Posts

Robotic Assistants for Dementia Family Caregivers — Here Now!

Robotic Assistants for Dementia Family Caregivers — Here Now!There have been many technological innovations that help family caregivers as they care for older adults.

Do we always love — or even use — them when we get them? Nope!

When it comes to older adults, the population is quickly becoming larger than the number of those available to care for them. Many family caregivers can’t stop working, for financial reasons, to become full-time caregivers, have other immediate family needs raising their children, or live at a great distance away all, any of which may prevent them from being full-time caregivers.

What about the number of seniors who have no family members, never had children, or have outlived their family members? What can they do to get their aging needs met?

This is a prime reason that technology to fill the gaps of caregiving is here to stay and will only continue to increase in breath and scope of devices and innovations.

Non-traditional solutions need to be embraced by caregivers and older adults, as well as made useable and practical by tech companies.

Many seniors have been slow to adopt new technology and many caregivers have stalled getting technology in place because they feel overwhelmed and undereducated about what is best for their senior loved one. Both of those must be overcome for caregivers and seniors to get the benefits of technology.

Smart home technology, voice activated assistants, and remote medical monitoring are all at the forefront in technology becoming part of daily life for our seniors.

Are we giving due consideration to robotics and the promise of great things to help manage chronic disease, reduce loneliness and improve the well-being of people living with dementia?

Dementia Decline Impacted by Robot Interaction

A new project has been focused on the effects that robots can have on the decline associated with dementia’s progress.

Advanced Brain Monitoring Inc (ABM) has introduced a robot companion that will interact with a person with dementia to determine if it can mitigate cognitive decline. ABM has received a grant from the National Institute on Aging at the NIH to carry out this study using socially assistive robot interventions. You can read more about it in this article.

Caregivers have been searching for strategies to meet the needs of their older loved ones and keep them mentally stimulated and engaged.

ABM used a socially assistive robot named Mabu from Catalia Health to interact with people with dementia in their own homes. The ABM team states, “We foresee the potential for the robot intervention to be used alone or in combination with other treatments for dementia.”

Mabu will ask questions, get answers, and give reminders as desired. It can be voice activated or directed using a touchscreen tablet. Daily conversations of only a few minutes at a time are individualized to the person and their needs. Although not mobile, the head and eyes move to interact with the person and follows their face to engage.

Change in Chronic Disease Needs Technology Solutions

Seniors today typically suffer from chronic diseases instead of an acute medical diagnosis that ends in their quick demise, as it did in the last century. The struggle then becomes managing chronic disease (and often more than one at a time) for optimal aging and independence that will allow aging in place.

Unfortunately, with the growth in the older population combined with the decline in number of people who can be caregivers to this population of elders, family caregivers will need to depend more on innovative technology to face health and aging challenges.

Success of technology to improve the life of our older adults will require engagement with this technology. That will mean, in a sense, having a relationship with our tech devices and staying engaged over time without abandoning it.

Clearly, if our seniors stop using a device, there is no benefit.

What if there was a technology that was engaging, effective, and acted as a companion that would become meaningful enough to achieve results of engagement that leads to true disease management and medication administration?

Technology such as this could keep a senior connected over a long period of time instead of being discarded. One that becomes almost a buddy.

Cost Versus Benefit of Technology Interventions

Many seniors who have begun needing additional care, but want to remain at home, need a helping hand.

Particularly for those older adults who live alone, a companion robot that interacts on a daily (even more than once a day) basis and is there to confirm they are following their treatment plan is very important to not only their medical status and quality of life, but also for the senior’s mental health to reduce loneliness.

Loneliness, which affects as many as one third of our seniors, has been shown to be a predictor of poor health.

The cost of most of this new technology rivals that of once a week in-home care. While the cost of care will likely rise over time due to supply and demand impacts, the cost of technology typically declines.

UBTECH Lynx (at Amazon)

Cost reductions in avoiding a medical crisis or hospitalization, home safety interventions, proper medication management, reduction in depression and loneliness, and the time given back to family caregivers far outweigh over the long-term other costs of facility or even routine home care.

Digital companions who interact with seniors and the healthcare team can help avoid health crises that lead to hospitalizations. It can also reduce the number of in-home visits needed when chronic diseases are monitored more closely and routinely using digital companions. Non-adherence to the treatment plan is a real barrier to health for many seniors.

Robots on the market and coming to market soon are not intended to take the place of in-home caregivers but to supplement the care they provide based on each senior’s situation.

It is important to note that many of these social robotic companions do not store health data. Any information relayed to a healthcare provider is encrypted, HIPPA compliant and secure.

Technology to Defeat Dementia

Robotics are being used with people with dementia in order to get their attention, engage them with companionship and stimulate them.

There are several of these robots either on the market in specific sectors or available to the consumer including MABU, ElliQ, CareCoach GeriJoy, Buddy, Paro the seal, and Hasbro’s Joy for All pets.

Robotic pets cost in the $100 range and are easily accessible. One of these would be a great gift for many seniors!

The sad truth is the level of frustration and anger family caregivers have when caring for elders in the advanced stages of dementia who ask repetitive questions and need constant redirection at tasks. It is human nature to react when someone asks 15 times in a row what time it is.

Robot companions, however, don’t react with judgment or frustration and are able to maintain a constant tone of voice. This interaction may help avoid conflict which could escalate behaviors in the person with dementia. A robotic companion can relieve a daily caregiver when seniors need constant conversation.

Robotics Doesn’t Replace but Enhance Caregiving

Many caregivers will balk at the thought of machines taking over the caregiving role and replacing the human touch.

This has never been the intention.

Everyone we have seen and heard in the field of robotic research and those implementing digital companions with seniors agree that a human caregiver is essential. Robots are to be used to enhance the experience of aging and augment the capabilities of busy caregivers not replace it.

You are the most important caregiver for your senior loved one, but you need help.

Socially assistive companion robots could help you improve the quality of life for your senior while helping you be able to continue to be a strong caregiver!

Source: Senior Care Corner by Kathy Birkett

Validation Therapy for Dementia: Calming or Condescending?

People with Alzheimer’s disease and other types of dementia often come to live in an altered reality that doesn’t mesh with ours. Their hallucinations and delusions may not make any sense to us, but their perceptions are as real to them as ours are. Dealing with this stark contrast can be difficult, but validation is often the kindest, most respectful way to handle the beliefs and perceptions that a loved one’s brain creates.

