Anosognosia: When Dementia Patients Can’t Recognize Their Impairment

Anosognosia: When Dementia Patients Can’t Recognize Their ImpairmentOne of the most common questions in the Alzheimer’s and Dementia Support Group pertains to how aware dementia patients are of their cognitive status. This can pose a bit of a dilemma, because with reduced mental function, there also comes a limited capacity for insight into and acknowledgement of their true condition.

Anosognosia Is Not Denial

Known as anosognosia, this phenomenon differs from the shock and denial that many individuals and families experience following an initial diagnosis. The word anosognosia is composed of three Greek roots, which combine to mean “without knowledge of disease.” Changes in the brain cause individuals with mental illness, brain tumors, stroke, Alzheimer’s disease and other forms of dementia to believe that there is nothing wrong with them.

A loved one’s lack of awareness of their impairment can be selective or complete, and it can pertain to their memory, general thinking skills, emotions and physical abilities. A dementia patient may experience occasional difficulty with language skills, like word-finding and vocabulary, but they may explain away these situations with a general excuse about forgetfulness or fatigue. Someone who has anosognosia regarding short-term memory problems, like forgetting to bathe, missing appointments, or leaving food on the stove, will typically insist that they do not need help and are fully capable of performing daily activities independently despite clear evidence to the contrary. They may also react with anger when reminded of their mental impairment, which they are fully convinced does not actually exist.

Caregiving and Anosognosia

For dementia caregivers, anosognosia can be more frustrating to deal with than a loved one’s actual lapses in memory. A senior’s abilities are changing before your eyes, but how can you convey that they are incapable of driving, cooking or handling their finances when they don’t understand they are ill? As with most unusual dementia behaviors, learning more about the issue can help you stay calm and find workarounds.

“My mother has anosognosia—something I didn’t even know existed until I read an article about it a couple of years ago. Just knowing that she lacks the capability to recognize her deficits does make it easier to work with her sometimes because I can strategize with that in mind.” –caregiverforum1

Some patients are so convinced they’re healthy that they may even refuse medical evaluations, treatments and medications. We are all familiar with the phrase you can’t help those that won’t help themselves. But with dementia, even when someone does not acknowledge the root of their problems or want assistance, intervention of some kind is usually necessary.

Visit the articles below for insights and suggestions from experienced caregivers on how to cope with the complications and lack of awareness that result from anosognosia.


Important Paperwork: What to Keep and For How Long

Important Paperwork: What to Keep and For How LongIf you’re like most people, you have boxes and boxes of old files cluttering your closets. You’d like to clean out but don’t know what you need to keep, and for how long. As a daily money manager and Certified Professional Coach, I often get this question from my clients.

 I’ve covered the most common documents below, but when in doubt don’t throw it out unless you are sure you can obtain the records electronically from the bank, insurance company, etc.

These recommendations apply to both caregivers and their elderly parents’ paperwork.

Tax returns and supporting documents

Anything to do with taxes should be kept for at least seven years. The IRS has three years from your filing date to audit your return if it suspects good faith errors and you have the same amount of time to file an amended return if you find a mistake. However, the IRS has six years to challenge your return if it thinks you underreported your income by 25 percent or more. If you fail to file a return or filed a fraudulent return, there is no limit on when the IRS can come after you. Specific items you should keep in addition to your tax returns themselves include documentation of income, alimony, charitable contributions, mortgage interest, and retirement plan contributions and any other tax deductions taken.

Medical bills and records

Keep all medical bills and supporting documentation such as cancelled checks or credit card statements until you are sure that the bill has been acknowledged as having been paid in full by you and/or your insurance company. If you are deducting unreimbursed medical expenses on your tax return, keep all supporting documentation as discussed above. Remember to keep all health-related bills including dental, eyeglasses or contact lenses, hearing aids, and over-the-counter medications, to name a few.

Retirement plan statements

Keep the quarterly statements until you receive the annual summary and if everything matches up, you can shred the quarterly statements. Keep the annual summaries until you close the account.

IRA contributions

If you made an after-tax contribution to an IRA, you will need to keep your records indefinitely to prove that you already paid tax on the money when it is time to make a withdrawal.

Brokerage statements

You must keep these until you sell the securities covered by them to prove whether you have capital gains or losses for your tax return. If you hold stocks or bonds for many years, you will need to keep the statements. The exception is if the cost basis and date of acquisition is listed on the statements. In this case, you only need to keep the year-end statements to support your tax return.

