t ignore it. A decline in the ability to handle financial matters is one of the early signs of Alzheimer’s disease. Even if your loved one is showing only mild symptoms, seek a diagnosis.

If your worries are confirmed, your family member should move quickly to get his or her finances and estate plans in order. “By the time you receive a diagnosis, almost all financial skills have been impaired,” says Daniel Marson, a professor of neurology at the University of Alabama at Birmingham, who has conducted extensive research on the relationship between dementia and the decline in financial capabilities.

In one federally funded study, Marson compared 23 healthy seniors to 30 people who had early-stage Alzheimer’s. He found that the patients with mild symptoms scored significantly below the healthy seniors on such tasks as understanding a bank statement and verifying the correct change in a one-item purchase.

Patients with mild symptoms were also unable to explain the risks of mail and telephone solicitations. Even seniors in the early stages are prey for financial predators, says Marson, director of the university’s Alzheimer’s Disease Research Center. “There’s an epidemic of financial exploitation aimed at people with mild cognitive impairment,” Marson says.

Once there’s a diagnosis, a family should consider assembling a team of experts. A financial adviser who specializes in planning for incapacity can devise a long-term strategy to pay the costs for care. An elder-law attorney can set up trusts to protect a family’s assets if the disabled relative seeks government benefits. Meanwhile, a geriatric-care manager will help with day-to-day tasks, such as hiring home-care aides and finding an adult daycare center.

As mentioned in the article, seniors can take steps to avoid scams and financial predators with a little planning and prevention while they are independent and capable of making their own decisions.  This process begins with assembling a team of people they trust to help make decisions as their mental capacity declines.  Close family members, friends, and senior care industry professionals are the first people who should be consulted to help in this process.  Such professionals include, but are not limited to, geriatric care managers, your physician, social workers, and elder law attorneys.

Of course, this type of planning is difficult to initiate.  The thought of giving up independence can be gut-wrenching enough and the act of planning for it is just as unsettling.  However, there is an abundance of evidence which shows there are people who seek out seniors who show signs of Dementia and Alzheimer’s and aim to take advantage of them.  It is an unfortunate reality, but we do need to take aim at putting an end to financial predators.