Sadly, this is a tough concept for many adult children and spouses of people with dementia to absorb. Most people’s initial reactions to an off-the-wall remark are to refute or correct it. Years ago, this kind of “reorientation” was widely accepted, but the downfall is that it only works on individuals who are capable of rational thinking. Dementia patients lose this ability as the disease progresses and can become agitated or upset when their concept of reality is challenged. Thanks to the work of one woman, jarring reality orientation techniques gave way to the gentler practice of validation in dementia care.

A Dementia Care Pioneer

Naomi Feil MSW, ACSW, was born in Munich in 1932. She grew up in the Montefiore Home for the Aged in Cleveland, Ohio, where her father was the administrator and her mother was the head of the social service department.

Feil earned her master’s degree in social work from Columbia University in New York and then began her own career with the elderly. Between 1963 and 1980, Feil grew increasingly dissatisfied with the traditional methods used to work with severely disoriented elders, so she developed a new technique aimed at acknowledging and accepting their irrational perceptions of reality.

Her first book, “Validation: The Feil Method,” was published in 1982. Although validation was slow to catch on with medical practitioners, by the mid-nineties Feil’s method began to gain popularity. Since then, her technique has gradually become accepted by most geriatricians, geriatric psychiatrists, social workers, nurses and other health care providers as a crucial tool in dementia care.

My Experience with Validation Therapy

I personally witnessed this transition of medical thought as I struggled to care for my father after he was suddenly thrown into dementia due to a botched brain surgery.

My family was completely caught off-guard by this new development and we initially just tried to muddle through. I quickly found that the only way to help Dad relax and retain any sense of self-esteem was to agree with him no matter how deluded his thinking was.

 I agreed with the “fact” that he’d earned his medical degree, even though a reality check would show that WWII had interrupted his studies and prevented him from realizing this dream. I even went so far as to create a faux medical diploma to hang on his wall at the nursing home, which helped for a while.

Then he became convinced that he had received an invitation from Lawrence Welk to be a guest conductor on the TV show, which of course was airing as reruns on PBS since Welk was long deceased.

I bought Dad a conductor’s wand and numerous big band CDs to play in a stereo. He was thrilled. Dad watched the Welk reruns, merrily directing the band whenever he felt up to it. I made him a certificate of thanks from Welk for Dad’s “services” and hung that on his wall as well.

And on it went.

I knew nothing of the validation theory during these early years, but I did know my dad. I could not put this intelligent, well-read man through the horror of correcting his thinking daily when he was no longer able to comprehend why he was wrong. I knew that I needed to get into his world, which was instinctive to me, perhaps because I’m a rather whimsical person by nature.

Years later, I learned that there is a word for my approach to Dad’s altered realities: validation. This technique is now accepted as a practical way of working with people who have dementia. It helps reduce stress, improve communication, reinforce self-esteem and infuse dignity into dementia care. It increases patients’ happiness because they aren’t continually being told that they are wrong and confused by truths that they cannot understand.

The idea of validation stems from an empathetic attitude toward our loved ones and a holistic view of them as individuals. We learn to effectively validate their thoughts and experiences by making ourselves see the world through their eyes.

Isn’t “Lying” to Our Elders Demeaning?

Understandably, my mother had difficultly validating Dad’s altered beliefs about himself and the world. This was the man to whom she’d been married for over half a century. She felt that she was being disrespectful when she placated him by agreeing with his delusions.

I understood why Mom had trouble joining Dad in his world, but I also witnessed the agitation and emotional pain he went through as Mom valiantly tried to make him rejoin reality when he simply couldn’t. She eventually gave up and tried to “play along,” but she was never very convincing. I can’t fault her for that.

Validation Lends Dignity and Respect

Some of us have been told by our parents to never treat them like children when they get old. No one believes more than I do that treating an elder like a child is unacceptable. There is, however, a big difference between raising and educating a child and validating an elder who has dementia.

Children with normal developmental abilities are able to learn and grow intellectually and emotionally. As they gain experience, they gradually understand more and more about people and the world around them. Therefore, gently correcting a child is our job as parents who strive to help them develop and become well-adjusted.

The reverse is true of someone who has dementia. These individuals gradually lose their ability to understand the world as others see it and interact with it appropriately. The disease changes how the brain works and processes information, creating warped perceptions that they cannot differentiate from “true” reality. This is just one way that caring for our elders is different from caring for children.

If we, as dementia caregivers, continually “correct” their thinking, we are chipping away at any self-esteem they have managed to retain throughout the course of this disease. A caregiver’s commitment to honesty and accuracy often comes from a good place, but it can be demeaning, even cruel, for a patient to endure.

Validation is not about treating someone as a child. It’s about respecting the person with dementia and how they see the world. It’s about overcoming our own bias. It’s about adding some dignity to the last years of our elders’ lives by accepting that maybe there is more than one way to look at things.

Yes, there are times when validation doesn’t work, so we lean on redirection and distraction instead.

“No, Dad, you can’t drive right now because I misplaced the keys. Let’s go see if there’s some music on TV.”

“No, Mom, there isn’t a war happening here in town. That is going on far away from us and we’re safe. Let’s change this news channel to Discovery and see what’s on.”

“I’m sorry you’re seeing bugs crawling on your bedroom walls. That must be very upsetting. I’ll call the exterminator and we can go have a cup of tea in the living room while we wait for them to show up.”

Dementia presents countless challenges that call for stellar patience and every tool at our disposal. It may seem backwards at first, but validating your loved one, rather than correcting them, is life-enhancing for both of you. It’s an expression of kindness and respect that will help them feel heard and prevent you from starting unnecessary arguments you will never win.

Source: AgingCare

Can a Caregiver Change a Loved One’s Power of Attorney?

While it may seem like an unusual scenario, there are a few legitimate reasons why family members may want to change an aging loved one’s power of attorney designation. Of course, changes are easy to make if the principal is still mentally competent and wishes to name someone else (known as the agent) to act on their behalf. However, things can get complicated when a loved one is incapacitated and family members believe that a change is in order.