Bank records

Keep any checks or statements related to your taxes, business expenses, home improvements, or mortgage payments.


Keep bills until you receive the cancelled check or credit card statement showing that your payment was received. Be sure to keep bills for big purchases like jewelry, furniture, art, appliances, cars, computers, etc. so that you can prove the value of these items to your insurance company in the event they are lost, stolen, or destroyed in a covered disaster such as a fire.

House/condo records

Keep all records documenting the purchase price and the cost of all improvements, as well as records of expenses incurred in selling and buying the property for seven years after you sell it.

Credit card receipts and statements

Keep original receipts until your statements come and then match them up. You can then discard the receipts. Keep the statements for seven years if they document tax—related expenses.

Paycheck stubs

Keep until you receive your annual W-2 form from your employer(s) and make sure the information matches. If it doesn’t match, request a corrected W-2 from your employer(s).

Using the above guide, you should be able to clear out the bulk of your saved paperwork and then establish a system for keeping up with things over time. Remember, you can obtain many of these documents in electronic format, or you can scan them and archive them electronically. If the task seems overwhelming, you might want to consider the help of a daily money manager or professional organizer.


The Difference Between Physical, Speech and Occupational Therapy

The Difference Between Physical, Speech and Occupational TherapyBy understanding what rehabilitation services have to offer, you can make well-informed choices.

What is physical therapy?

Physical therapy (sometimes called PT) can help enhance mobility and quality of life by improving strength, balance, endurance, flexibility and posture. Physical therapy can maximize your loved one’s ability to get around at home and community, as well as participate in favorite recreational activities.

Where can I get physical therapy, and what happens during the sessions?

Physical therapy services are available in multiple settings including the hospital, rehabilitation centernursing home, outpatient clinic, adult medical day care, and at home.

In the hospital, rehab hospital or long-term care facility, most treatment sessions take place either in a hospital room or “therapy gym.” The goal of physical therapy in these settings is typically to improve function so that the patient is safe to return home with assistance. Your loved one may perform exercises lying down in bed or on a padded mat table to improve ability to get in and out of bed. Doing exercises with weights while sitting increases one’s strength and ability to get out of a chair, while exercises with weights while standing improve strength, balance and ability to walk. Very often “parallel bars” are available to provide support for both hands as the patient practices walking.

Physical therapy in an outpatient facility is usually for people who aren’t homebound and are able to tolerate a much higher level of activity. It often includes a variety of exercise equipment and machines to improve strength and balance. You may see stationary bicycles, treadmills, arm bikes as well as machines like the leg press. Don’t worry – the physical therapist will explain exactly how to use the machines properly and safely at the appropriate amount of weight and resistance for your relative.

Physical therapy in the home may be for those who are unable to leave home due to their medical status. It may also be for people who can get out and about, but logistical issues such as lack of transportation make it difficult to get to an outpatient facility consistently. The goal for PT at home is to maximize function at home and community to improve quality of life. Your loved one may do strengthening exercises lying on the bed, sitting in a chair or standing at the kitchen counter with weights or exercise resistance bands. Balance exercises may also be part of the mix. Your relative may practice going up and down your stairs, getting in and out of the car and walking in the neighborhood.

Speech language pathology

Speech-language pathology services (SLP) boost a person’s ability to communicate and to swallow.

In our society, it’s a common comfort to sit down and have a great conversation with family and friends over a great meal. That requires two essential skills: the ability to eat and swallow safely, and the ability to communicate. Both are absolutely critical to a good overall quality of life.

Nearly all activities of daily life require us to communicate, interact, and process information. Communication skills are necessary not only to convey wants and needs, but to socialize and connect with others.

What conditions can benefit from Speech-language pathology?

SLP addresses the declines associated with the aging process, such as neurological difficulties, age-related illness, and deterioration of the swallowing mechanism.

SLP may be able to help your loved one with declines due to brain injury, stroke, cancer, infection, or physical abnormality. It’s used to treat breathing problems due to lung diseases or tracheotomy.

Speech therapists also provide treatment of cognitive-linguistic impairments. This treatment focuses on restoring memory, sequencing, problem solving, safety awareness, attention, and their effects on the function of ADLs. Exercises may include breaking down a complicated task, like making a grocery list, to small simple steps. In this case, the steps include identifying what items you need (problem solving), finding a pen and paper, remembering the words for the items you want (memory), and writing the list (communication).

