ALZHEIMER’S UPDATE
Incidence Rates of Alzheimer’s Disease Rise

From:  Nursing made Incredibly Easy! eNews - June 2007

The Alzheimer’s Association released updated estimates on the prevalence of Alzheimer’s disease in the United States, and they show a 10% increase in the number of patients with the disease over the last 5 years.

The report states that Alzheimer’s disease, which affects memory, reasoning, and communication, afflicts 13% of people (1 in 8) over age 65 and 42% of people over age 85. It also estimates that 200,000 to 500,000 people under age 65 have some form of early onset dementia.

Without a cure, the number of Alzheimer’s disease cases is expected to more than triple by 2050 as the age 85-and-over population grows and baby boomers move into their late 60s and 70s. Estimates for the report were based on research done by the Rush Alzheimer’s Disease Center in Chicago.

DIABETES NEWS
Saying Goodbye to Finger Pricks?

From:  Nursing made Incredibly Easy! eNews - June 2007

Expected to be commercially available in about a year, a new device invented by Hong Kong scientists promises to measure blood sugar without having to prick the finger. The device emits a near-infrared signal, which penetrates the skin and identifies bits of glucose through the wavelengths they transmit, displaying results in 10 seconds. After five clinical trials, the device has been proven to be at least 85% accurate; the same accuracy rate of the conventional finger-prick method (80% to 85%).

PARKINSON'S DISEASE WITH DEMENTIA
Special Challenges

From:  Caregiver.com, written by Sandra Fuson, Staff Writer

In the U.S. today there are more than one million people with Parkinson’s Disease (PD). Approximately 50,000 new cases are diagnosed annually. PD is a progressive movement disorder that affects the central nervous system. Its causes are unknown, and while physicians can manage some symptoms of the disease, there is no known cure.

Primarily individuals over the age of 60 are most at risk for developing PD, although cases as young as 30 years old have been diagnosed (juvenile PD). For some patients, however, hallucinations and severe uncontrollable muscle difficulties make them especially vulnerable for dementia as PD progresses. Dementia has been defined as cognitive impairments that are sufficient to interfere with activities of daily living. Dementia worsens over time, with cognitive processing declining each year faster than that of the general population. Most people think of Alzheimer’s disease when dementia is mentioned, although there are many types of dementia with various causes.

Estimates are that 20 – 30 percent of the patients with PD will develop dementia, generally after age 70. If it is going to develop, there is generally a 10 to 15 year lag from the time that motor difficulties appear with PD. If symptoms of dementia appear earlier, experts suggest that the cause could be something other than PD.

Signs of Dementia: Before discussing possible causes of dementia, it would be helpful to explore what signs or symptoms the PD patient may experience. Dementia will first be noticed at home, not in the doctor’s office, even if you don’t have a name to put with it. Since caregivers are with their loved ones more often than doctors, it is helpful to bring any changes in behavior to the doctor’s attention.

Some of the most common signs of dementia in PD include:

Memory recall and processing
• Impaired thinking, often at a much slower rate
• Apathy or lack of motivation
• Moodiness
• Confusion and disorientation
• Easily distracted

Keep a diary of signs as they develop and schedule an appointment with your physician to discuss them. It would also be helpful to note how often symptoms appear and even the circumstances when they were first noticed. Giving your doctor enough information to make a determination is the first step in making the correct diagnosis.

Remember that if someone is going to develop dementia, there is generally a “lag” of at least 10 to 15 years. If dementia develops earlier, it is important to take note of the symptoms and discuss them with your physician. Correctly diagnosing the cause will make treatment and adjustments much easier. Some signs that the dementia is caused by something other than Parkinson’s disease include: anxiety, restlessness, and even delusions (irrational thought processes). Speech or language difficulties are also a signal that the dementia is not caused by Parkinson’s.

Finally, depression can mimic the signs of dementia in Parkinson’s patients. Depression is a common companion to PD, and having your loved one fully evaluated can aid in their recovery from these troublesome symptoms if depression is the underlying cause. Medications to treat depression can bring relief and can even improve memory and mood.

Lewy Bodies and their Role in Dementia: In patients who develop dementia, Lewy bodies are usually present. Lewy bodies are protein deposits on the nerve cells. Scientists haven’t determined yet if the Lewy bodies play a role in killing the cells or if the cells, in the process of dying, are more susceptible to developing the protein deposits. Perhaps even the Lewy bodies develop as a method to repair the cell, and instead play a role in developing dementia. Dopamine is the neurotransmitter involved in regulating movement. In Parkinson’s patients, the ability to regulate the amount of dopamine is damaged. For this reason, medications such as Levodopa, try to increase the amount of dopamine in the brain, thus helping the movement issues with Parkinson’s. Lewy bodies generally damage not just dopamine, but other neurotransmitters as well. By impairing movement and thought processes, the person with Parkinson’s demonstrates the symptoms of dementia: unable to process new information, blankly staring off into space, unable to recall specific incidences, and inability to make sound judgments. There are other symptoms as well, depending on the area of the brain that is damaged.