There are a couple of different ways to go about this, but it depends on how a person’s POA document is written and what the desired outcome is. Two of the most common scenarios are when a caregiver no longer wishes to serve as POA for a loved one and when a family member wants to challenge the legality of the current POA’s actions.

 What to Do if You Want to Resign as Power of Attorney

Any caregiver will tell you that this responsibility is not for the faint of heart. There are many reasons why an agent may need or want to step down as POA. Perhaps they have moved out of state and are too far away to effectively manage a loved one’s medical and financial affairs. In some cases, the principal may be abusive and the agent must resign in order to safeguard their own physical and mental health. Acting as a person’s agent is a serious legal responsibility and, regardless of the reason, it is important for an agent to resign if they feel they cannot carry out their duties.

To resign, an agent must compose a formal letter notifying the principal, any co-agents and all parties with which the original POA has been filed, such as banks, elder care providers, etc. While each state has different rules for relinquishing POA, taking formal steps to notify all involved parties offers the most protection from any legal issues. It’s best to sign the resignation letter before a notary and then send copies of it via certified mail with return receipt requested. In this letter, you’ll want to include your full name, the principal’s full name, the date that the original POA document was signed and the date you will terminate your position as an agent. An attorney can help you draft this document easily and at minimal expense if you need help.

Can an Agent Give POA to Someone Else?

The process of resigning as an agent is not particularly difficult, but it can have serious implications for the principal. Who will assume the agent’s responsibilities? If a successor is listed on the original power of attorney document, then he or she will become the new acting agent. It would be wise to cancel the original POA and have a new document drawn up, directly naming the successor as the new agent. However, this is only possible in cases where the principal is still of sound mind. POA can be difficult to “prove” and have accepted by certain entities like banks, so a simple and straightforward document is ideal.

Naming a successor agent (or two) is recommended. It gives the principal a legal back-up plan in case the original agent resigns, becomes incompetent themselves or passes away. If no successor is listed on the original POA document and the principal is already incapacitated, then there are few options left. Unless the document grants the original agent the specific ability to delegate powers to another individual, the general rule is that he/she may not do so. Guardianship is the only other option for passing on this responsibility.

How Guardianship Factors Into Resigning POA

Continuing with the scenario above, an interested family member or friend would have to petition the court for guardianship of the incompetent principal to ensure that their medical and financial affairs continue to be managed responsibly after the original agent resigns. This is a lengthy and expensive process that should only be considered as a last resort, but sometimes there is no other choice.

If no other individuals are interested in or capable of serving in this role, then the principal may wind up as a ward of the state and under public guardianship. A concerned party, such as a physician or Adult Protection Services (APS), may file a referral to a local public guardianship service provider indicating that the indigent and/or incompetent adult requires assistance making medical, financial, and/or daily living decisions. Information is collected about the incapacitated individual and a hearing is conducted to determine if they meet the legal guidelines for public guardianship and rule out the possibility of another suitable person serving as their private guardian. Guardianship in any case is not ideal. It is costly and time consuming and it strips wards of their independence and many personal rights. However, it is sometimes necessary to protect vulnerable adults from neglect and abuse.

Contesting a Power of Attorney

Guardianship can also play a significant role when a person wishes to challenge a current POA. This may be appropriate if you know or suspect that an agent has abused their authority and you wish to take over their duties. Again, going to court to prove that a POA document is invalid or that an agent has mismanaged a principal’s funds or neglected their needs can be a long, expensive and emotional process. These suspicions must be proven in court and, if the agent is removed and the principal is deemed incompetent, then a petition for guardianship will also have to be filed.

It is crucial to understand how power of attorney documents work and carefully consider who to appoint as an agent. Guardianship is an important method of protecting vulnerable seniors, but it should only be used as a last resort. Ultimately, every caregiver’s focus should be on meeting their loved one’s needs and safeguarding their wellbeing. It is imperative to take action if any agent, whether it is yourself or someone else, is unable to handle this responsibility.

Source: AgingCare.com

Skin Care Tips for Seniors

Skin Care Tips for Seniors

Our skin is often the first place we notice signs of aging. Beyond just wrinkles and age spots, our skin is a reflector of our overall health, and yet it is often overlooked.  

Did you know… 

The skin is the largest organ in the body. It has a very important job — protecting our internal organs and systems from bacteria and other foreign matter that can make us sick or otherwise damage us. 

As we age, however, our skin also begins to change. It loses elasticity, becomes thinner and drier, begins to sag, and takes longer to heal. Damage to the skin that occurred in our youth can also start to appear in the form of age spots and dry patches. Medications, diet and exercise can also impact your skin, which is why it is important to check it regularly for changes. 

Among the changes that require attention is the appearance of moles and skin tags, as they can indicate more serious conditions, including diabetes, kidney disease, and several forms of cancer. (link to: https://www.cancer.gov/types/skin) 

 Good Skin Care Is a Must 

  • Drink plenty of water! The human body is 70 percent water. Staying hydrated is essential to overall health as well as keeping your skin soft and supple. Dry skin can create itchy patches, redness and, if you scratch them, sores that can take time to heal and allow bacteria to enter the body. 
  • Eat your veggies! A well-rounded diet that includes lots of vegetables is a must. Beyond our overall health, vegetables contain the ingredients essential for healthy skin. 
  • Moisturize! Use a good body lotion daily in order toto keep skin supple and smooth. Moisturizing also helps with itching and reduces self-imposed scratch marks. Other ways to keep your skin moist is to take fewer baths. Use warm, not hot, water. And, if dry air in your room is a problem, try a humidifier to add a little moisture. 
  • Use Sunscreen! Everyone today knows the dangers of too much sun. While we need sunlight to provide the vitamin D that we absorb through our skin, too much sun is responsible for age spots and several types of cancers. 

Be Vigilant 

Skin checks are not often standard in wellness checks at the family doctor. In addition to annual visits to the dermatologist, With months in between visits, however, it is good practice to do a skin check every month or two.  

Even if your loved ones are in an assisted living or other facility, it is a good practice check their skin periodically. The aides that dress or bathe them may not notice or be as adequately trained to spot changes in skin health other than skin breakdown that may indicate a serious health issue.  

Catching problems early is the best prevention.  

The National Institutes of Health has provided  this handy guide for what to look for. 