Does your loved one have trouble speaking, articulating words, or using expressive language? SLP can help in these instances, too, for conditions such as dysarthria or apraxia (motor speech disorders); hoarse or harsh vocal quality; complete or partial loss of voice; or aphasia(a language disorder).

Your parent may be taught specific exercises to strengthen the muscles of the face, mouth and throat such as blowing out, sipping in through a straw and making specific sounds like “pa” and “ma”.

Finally, speech-language pathology plays a critical role in the treatment of dysphagia, or swallowing disorder. The treatment of dysphagia is essential in maintaining healthy lungs and avoiding pneumonia. Beyond that, a therapist may be able to help your loved one enjoy a less restrictive diet with a wider variety of foods.

PT, OT, and SLP are typically available to patients via a referral from their physicians. At my practice, Fox Rehabilitation, we have seen all three of these therapies restore and rehabilitate the lives of thousands of seniors. If you believe your loved one might benefit from PT, OT or SLP, I encourage you to research practitioners in your area and talk with your family doctor. In a few months, you may see your loved one recover abilities once believed to be gone, and rejuvenate in a way you might never have thought possible.

Occupational therapy

Occupational therapy (also known as OT) focuses on your ability to fulfill your “occupations.” So for your parent, the roles could include mother, spouse, homemaker, grandparent, caregiver, or bridge player. Generally, OT assists with the ability to perform Activities of Daily Living (ADLs) such as getting dressed, toileting and bathing as well as Instrumental Activities of Daily Living (IADLs) such as driving, shopping, cooking and recreational activities.

What happens during occupational therapy?

Occupational therapy services are available in many of the same settings as physical therapy. The goal of OT in a hospital, rehab hospital or long-term care facility is often to improve function so that your loved one is safe to return home with assistance.

Treatment sessions, either in the hospital room or therapy gym, may focus on your parent’s posture and use of her arms to improve her ability to eat, dress, bathe and perform other ADLs. Exercises may include stretching and strengthening to make sure she has enough flexibility and strength to perform ADLs. A large part of OT is practicing, developing new strategies and using adaptive equipment to perform activities such as eating, dressing and bathing.

OT in an outpatient facility is not as common as outpatient physical therapy. When it’s offered, outpatient OT is usually for injuries to the hand or arm to maximize function in ADLs, IADLs and recreational activities. Patients may use the arm bike, arm exercises with weights, or special “silly putty” to improve hand strength and dexterity.

OT in the home offers the same benefits as PT at home. The goal is to maximize your parent’s function in his home and community to improve his quality of life. OT at home can include training in doing laundry, light meal preparation, grocery shopping and driving.

Source: by MIMI JACOBS

Managing LTSS Services to Help Seniors Age in Place

IntroductionManaging LTSS Services to Help Seniors Age in Place

The ongoing repeal and replace debate has brought to light something that most Americans are not aware of—the fact that nursing home and other long term services and supports are financed almost entirely by the Medicaid program and about half of Americans will need Medicaid at some point in their lives. At the same time, the U.S. population is aging. By 2040, more than one in five of us will be over age 65. Most seniors want to live independently in their own homes for as long as possible and age in place.

More than 13 million Americans, many of them seniors, use assistance with basic daily tasks like eating, dressing and bathing, as well as activities such as preparing meals, money management, house cleaning and transportation—long term supports and services or LTSS. LTSS services can be provided in a home- or community-based setting and can extend the amount of time a person can remain independent. The Department of Health and Human Services estimates that for people who are age 65, more than half (52%) will have LTSS needs for up to two years. Medicaid is the primary payer of LTSS in the U.S. and spent over $150 billion for LTSS in 2014, the latest year for which data are available.

In recent years, more and more states have begun to incorporate LTSS into Medicaid managed care programs. Today 22 states have Medicaid managed LTSS (MLTSS) programs and more are implementing or exploring MLTSS. Managed care plans have greater flexibility to pay for a range of covered and non-covered services that can help keep people in their home.

Medicaid Managed LTSS

In Medicaid MLTSS programs, states pay a set amount per enrollee to a managed care plan, and the managed care plan is responsible for providing a designated package of healthcare and related supportive services to that enrollee. MLTSS plans may choose to provide additional services for enrollees. Plans often receive a mix of enrollees who are in institutional and community-based settings, and are paid based on the expected number who will stay in each setting. In order for managed care plans to provide care coordination and LTSS to enrollees, it is crucial for Medicaid programs to predict the costs for enrollees and pay the managed care plans adequate, actuarially-sound capitation rates. That is, the rates that are paid are reasonable projections of expected costs to the managed care company.