Check Moles, Birthmarks, or Other Parts of the Skin for the “ABCDE’s” 

A = Asymmetry (one half of the growth looks different from the other half) 

B = Borders that are irregular 

C = Color changes or more than one color 

D = Diameter greater than the size of a pencil eraser 

E = Evolving; this means the growth changes in size, shape, symptoms (itching, tenderness), surface (especially bleeding), or shades of color 

See your doctor right away if you have any of these signs to make sure it is not skin cancer. 

Winter Top Tips: How to Keep Seniors Happy, Healthy and Warm

Winter Top Tips: How to Keep Seniors Happy, Healthy and WarmThe AgingCare.com forum is filled with people coming together to share valuable information. We’ve compiled experienced caregivers’ suggestions for keeping a loved one cozy, content and clean in spite of cold winter weather.

 Winter Skincare Tips

“Although many people use baby oil, it contains mineral oil and artificial fragrances. If your loved one has any chemical sensitivities (and a lot of older people do), it is best to stay away from any artificial fragrances, artificial ingredients and mineral oil. Try organic coconut oil for soothing and moisturizing dry skin. It is simple and very effective. I also recommend visiting a good health food store and asking about lotions that are all natural.” –oceansong

“My primary care physician (whom I hold in very high regard) recommends Eucerin lotion products. They are a little pricey, but they last forever. I think they also make a lotion specifically for diabetics.” –Miasmom1

“Many of us love the bath or shower to be very hot, especially when it is cold outside. However, high temperatures can be very drying for the skin. I know my hands also become super dry in colder weather. I tried just about everything, but my hands felt like I had a dozen paper cuts and I looked like I was attacked by my cats! Then I found O’Keefe’s Working Hands Hand Cream. It’s mainly advertised to men, but I tried it and so far, so good! It can be found in grocery stores and hardware stores.” –freqflyer

“My mom developed dry, irritated skin last winter, and I thought she was having an allergic reaction. When we went to the doctor, he called it ‘winter itch’ (a seasonal type of eczema). It was all over her body and, of course, she has opened some areas on her skin. We are using antibiotic ointment and heavy cream specially forumlated for eczema. This has helped a great deal in just a couple of days!” –Seastar

Staying Warm While Bathing in Winter

“Temperature! Turn up the central heat to keep the bathroom warm during bath time. Seniors are often cold, even when we are wearing short sleeves. If there is cold tile in the bathroom, cover it with a plush bath rug and make sure they don’t fall. If you have an overhead heater, turn that on, too. Wear light clothing so you do not get totally overheated while helping them!” –homeandhearth

“A radiant heater panel can be especially useful for bathrooms. During fall and winter, mine is plugged into a motion sensor timer that you set for automatic shut off. We have it set to go on when motion starts, and it goes off when no motion is detected for five minutes. It makes the bathroom warm (I go and trigger it before Mom goes into the bathroom for a shower), and there’s no risk of it tipping over because it’s anchored to the wall.” –glasshalffull

“I purchased a small fan heater for our bathroom. My loved one gets cold easily, especially since the water is not running on her constantly because she uses a shower seat while bathing.” –Anonymous6636

Ending the Thermostat Wars

“As people age, typically the circulation in their extremities (arms and legs) diminishes, causing them to feel cold. Any time you go to a senior living center, you’ll see older people dressed far more warmly than younger people because the seniors are chilly. They’ll even wear sweaters when it’s hot and humid outside. Low thyroid can be another cause of being cold, so be sure to get that checked. My mom’s thyroid quit working about two years ago. Once we got her on thyroid medications and got the dose regulated, she felt warmer and had more energy.” –blannie

“Last winter (out of desperation), my husband and I installed a programmable thermostat and we put it high enough that Mom can’t reach it to crank the heat up. It has worked so well without having to leave notes or try to remind her not to touch it.” –chrisblair63

“I use a Sunbeam heating pad on the back of my dad’s chair. I just saw that Sunbeam and Sure Fit offer heated slip covers, too. As for me, I have been spared by a tall Dyson fan. It makes very little noise and feels like the air it puts out is cooled even though it isn’t. I set it up pointed directly at my chair. It can also oscillate, but the stationary position is perfect since my dad does not feel it and I do. This setup has kept him warm and me cool—something that many caregivers struggle with.” –pipruby

“If you get an electric blanket, make sure it has a cutoff temperature. My mom hates my electric heating pad for her back because it will only keep a high temperature for so long and then it turns off as a safety feature. I told her it’s better than falling asleep on it and getting burned.” –timbuktu

“Beanbag/microwavable heat packs can be heated and strategically placed at the hip, stomach, back and feet. They also make a slipper version that has helped my mom with the Raynaud’s syndrome in her feet.” –glasshalffull

Indoor and Outdoor Safety Tips

“My dad has two walkers. There is one that he leaves in the garage after going all over the yard and through the snow/dirt. Mom won’t let him in the house with it unless he cleans it off, so Dad just bought another walker for indoor use only.” –freqflyer

“Your loved one’s favorite holiday decoration may be a fifty-year-old menorah or Nativity scene with incandescent bulbs. On all décor, check thoroughly for dried and cracking wires and loose connections on the plug. It may have been perfectly safe for many years, but old wiring causes many fires this time of year.” –pamstegma

“A word of caution: canes are terrible on ice. If your loved one needs someone or something to help them walk, it is better that they stay indoors until the weather improves. If they need to get out and about, have someone meet them at home to help them on snowy, icy walkways.” –freqflyer

“I worry when my mother-in-law runs the temperature up higher in her home due to her tendency to get dehydrated. Each and every time she has been hospitalized, it has been because of dehydration. It is common knowledge that it is easier for seniors to get dehydrated when it is hot outside, but it is also a serious issue during winter, especially for those who have trouble getting enough liquids. Help them hydrate any way you can!” –oldcodger2

Source: AgingCare.com

Baby Boomers Are at High Risk for Hepatitis C

Baby Boomers Are at High Risk for Hepatitis COver the past several years, there has been a lot of interest in hepatitis C (HCV)—television commercials about new HCV drugs, increased media coverage on drug prices and even discussion among presidential candidates.For a disease called the “silent epidemic,” that’s a fair share of attention.