But predicting LTSS needs and related costs can be challenging! As states move to Medicaid MLTSS, states, plans and other stakeholders have recognized the need to improve models to predict costs among the enrolled MLTSS population. States use risk adjustment and other risk mitigation strategies, paying higher rates for individuals who are expected to have higher care needs, to reduce the incentive for managed care plans to “cherry pick” healthier enrollees or withhold care for those with higher needs. In traditional managed care programs, states and plans use age, gender or diagnoses to predict future costs. However, for those who need community-based MLTSS services, information about functional status is a stronger predictor of costs than age, gender or medical conditions. Functional status information, however, is not routinely or consistently available for those with LTSS needs. This lack of information stands in the way of efforts to reliably predict costs. Although some models exist to take functional status into account, the development of reliable risk adjustment strategies for this population is in its infancy.

At this time only a small number of states have had the opportunity to invest the time and resources into risk adjustment methods for Medicaid MLTSS that use functional assessment data, because of a number of important challenges. First, the heterogeneity of the population makes risk adjustment for Medicaid MLTSS population difficult. States enroll frail seniors, younger adults and children with a range of physical disabilities, and individuals with intellectual and developmental disabilities—sometimes within the same MLTSS program. The needs of these individuals may vary widely, making predictions of their expected costs very complicated. In addition, states vary in the level of need that is required for MLTSS enrollment (e.g., some states require an institutional level of care). Second is the lack of a consistent approach to collecting functional assessment information for those enrolled. A functional assessment seeks to gather information on a person’s ability to conduct everyday tasks. However, the tools used to collect functional assessment information differ among the states, and even across programs or target populations within the same state. A 2015 analysis by the Medicaid and Children’s Health Insurance Program Payment Advisory Commission (MACPAC) found that there are 124 different functional assessment tools in use across the country. Although there are benefits to having unique tools for different populations and geographic areas, this makes it extremely difficult to make comparisons across programs or states.

MLTSS Rate Setting Opportunities

Managed LTSS with the opportunity for coordination of care that comes with it can be immensely helpful to participants with complex medical and social support needs, especially for those with cognitive decline. In order to attract payers to keep and expand these programs, it is important that state Medicaid programs continue to develop models that can accurately predict costs, and for managed care plans that attract a more complex population with higher associated costs to be paid accordingly. Managed care plans can also be given incentivizes to keep individuals in community-based settings, or even move them from institutions to community-based settings. States can, for example, use a blended rate for individuals in both home and community-based settings and institutional settings, encouraging the plan to keep people in lower cost community-based care as long as possible.

The Gary and Mary West Health Policy Center recently funded a project with eight states (Arizona, Kansas, Massachusetts, Minnesota, Tennessee, Texas, Virginia and Wisconsin) to test new rate-setting, risk adjustment, and data collection approaches with a focus on using functional assessment and other relevant data to inform reimbursement strategies. Coordinated through the Center for Health Care Strategies and partners at Mathematica Policy Research and Airam Actuarial Consulting, this engagement provided a forum for selected states and key stakeholders to examine in detail current state opportunities and challenges in setting and risk adjusting managed long-term services and supports (LTSS) rates. These approaches can help better protect states and managed care plans from adverse risk and uncertainty, and support managed care plans’ ability to provide high-quality LTSS in the most integrated and cost-effective care setting. The project resulted in a toolbox of practical resources for states interested in developing their own risk adjustment methodologies.

After we identify how to better predict costs based on functional data, the next step will be adjusting payment rates for LTSS services based on value. Starting in 2017, the Gary and Mary West Health Policy Center will bring together states with MLTSS programs to identify strategies and tools they may be using to advance value-based purchasing (VBP) within their programs to promote the use of home and community-based services and successful aging in place. Our Value-Based Payment Learning Collaborative will (a) identify and promote the spread of best practices in MLTSS rate setting and risk adjustment and adoption of alternative payment models in LTSS; and (b) further refine and promote the spread of VBP approaches in MLTSS and other LTSS delivery system strategies, as appropriate. The overarching goal is to advance the adaption of operational strategies that promote cost-effective home and community-based LTSS services for successful aging in place.