In a lot of ways, though, it remains silent: Most people, especially baby boomers, who are at risk of having hepatitis C, don’t know it and don’t get tested for it. Most people who have HCV don’t know it because it usually doesn’t have noticeable symptoms for years. Many people don’t want to know about it because of stigma or fear.

Caregivers and professionals play an important role in educating baby boomers about hepatitis C and their risk of having the virus. Everyone can do a better job of ensuring baby boomers are educated on and tested for HCV.

What Is Hepatitis C?

Hepatitis C is a disease of the liver caused by a virus primarily transmitted by contact with infected blood. It’s relatively common—3.5 to 5 million people in the United States live with it. There is no vaccine for HCV, but it can be treated and cured. The trick is finding out you have it. Hepatitis C is not routinely tested for and there are often no symptoms for decades (hence the “silent” in silent epidemic).

When there are symptoms, initially they are often mild—fatigue, joint aches or mood changes—and mirror other conditions, so people often ignore or work through them. If hepatitis C is left untreated, it may lead to scarring of the liver, a condition called cirrhosis. Cirrhosis can lead to liver cancer, liver failure and death. These outcomes can be avoided when hepatitis C is detected early and treated.

Testing for Hepatitis C

Hepatitis C can be diagnosed with a simple blood test. If that test is negative, and there are no ongoing risks for infection, then no further testing is needed. If the first test is positive, then a second confirmatory test is needed. People often assume their medical provider will order an HCV test as part of routine blood work, but it must be specifically ordered.

Individuals born between 1945 and 1965 account for 75 percent of those living with HCV. The reasons for this are many and varied, but many people were exposed by medical procedures, long-term hemodialysis or blood transfusions prior to July 1992, before we even knew HCV existed and developed the knowledge to prevent it.

See a complete list of who should be tested here.

Why Baby Boomers Should Be Tested

Many baby boomers think they don’t need to be tested for HCV because they don’t have any symptoms of the disease or believe they aren’t at risk. Because HCV is usually asymptomatic, and because baby boomers often don’t have a clear identifiable risk for HCV, yet make up the vast majority of people living with it, it is recommended that all baby boomers get tested for HCV once in their life. While this should happen automatically and with no questions asked, it is still a relatively new recommendation and many medical providers aren’t testing baby boomers for HCV. Anyone born between 1945 and 1965 should ask his or her medical provider if he or she has been tested, and if the answer is no, a test should be ordered. The same goes for the aging adults you work with. Let them know about hepatitis C and tell them they should get tested.

Treating and Curing Hepatitis C

Anyone who tests positive for HCV can begin treatment immediately. Treatments typically include taking pills for 8 to 12 weeks (Some people may need as long as 24 weeks) with mild and manageable side effects. With treatment, 95 percent to 99 percent of people end up cured. Once cured, most people report improved liver health and a reversal of liver disease.

Hepatitis C can feel scary, but it doesn’t have to be. All baby boomers, including baby boomers working in aging services, and their clients, should be tested. The message is simple: baby boomers are at risk—get tested, get cured.

Source: ASA – American Society on Aging

Early Diagnosis of Alzheimer’s Is Crucial for Effective Planning and Treatment

November is National Alzheimer’s Disease Awareness Month—an important opportunity to shed light on a condition that is often misperceived as untreatable. Alzheimer’s disease (AD) is the sixth leading cause of death in the United States, but dementia from Alzheimer’s continues to be underdiagnosed and underreported. In fact, according to a U.S. survey conducted by the Alzheimer’s Association, almost half of patients with AD are already in the moderate to severe stages by the time they are diagnosed. This lack of attention to the early stages of Alzheimer’s is unfortunate, because there are things we can do to help those who are starting to experience memory loss and support the people who are caring for them. Although a cure does not yet exist, available treatment options can help to slow down the progression of symptoms, especially if diagnosed early.

Caring for Someone with Alzheimer’s Disease

AD poses real challenges not only for the people diagnosed with the disease but also for the 15 million Americans who assume caregiving responsibilities. The multitude of obligations can have a huge impact on caregivers, with one out of every two of them developing major depression. The economic burden of providing care is huge as well. In 2016, the annual cost of care was $230 billion in the U.S. alone.

Many of my patients and their caregivers are hoping and waiting for a cure to become available. Even though there are novel drugs and other interventions in various phases of research and development, patients’ mental states continue to deteriorate with each passing day as their families wait for a disease-modifying treatment. The road to development and approval of a new drug is long and rigorous, and only a small percentage of medicines ever make it to market. This is time that Alzheimer’s patients simply cannot afford to waste.

A diagnosis will spur family members to start a conversation about planning for the future—a difficult, yet necessary discussion that they may have shied away from without a clear understanding of their loved one’s health. Timing is crucial because this planning phase must be done while the patient is still capable of sharing their wishes and competent to execute all the necessary legal documents, such as medical and financial powers of attorney, a will, advance health care directives, trusts, etc. These preparations enable the family to understand their loved one’s preferences for long-term and end-of-life care and give them the legal authority to see them through once their loved one has lost the ability to handle their own affairs.

The Treatment Journey

While there are no treatments available that can prevent, cure or change the underlying progression of Alzheimer’s disease, there are medications that can help minimize symptoms for a while. Once again, early diagnosis is key since each prescription is approved for different stages of the disease. These medicines can help people living with AD maintain their cognitive abilities and continue functioning at higher levels longer.

In addition to pharmaceutical treatments, there are also lifestyle choices that can help lower the risk of developing the disease and stabilize the symptoms of AD for those who already have it. These activities include regular physical exercise, stress management, proper diet, and prompt treatment of medical conditions like hypertension and high cholesterol. These lifestyle modifications can have a huge impact on a person’s brain health.

If you are concerned about a loved one’s memory, encourage them to go see a doctor. The good news might be that there is nothing to worry about, but if a problem is detected, ask about available treatment options. Early diagnosis and proactive treatment could help some of the 5.5 million Americans who are currently living with Alzheimer’s disease and their loved ones.

Source: AgingCare.com

Partnerships Pave the Road to Effective Alzheimer’s Drug Treatment

Partnerships Pave the Road to Effective Alzheimer’s Drug TreatmentAdvancements in treatment for heart disease, stroke and cancer can be traced back to the use of imaging technologies that enable doctors and researchers to visualize the impact and progression of these diseases inside the body.