The Gary and Mary West Health Policy Center’s philanthropy funded research is working to advance policies which support and enable aging-in-place. Increasing philanthropic dollars in this area would accelerate efforts to improve, develop, and test innovative models in risk adjustment and value-based purchasing to improve the supportive services available to help seniors age in place.

Source:  by Amy Herr

Stages of Alzheimer’s

Alzhiemer'sAlzheimer’s disease typically progresses slowly in three general stages — mild (early-stage), moderate (middle-stage), and severe (late-stage). Since Alzheimer’s affects people in different ways, each person will experience symptoms – or progress through Alzheimer’s stages – differently.

Overview of disease progression

The symptoms of Alzheimer’s disease worsen over time, although the rate at which the disease progresses varies. On average, a person with Alzheimer’s lives four to eight years after diagnosis, but can live as long as 20 years, depending on other factors.

Changes in the brain related to Alzheimer’s begin years before any signs of the disease. This time period, which can last for years, is referred to as preclinical Alzheimer’s disease.

The stages below provide an overall idea of how abilities change once symptoms appear and should only be used as a general guide. They are separated into three different categories: mild Alzheimer’s disease, moderate Alzheimer’s disease and severe Alzheimer’s disease. Be aware that it may be difficult to place a person with Alzheimer’s in a specific stage as stages may overlap.

Mild Alzheimer’s disease (early-stage)

In the early stages of Alzheimer’s, a person may function independently. He or she may still drive, work and be part of social activities. Despite this, the person may feel as if he or she is having memory lapses, such as forgetting familiar words or the location of everyday objects.

Friends, family or neighbors begin to notice difficulties. During a detailed medical interview, doctors may be able to detect problems in memory or concentration. Common difficulties include:

  • Problems coming up with the right word or name
  • Trouble remembering names when introduced to new people
  • Having greater difficulty performing tasks in social or work settings
  • Forgetting material that one has just read
  • Losing or misplacing a valuable object
  • Increasing trouble with planning or organizing

Moderate Alzheimer’s disease (middle-stage)

Moderate Alzheimer’s is typically the longest stage and can last for many years. As the disease progresses, the person with Alzheimer’s will require a greater level of care.

You may notice the person with Alzheimer’s confusing words, getting frustrated or angry, or acting in unexpected ways, such as refusing to bathe. Damage to nerve cells in the brain can make it difficult to express thoughts and perform routine tasks.

At this point, symptoms will be noticeable to others and may include:

  • Forgetfulness of events or about one’s own personal history
  • Feeling moody or withdrawn, especially in socially or mentally challenging situations
  • Being unable to recall their own address or telephone number or the high school or college from which they graduated
  • Confusion about where they are or what day it is
  • The need for help choosing proper clothing for the season or the occasion
  • Trouble controlling bladder and bowels in some individuals
  • Changes in sleep patterns, such as sleeping during the day and becoming restless at night
  • An increased risk of wandering and becoming lost
  • Personality and behavioral changes, including suspiciousness and delusions or compulsive, repetitive behavior like hand-wringing or tissue shredding

Severe Alzheimer’s disease (late-stage)

In the final stage of this disease, individuals lose the ability to respond to their environment, to carry on a conversation and, eventually, to control movement. They may still say words or phrases, but communicating pain becomes difficult. As memory and cognitive skills continue to worsen, personality changes may take place and individuals need extensive help with daily activities.

At this stage, individuals may:

  • Require full-time, around-the-clock assistance with daily personal care
  • Lose awareness of recent experiences as well as of their surroundings
  • Require high levels of assistance with daily activities and personal care
  • Experience changes in physical abilities, including the ability to walk, sit and, eventually, swallow
  • Have increasing difficulty communicating
  • Become vulnerable to infections, especially pneumonia



Maple Syrup Fights Alzheimer’s

Maple syrup isn’t just delicious, it also could cure Alzheimer’s disease

It’s a sweet new health discovery: Maple syrup could cure Alzheimer’s disease.Maple Syrup Alzheimer's

The delicious pancake topping may soon find its way into granny’s pill bottle because it stops brain cell damage that causes the disease, scientists revealed Monday.

The tasty treat may prevent the clumping and “misfolding” of brain cell proteins — which build up and cause plaques that trigger the devastating disease, researchers at the American Chemical Society said.

An extract of the sticky stuff stopped the dangerous “folding” in two types of brain proteins, researchers from the Krembil Research Institute of the University of Toronto said.

“Natural food products such as green tea, red wine, berries, curcumin and pomegranates continue to be studied for their potential benefits in combating Alzheimer’s disease,” said symposium director Dr. Navindra Seeram.

“And now, in preliminary laboratory-based Alzheimer’s disease studies, phenolic-enriched extracts of maple syrup from Canada showed neuroprotective effects, similar to resveratrol, a compound found in red wine,” she said.

Researchers plan to study whether a maple syrup extract can be effective as a cure for degenerative brain disease.

The syrup protects two brain proteins — beta amyloid and tau peptide, researchers said.

Researchers from the American Chemical Society discussed the discovery at an annual symposium, which is being held March 13-17 in San Diego.

Dr. Donald Weaver of the Krembil Research Institute revealed the discovery.


Source: New York Post, March 17, 2016

Abuse and Neglect

Abuse and neglect of a senior or vulnerable adult happens much more often than most of us have any idea.  Approximately 9.5% of the US population over the age of 65 experiences some type of abuse, neglect and/or exploitation. We like to think that it won’t happen in our families.  Unfortunately, it can and very well may.Abuse and Neglect Women

Females are abused more frequently than males, and the older the individual is, the more likely they are to be abused.   The vast majority of abusers are family members (approximately 90%); most abusers are adult children, spouses, or partners. Family members who abuse drugs or alcohol, who have a mental/emotional illness, and those who feel burdened by their caregiving responsibilities abuse at higher rates than those who do not.

Abuse comes in many forms, neglect being the most frequent, followed by physical abuse, financial exploitation, and emotional abuse.  Neglect is the refusal to provide an elderly person with life necessities such as food, water, clothing, shelter, personal hygiene, medicine, comfort, and personal safety.  Physical abuse is a physical force that causes or is likely to cause injury, pain or impairment to an elder. Financial abuse or exploitation is the illegal or improper use of an elder’s funds, property or assets.

The elder is often reluctant to acknowledge or report abuse themselves because of fear of retaliation, fear of abandonment, lack of physical and/or cognitive ability to report, or because they don’t want to get the abuser, often a family member, in trouble.

We must be willing to stand up to protect our elders.  If you have concerns, or suspect abuse, do your part – talk to someone, call Adult Protective Services (APS).  APS provides services in each state to insure the safety and well-being of elders and adults with disabilities who are in danger of being mistreated or neglected, are unable to take care of themselves or protect themselves from harm, and have no one to assist them. A staff member will make contact with the elder to assess their current risk factors.  With the help of the elder, the APS worker will develop a plan to assist them. Those who have the capability to understand their circumstances have the right to refuse services, regardless of the level of risk. If you suspect abuse, call 208-334-3833.

Written by: Dee Childers, Life Changes Elder Care Consulting, LLC

Being a Healthy Caregiver


As a caregiver, you may find yourself with so many responsibilities that you neglect taking good care of yourself. But the best thing you can do for the person you are caring for is stay physically and emotionally strong. Here’s how:

See the doctor

Be sure to visit your physician regularly (at least annually), and listen to what your body is telling you. Any exhaustion, stress, sleeplessness, or changes in appetite or behavior should be taken seriously. Ignoring these symptoms can cause your physical and mental health to decline.

If you are caring for someone in the late-stages of Alzheimer’s, talk to your health care provider about the seasonal flu shot. Being vaccinated protects both you and the person you are caring for.

Get moving

No doubt you know that exercise is an important part of staying healthy — it can help relieve stress, prevent disease and make you feel good. But finding the time to exercise is another story.

Use these tips:

  • Take friends and family members up on their offers to help.
    You can get in a good workout in a short amount of time — even a 30 minute break. Use our Care Team Calendar to help coordinate a schedule where you have breaks to exercise and take care of your health.
  • Start small.
    While it is recommended that you get 30 minutes of physical activity at least five days a week, even 10 minutes a day can help. Fit in what you can, and work toward a goal.
  • Exercise at home.
    When the person with dementia naps, pull out a yoga mat and stretch, set up a stationary bike, or try exercise tapes.
  • Find something you love.
    If you enjoy the activity, it will be easier to make it a habit.