Just a decade ago, we had no way of seeing or measuring the hallmark amyloid brain plaques of Alzheimer’s disease dementia in living people. Now there is brain imaging that makes this possible. Known as amyloid PET scanning, this technology helped establish the widely held view that Alzheimer’s may begin up to 20 years before problems with memory and thinking are noticeable.

This progress would not have been possible without innovative and strategic collaborations to build research infrastructure and overcome obstacles to advancing critical studies. A clear example of this is the landmark Alzheimer’s Disease Neuroimaging Initiative (ADNI).

ADNI launched in 2004 to identify and understand markers of Alzheimer’s in body fluids and brain tissue. Now more than 1,000 participants at 57 locations across the U.S. and Canada are enrolled in it. Led by the U.S. National Institutes of Health (NIH) with private sector support coordinated by the Foundation for the NIH, ADNI unites federal agencies, academia, industry, and nonprofit organizations (including the Alzheimer’s Association) to make large-scale research possible. Importantly, there are no intellectual property or other limitations placed on data and samples generated through the initiative.

ADNI findings provided support for FDA approval of the first chemical tracer making amyloid brain plaques visible on a PET scan. Alzheimer’s Association funding supported expanding ADNI to include PET imaging. The work enabled by this funding made a huge difference in our understanding of the role amyloid, both in people with Alzheimer’s dementia and those with normal cognition.

In fact, ADNI and other studies laid the groundwork that led to the FDA approval of three amyloid PET tracers by 2013. In response to this new technology, the Alzheimer’s Association partnered with the Society of Nuclear Medicine and Molecular Imaging to lead an expert group of researchers to develop Appropriate Use Criteria (AUC) for amyloid PET. The AUC have provided important guidance to physicians and patients on the use of amyloid PET.

However, also in 2013, the Center for Medicare and Medicaid (CMS) issued a decision that they would not reimburse for amyloid PET. Once again, the Alzheimer’s Association responded by launching the $100 million IDEAS Study with the American College of Radiology (and significant funding from CMS for the scans, plus support from Lilly, GE and Piramal) to generate data on the impact of amyloid PET on medical management of people with MCI and dementia in the hope of changing the CMS decision.

One of the major findings from ADNI is that up to 30 percent of people believed to have Alzheimer’s did not have abnormal amyloid build up. As a result, researchers are using amyloid PET imaging to improve clinical trials. For example, Biogen’s Phase 1b trial of the anti-amyloid agent aducanumab enrolled only individuals with high levels of amyloid buildup in their brains based on the scan – ensuring participants have the problem the drug candidate is meant to address.

We are at a moment of unprecedented promise in Alzheimer’s research. It is time for even greater collaboration and innovation. Alzheimer’s is a complex disease that still lacks an effective treatment or prevention. If new treatments aren’t found, the number of Americans with Alzheimer’s is expected to triple from more than 5 million today to as many as 16 million by 2050, costing the nation $1.1 trillion annually and potentially crippling our healthcare system. (Alzheimer’s Association 2017 Alzheimer’s Disease Facts and Figures)

The majority of Alzheimer’s investigational therapies that have advanced to late-stage clinical trials have targeted amyloid plaques, but numerous studies suggest additional factors contribute to the disease’s development. For example, there is evidence that the accumulation of tau tangles – another hallmark brain change of the disease – is more closely associated with cognitive decline in Alzheimer’s than levels of amyloid. Other contributors may include inflammation, problems with blood circulation in the brain, and reduced clearance of abnormal proteins.

In October 2015, the Alzheimer’s Association Research Roundtable (AARR) brought together experts from academia, industry, and regulatory agencies to examine the underlying biology of tau in neurodegenerative diseases and explore strategies to expedite development of tau-targeted therapies. At AAIC 2016, researchers for TauRx Therapeutics reported results of a trial of an anti-tau drug for Alzheimer’s. While it failed to demonstrate a treatment benefit in the full study population, it was the first completed phase 3 trial of an anti-tau therapy.

Anti-tau therapeutics is a growing area of interest for pharmaceutical/biotechnology companies. Currently, there are several anti-tau drugs in clinical trials, plus multiple studies are honing the measurement of tau buildup using tau PET imaging and cerebrospinal fluid (CSF) analysis, according to a May 2017 article in Alzheimer’s & Dementia: Translational Research & Clinical Interventions.

Regardless of the treatment target, one of the biggest bottlenecks in the drug development process is transitioning drugs from preclinical testing into clinical trials. To ensure that more promising drug candidates advance past this “valley of death,” the Alzheimer’s Association, in partnership with philanthropist Michaela Hoag, leads an initiative called Part the Cloud (PTC) Translational Research Grants. PTC funds research specifically designed to accelerate the transition of research findings from the laboratory, through clinical trials, and into practice.

One PTC grant recipient is Tim West, Ph.D., of C2N Diagnostics. The funding enabled the company to conduct a Phase I study of an investigational tau-targeting drug now known as ABBV-8E12. In 2015, C2N entered into an exclusive partnership with global biopharmaceutical company AbbVie, Inc. for the drug’s continued development. Now there are two ongoing international Phase II studies of the compound. It has received both Orphan Drug Designations for Progressive Supranuclear Palsy in the U.S. and Europe, and Fast Track Designation from the U.S. Food and Drug Administration.

The PTC initiative supports both academic and company-based projects. Since its inception 2012, it has raised more than $20 million for Alzheimer’s research with the help of more than 300 donors – many of them leaders in the technology industry in California’s Silicon Valley. In 2017, PTC announced a $7 million investment in four clinical trials targeting brain inflammation as an innovative avenue for Alzheimer’s therapy. The hope is success stories similar to C2N’s will be the result.

Looking ahead, researchers hope to discover even easier and more accurate ways to detect Alzheimer’s before its devastating symptoms begin. There are ongoing efforts to show that markers of Alzheimer’s in blood and CSF can be identified and measured to determine who is at increased risk for developing the disease. Additional studies suggest smell and eye tests may be able to detect memory decline and dementia.

Before these and other diagnostic measures, known among scientists as biomarkers, can be widely incorporated into clinical practice, they must be standardized. This is another area where collaboration will be key to success.