There also are many ways you can be active with the person with dementia. Here are a few ideas:

  • Take a walk together outside to enjoy the fresh air
  • Go to the mall and take a stroll indoors
  • Do seated exercises at home
  • Dance together to favorite music
  • Garden or do other routine activities that you both enjoy

Eat well

Heart-healthy eating patterns, such as the Mediterranean diet, are good for overall health and may help protect the brain. A Mediterranean diet includes relatively little red meat and emphasizes whole grains, fruits, vegetables, fish, nuts, olive oil and other healthy fats. Try new recipes and involve the person with dementia.

Need ideas on how to go healthy?
Try these resources:

Five tips to help you cope

  • Manage your level of stress.
    Consider how stress affects your body (stomach aches, high blood pressure) — and your emotions (overeating, irritability). Find ways to relax.
  • Be realistic.
    The care you give does make a difference, but many behaviors can’t be controlled. Grieve the losses, focus on positive times as they arise, and enjoy good memories.
  • Give yourself credit, not guilt.
    It’s normal to lose patience or feel like your care may fall short sometimes. You’re doing the best you can. For support and encouragement, join ALZConnected, our online caregiver community.
  • Take a break.
    It’s normal to need a break from caregiving duties. No one can do it all by themselves. Look into respite care to allow time to take care of yourself.
  • Accept changes.
    Eventually your loved one will need more intensive kinds of care. Research care options now so you are ready for the changes as they occur.



Tips to Help Avoid Medication Mistakes for Seniors

Tips to Avoid Medication Mistakes

Ninety-one-year-old Fred lives in an independent retirement community and is usually skilled at managing all of his many medications. After a bout with congestive heart failure, he was prescribed a diuretic to help eliminate fluid from his system. It worked and he got better. So he quit taking the medication. It was one less pill he had to remember to take. He viewed the prescription as a temporary medication when the doctor actually intended for him to keep taking the prescription. Soon the fluid began to build up again and Fred was back in the hospital.

Nearly 20 percent of seniors who are taking five or more prescription medications surveyed by Home Instead, Inc., franchisor of the Home Instead Senior Care® network, reported challenges in managing their medication regimen including understanding directions for taking the medications.

Such medication management uncertainty could put seniors at higher risk for a medical issue or emergency due to incorrect dosage or adverse medication interactions. And that can lead to potentially devastating consequences. Each year, there are nearly 100,000 emergency hospitalizations for adverse drug events in U.S. adults aged 65 years or older, according to the Centers for Disease Control and Prevention.

Following, from Home Instead Senior Care and Dr. Jane Potter, geriatrician and director of the Home Instead Center for Successful Aging at the University of Nebraska Medical Center, are suggested ways to help minimize the risk of medication mistakes.

Get a pill organization system or service

Approximately 50 percent of patients do not take their prescriptions as prescribed, according to the 2011 study, “Medication Adherence: WHO Cares?”. That’s why a pill organizer can be such an important tool.

Check out Simple Meds℠ to learn more about the benefits of an organized system for medication management. Simple Meds pharmacists dispense prescriptions, over-the-counter medications and vitamins in simple, multi-dose packets. The medications will be sorted and conveniently organized into single serving packets, labeled with the date and time they should be taken as prescribed by the senior’s doctor.

Make one doctor the gatekeeper to manage medications

It’s typical for an older adult to have multiple doctors, which is potentially dangerous. Dr. Potter suggests that your senior designate a primary doctor as the gatekeeper. Most people assume that doctors talk to one another, but you can’t assume that’s the case. They may not be aware of everyone involved in your older adult’s care. It’s best to keep a list of all providers and who is managing what, and update the list at least annually or whenever a change in medications is made.

“Bring into doctor appointments the actual medication bottles along with bottles of over the counter drugs your senior is taking so the doctor can cross check those each time,” Dr. Potter recommends. Medication tracker worksheets, where you can help your loved one record all the necessary information, can help as well.

Know why your loved one is taking the medication

What specific condition(s) or symptom(s) was the medication prescribed to help alleviate? Make sure your senior can read and understand the medication’s instructions. And verify with the pharmacist that the medication being given is what the doctor prescribed. Double check with the pharmacist to make sure the medication won’t interact with any other prescriptions being administered. Make sure you and your senior are aware of all potential side effects.

Call the doctor about any changes in how your senior is thinking, feeling or looking

Many people have a sense when they feel different, especially after a change in their medication. But your senior could also develop a reaction after years on the same medication. Be sure to bring these issues to the attention of a health care provider.