The Global Biomarker Standardization Consortium (GBSC) is one partnership that is driving discussions on global standardization, and is led by the Alzheimer’s Association. GBSC brings together researchers, clinicians, and industry, regulatory and government leaders to achieve this. Its efforts include demonstrating the safety of lumbar punctures for collecting CSF so researchers, clinicians, and patients will be more comfortable using this procedure in Alzheimer’s research and diagnosis. GBSC also is working to standardize procedures for processing, handling, and storing CSF samples.

Similarly, a partnership called the Coalition Against Major Diseases (CAMD) is working to secure regulatory support for use of certain Alzheimer’s biomarkers in clinical trials. CAMD’s coordinating committee consist of 18 pharma/biotech companies, four patient advocacy groups, and drug regulatory agencies in the U.S. and Europe

The Alzheimer’s Association encourages federal agencies, academia, industry, and advocacy groups to join partnerships that drive Alzheimer’s research forward and is open to discussing such possibilities with all who are interested. While research is the vehicle, these collaborations pave the road to making sure no one has to suffer the devastating effects of Alzheimer’s – a destination we all want to reach.

Source: R&Dmag.com

Capgras Syndrome: How to Cope with a Loved One’s Delusions

Capgras Syndrome: How to Cope with a Loved One’s Delusions

Capgras is a type of delusional misidentification syndrome (DMS) that may present due to any number of neurological diseases or psychiatric disorders. Although the exact prevalence of this disorder is unknown, a 1999 study estimates that it is present in between two and 30 percent of individuals with Alzheimer’s disease. This disorder can seriously complicate a dementia patient’s quality of life and their caregivers’ efforts, so it is crucial to spread awareness of this little-known condition.

What is Capgras Syndrome?

“Capgras is a misidentification syn­drome characterized by the transient, recurrent, or permanent belief that someone known to a patient has been replaced by an impostor with a strong physical resemblance,” explains Erin Shvetzoff Hennessey, MA, NHA, CPG, and Vice President of Health Dimensions Group. “These delusions are suggested to stem from impairment of the brain’s facial recognition system and are also associated with brain lesions.” There is limited research available on this condition, but it affects those with a variety of neurological and psychological diagnoses, including schizophrenia, Alzheimer’s and other forms of dementia.

Capgras can be extremely stressful for the person with the syndrome, but it is also very disturbing for those around them. “While dementia caregivers usually anticipate a loved one’s forgetfulness and inability to remember close family members and friends, it can be very painful and confusing when this syndrome causes a different kind of loss of recognition,” laments Shvetzoff Hennessey. A loved one may remember their caregiver, spouse, or other relative—and may even ask for them by name—but they believe that this person is an impostor. Such delusions can make caregiving, family time, and other social experiences extremely painful and confusing.

Reality Orientation Techniques

When interacting with a person who is experiencing Capgras, it is common for caregivers and family members to attempt to correct or explain their delusions. A research article in the Frontiers in Human Neuroscience journal states that, “A defining characteristic of delusions also present in Capgras syndrome is that patients will firmly hold on to their delusional beliefs [even] in the presence of mounting contradictory evidence.”

While some caregivers may continue to correct sufferers and try to convince them that they are merely experiencing delusions, the use of reality orientation techniques for sufferers of memory loss has declined in recent years. “This strategy includes frequent reminders of present time, location and facts based in reality, including deaths, moves or other major life events,” Shvetzoff Hennessey explains. Reality orientation may be logical and appealing for those without Capgras but is often frustrating and upsetting for individuals who are experiencing delusions.

Validation Therapy

Shvetzoff Hennessey says that reality orientation has largely been replaced by validation therapy, which supports the patient’s delusions rather than correcting or contradicting these very real ideas, thoughts and feelings. Validation techniques have been found to reduce stress and anxiety in both dementia patients and their loved ones.

For some sufferers, neither reality orientation nor validation techniques are successful, leaving both the patient and their loved ones frustrated, lonely and anxious. For these situations, a mixture of several techniques may be needed in order for both parties to enjoy spending time together. “By working with the patient’s care team, including direct care providers, physicians, social work professionals, pharmacists and therapists, techniques and strategies can be developed to relieve the symptoms in the patient, as well as reduce the stress and frustration of loved ones,” advises Shvetzoff Hennessey. “This can include communication techniques, medications, and creative problem-solving methods.”

Interactions and Caregiving

Research shows that time and interactions with loved ones who have Alzheimer’s or other types of dementia is valuable for both the patients and their caregivers. However, this delusional condition can make it difficult, if not impossible, for the patient and the believed impostor to interact. Some patients may blatantly refuse to speak or cooperate with the “impostor.” Changing the format, timing and length of visits may help in some cases.

“If the patient does not live with those they do not recognize, these loved ones may have to visit during certain times of the day when the patient is more relaxed,” Shvetzoff Hennessey recommends. “Impostors” may need to visit along with other people that the patient recognizes, or even visit as a stranger, but these options may still allow for interaction.

Shvetzoff Hennessy emphasizes that safety and wellbeing are paramount. “If the patient’s delusions make caregiving, living together and safety challenging, housing changes may be needed to ensure the emotional and physical health of everyone involved.” In such cases, placement in a specialized memory care unit might be the best option.

Care for Yourself, Too

Alzheimer’s and dementia caregivers already experience serious emotional and physical strain, and this is only compounded by the development of Capgras syndrome. “It is important for family members and caregivers of sufferers to care for themselves in order to better care for their loved ones,” Shvetzoff Hennessey urges. This self-care can include increased time away from the patient, self-acceptance of limitations and reliance on other support systems including friends, family, and community and healthcare resources.

Interacting with Someone Who Is Suffering from Delusions

Shvetzoff Hennessey offers family caregivers the following tips for interacting with a person who is experiencing Capgras syndrome.

  • Validate their feelings and concerns. Rather than challenging their perspective, make it clear that you understand how they are feeling and that it is perfectly acceptable for them to feel this way. Try to identify with their reality rather than correct it.
  • Make a safe, emotional connection. Dementia alone can be extremely confusing and disorienting for a patient. Adding delusions that someone they trust has been replaced with an identical fraud can be very frightening for them. Remind the patient of how much you love them and how much the “impostor” loves them. If the patient has additional misconceptions that this fake is trying to harm them or steal from them, gently reassure them that they are safe and you will not allow anything of the sort to happen.
  • Rely on auditory interactions. Since this disorder makes it difficult or impossible for sufferers to visually connect with loved ones, sound is the next best way to communicate. Rather than visiting face-to-face, try conversing over the telephone or just outside of their line of sight. If a patient has difficulty interacting in person, it can help for the impostor to announce themselves while still out of sight. This helps to establish an emotional connection and begin a conversation that continues while they come into sight. This may assist the patient in positively identifying their loved one.

Source: AgingCare.com

Hallucinations, Delusions and Paranoia Related to Dementia

Hallucinations, Delusions and Paranoia Related to DementiaHallucinations, Delusions and Paranoia Related to Dementia

According to the Alzheimer’s Foundation of America, the major psychiatric symptoms of middle stage Alzheimer’s disease and other forms of dementia include hallucinations, delusions and paranoia. About 40 percent of dementia patients experience delusions, while hallucinations occur in about 25 percent of cases. When a senior is experiencing hallucinations and delusions, their caregiver often wants to help them understand that these beliefs and experiences are not real.

 “It is not helpful to argue or rationally explain why something happened,” says Lisa P. Gwyther, associate professor in the Department of Psychiatry and Behavioral Sciences at Duke University and director of the Duke Aging Center Family Support Program. “It just frustrates the person. They somehow know that you are not taking their thoughts and feelings seriously.”

While reinforcing reality seems like the logical and kind thing to do, this natural instinct can be wrong. Family caregivers can ensure they’re prepared to handle these challenging behaviors by learning the differences between them and proper coping techniques for each one.

 Understanding the Differences

Hallucinations, delusions and paranoia are symptoms of disease and not a normal part of aging. While they may seem similar, they are actually very different.

Hallucinations are false sensory experiences that can be visual, auditory and/or tactile. These perceptions cannot be corrected by telling a patient that they’re not real. Examples include a dementia patient hearing music when none is playing or seeing bugs on a surface where there aren’t any.

Delusions are fixed false beliefs that are not supported by reality. They are often caused by a faulty memory. Examples include accusing caregivers of theft and infidelity.

Paranoia is centered around suspiciousness. Elderly individuals often project hostility and frustration onto caregivers through paranoid behaviors.

Coping with Hallucinations

When it comes to handling a senior’s hallucinations, Dr. Marion Somers, author of “Elder Care Made Easier: Doctor Marion’s 10 Steps to Help You Care for an Aging Loved One,” suggests joining them in their version of reality. Ask them about what they are experiencing as if it is real so that you can more effectively defuse the situation. Refrain from trying to explain that what they are seeing or hearing is all in their head. “Otherwise, you’re going to aggravate them, and you don’t want to increase the level of agitation,” says Dr. Somers.

Reassure them by validating their feelings. Say something like, “I see that you’re upset. I would be upset if I saw those things, too.” Tell them that they are safe with you and you will do whatever you can to help them feel secure.

A comforting touch, such as gently patting their back, may help the person turn their attention to you and reduce the hallucination, according to the Alzheimer’s Association. You also can suggest that they move to a different room or take a walk to get away from whatever may have triggered the experience.

Realize that some hallucinations, such as seeing children or hearing music, can be comforting. If the individual is reassured by a hallucination, caregivers don’t need to do anything to stop it, Gwyther says. “You only need to respond to things that are scary or disruptive or keep the person from getting adequate care,” she says.

In addition to dementia, poor eyesight, hearing loss, certain medications, and physical problems like dehydration and urinary tract infections (UTIs) can contribute to hallucinations. If all other factors are ruled out and a loved one’s hallucinations are disturbing and persistent, then antipsychotic medication may be prescribed to reduce them. However, Gwyther says these medications can present a risk for dementia patients. She recommends first changing the way you communicate during these episodes and changing the activity and environment to remove or reduce triggers.

The Alzheimer’s Association offers these tips to change the environment:

  • See if any lighting or lack of lighting casts shadows, distortions or reflections on walls, floors and even furniture that could contribute to visual hallucinations.
  • Listen for any sounds, such as TV or air conditioning noise, which could be misinterpreted.
  • Remove or cover mirrors if they could cause someone to think they are seeing a stranger.

Dealing with Delusions

Delusions among dementia patients typically result from their cognitive impairment. They occur when a senior tries to make sense of a situation, but their confusion and memory problems make it impossible. “They end up filling a hole in a faulty memory with a delusion that makes sense to them,” Gwyther says. For example, if a loved one cannot find their purse, they may decide that it is missing because someone stole it.

Delusions can be frightening for the person living with dementia, but they can also be very hurtful for caregivers when they are the accused. Recognize that the elderly individual is living in a world that doesn’t make sense to them and is likely scared. Do not take any accusations personally or respond with logical explanations. Instead, reassure the person and avoid asking questions that may cause more confusion. If they are looking for an item, tell them you will help them find it. In cases where a loved one regularly misplaces an item and becomes agitated over the loss, the Alzheimer’s Association recommends purchasing a duplicate of the item to quickly resolve the issue until the original is found.

Distraction is another strategy that dementia caregivers use in response to delusional thinking, but it may not work for every patient or every delusion. If a loved one is experiencing a mild delusion, offering a favorite snack or activity or asking them to tell you about an important experience in their life may be sufficient to redirect their attention. In cases where the person is very upset, reassurance may be the only viable option. Again, it is crucial to avoid rationalizing the situation and stress your commitment to their security and happiness.

Responding to Paranoia

Paranoia is less common than delusions and hallucinations but can still be very troubling. According to the Alzheimer’s Association, when paranoia occurs, caregivers can assess the problem by considering these questions:

  • What happened right before the person became suspicious?
  • Has something like this happened before?
  • Was it in the same room or at the same time of day?
  • Can this trigger be removed or altered to avoid eliciting suspicion?

If someone is experiencing paranoia, it is important to discuss their medications (prescription and over the counter drugs as well as vitamins) with their doctor. “Sometimes medications interact with one another or the dosages are too large,” notes Somers. “That can bring on paranoia, but a doctor can address problems and adjust the senior’s regimen to minimize issues.”

Recognizing the causes for all three behaviors and understanding what a loved one goes through while enduring hallucinations, delusions and paranoia can help you both keep calm and find solutions.

Source: AgingCare.com