Keep regularly scheduled appointments and an open dialogue with your loved one’s health care provider

Encourage your senior loved one to keep a regularly scheduled appointments and maintain open communication with the doctor to help avert medication problems. Consider writing down questions in advance so you and your loved one remember everything you intended to discuss during an appointment.

If your senior is having trouble paying for medications, talk with the doctor

One of the biggest deterrents to medication adherence is cost. If an older adult is having trouble paying for a medication, discuss this with the doctor and pharmacist. Generic options can be cheaper and some pharmaceutical companies offer discounts.

Tell your senior loved one’s health care provider if you suspect he/she is depressed

Depression might make sticking to a medication regimen more difficult. Furthermore, some medications can contribute to depression. Be sure to let your doctor know if your senior loved one seems depressed.

Discuss any problems an older adult may have in taking a medication, such as the inability to swallow or difficulty opening a pill bottle

Solutions exist for some medication challenges. For instance, a liquid can be prescribed as an alternative to pills for some medicines. What’s more, pharmacists are required to provide easy-open bottles that can help individuals with arthritis. Discuss these options with your senior’s pharmacist.

Tell a health care provider if you suspect a loved one is forgetting to take a medication

It’s easy to become confused about the medications that have been prescribed, when they should be taken and how often. Confer with your senior’s health care provider about the appropriate level of medication assistance for your loved one.

Consider a caregiver

Help a senior assess the risk of medication mismanagement or side effects by going to the Let’s Talk About Rx℠ Solutions Guide.


Source:,  January 21, 2016

Why Does Alzheimer’s Disease Affect More Women Than Men?

Women are disproportionately affected by Alzheimer’s disease (AD). Nearly two-thirds of the more than 5 million Americans living with Alzheimer’s are women and two-thirds of the more than 15 million Americans providing care and support for someone with Alzheimer’s disease are women. This devastating disease places an unbalanced burden on women at work and at home, forcing them to make difficult choices about their careers, their relationships and  their futures.

As real a concern as breast cancer is to women’s health, women in their 60s are about twice as likely to develop AD over the rest of their lives as they are to develop breast cancer.

So why does this disease seem to affect more women than men? At first glance, the answer may be that women generally live longer than men, making them more likely to reach the ages of greater risk. However, there is emerging evidence that suggests there may be unique biological reasons for these differences beyond longevity alone. These biological underpinnings may contribute to the underlying brain changes, progression and symptom manifestation in Alzheimer’s disease.

There is evidence that biological sex differences may affect mortality in men differently than women, but how that affects Alzheimer’s disease and related dementia incidence is not clear. Do hormones play a role? What about our genes? Do lifestyle components such as sleep patterns, stress and depression influence sex differences in Alzheimer’s disease?

To tackle many of these questions head on, the Alzheimer’s Association convened top experts in the field of biological sex and Alzheimer’s disease to explore these issues in depth. The “Gender Vulnerability Related to Alzheimer’s Disease” think tank identified gaps in our knowledge and next steps in research needed to advance our understanding. During the think tank, three main topics were discussed: underlying biological mechanisms, the role of hormonal factors and the impact of lifestyle factors.

As a direct result of this think tank, the Alzheimer’s Association announced the new Sex and Gender in Alzheimer’s (SAGA) grant funding program, aimed at supporting scientific investigation that addresses the gaps in our understanding of the role biological sex and related genetic, biological, lifestyle and societal factors may play in increasing vulnerability for Alzheimer’s. Additionally, projects funded through SAGA will help meet a need to incorporate learnings from the developing biology fields to merge the expanding field of sex biology research with Alzheimer’s pathophysiological studies.mariacarrillo

As with all of our grants, applications for SAGA funding will undergo the Alzheimer’s Association’s rigorous peer-review process. I look forward to sharing more about these grants when they are awarded later this year.


About the Author: Maria Carrillo, Ph.D., is Chief Science Officer, Medical and Scientific Relations, at the Alzheimer’s Association.

SAGA was made possible from the generous support of the Women’s Alzheimer’s Research Initiative (WARI), a campaign that supports research grants specific to sex-biology and gender issues in Alzheimer’s and other dementias. To date, the Alzheimer’s Association has raised $1.6 million for the initiative, including a generous $1 million in support from the Sigma Kappa Foundation.


Source:, Feb 11, 2016