Medication-induced Dementia: In some patients, the type of medication that they are taking can induce the symptoms of dementia. Regardless of the cause, your doctor needs to be involved as soon as symptoms are noted in the patient. By adjusting medications, your physician may be able to detect whether or not Lewy bodies are to blame or if the medication is actually causing the problem. Dementia is not a normal process of PD; and in the cases of medication inducing the dementia, it can be reversed.

Vascular Dementia: Although not common in Parkinson’s, it is possible to have vascular dementia. Vascular dementia generally develops when there are small, unnoticed strokes. By determining if vascular dementia is indeed present, doctors can sometimes halt the advancement by treating the underlying causes. Further tests will be needed to find out if these strokes have occurred and what the underlying cause of the stroke was. By stabilizing the patient’s vascular health, you can greatly improve chances of improving vascular dementia.

Changes in Daily Living: Finding out that your loved one had Parkinson’s was difficult enough. Adjusting to dementia can significantly add to stress. Remember not only to consider the person with Parkinson’s and how their life is affected, but it is especially important to reduce caregiver stress during this adjustment. In order to make a successful transition, you’ll need to make changes to daily routines. This requires not only cooperation from the patient, but the caregiver as well.

Avoid open-ended questions such as “What would you like to eat?” Since thought processing is affected, the patient may feel frustrated when they are unable to name something specific that they like to eat. Offer choices: “Would you like chicken or pork chops?” Give a limited number of choices so the person can name what they want without too many options.

Establish schedules and stick to them. Lists of activities may help. For example, next to the bed may be a list that reads:

• Wake up
• Put on slippers
• Put on robe

By breaking down the daily routine into small, manageable steps, you can avoid frustration from the patient and the caregiver perspective. Both people know what to expect and in what order you need to do the steps.

Remember that as the dementia worsens over time, you may need to develop lists with more specific steps. For example, the first list may have said, “Brush your teeth.”

The new list may read:

• Open toothpaste
• Get toothbrush
• Put toothpaste on toothbrush
• Brush teeth
• Rinse

If you think your loved one may not be able to remember which medications they need to take, how much they need to take, etc., you may have to lock away medications and dispense doses as needed. This may be an adjustment to the person who was accustomed to independence in taking their medication. Explain the reasons why you need to control medications and that you want the person to be safe. Over time you can make this transition as well.

Keep living environments simple, free of clutter. Clutter in the home can resemble the clutter that the person feels in their thought processes. By keeping the environment free to extraneous objects, you can help decision-making processes go much smoother. Remember too that Parkinson’s will gradually worsen over time, making smooth movements almost impossible. Keeping the home area safe and fall-free will help with this as well.

Other ideas that you may want to consider:

• Keep travel plans simple. As much as possible, continue established routines if you need to travel.
• Keep dangerous objects, such as knives, out of reach and out of sight. Other objects you may want to put away include ladders, step stools, small appliances that require supervision when in use, and anything else in your home environment that you think would be a danger to your loved one.
• Use mental exercises to keep memory as sharp as possible. These include puzzles, card games, reading, listening to music, and even keeping a diary.
• Continue a good exercise routine. This not only keeps the movement portion of PD under control, but it can aid in cognitive processing as well.
• Keep dressing as simple as possible. Buttons and snaps can be a challenge. Slip-on clothing and even Velcro work well.
• Get a wrist or pendant ID for your loved one to wear. The Alzheimer’s Association can provide one.

Financial Obligations:
Develop a plan for finances and how your loved one’s assets will be used before the dementia develops too much. Scientists have demonstrated that each year the person with dementia loses mental processing at more than twice the rate of a person without dementia. You’ll want to put these arrangements in place as soon as possible.

You’ll want to consider:

• Preparing a will and keeping it in a safe place.
• Consulting a financial planner to decide how assets need to be used, dissolved, or otherwise distributed.
• Deciding about long-term care options.
• Deciding how bills will be paid on an ongoing basis – especially important if the person with Parkinson’s is not married, is widowed or lives alone (although they may not be able to continue living alone for long).

Many people with Parkinson’s will not develop dementia. For those patients who do, it is important to learn your medical options and make adjustments to the home environment. Some of these adjustments can transition over time, while others need to be made more quickly. Even with dementia, the person will have good days and days that thought processes are not as sharp. By keeping the lines of communication open with your doctor, the disease can be managed as effectively as possible, despite its debilitating effects on daily living.

WHEN THE ELDERLY REFUSE CARE

By:  Jo Nelson, RN, Administrator of Servant's Heart Homemaker/Home Health Services

You've spent hours pouring over information regarding elder care; you've researched and developed a plan of care for your elderly loved one that should be etched in gold!  You're feeling so relieved, knowing that they will now be safe at home, and a caregiver will be there with them when you can't... until the day arrives when the caregiver comes to meet them, and your loved one refuses to open the door!  What do you do now?

There can be many causes for this reaction to your plan. Perhaps they feel a loss of control in their lives. Maybe they resent feeling like they aren't trusted to be alone at home any longer, and their self esteem is hurting. Maybe they're afraid of having a stranger in their home. Maybe they want their privacy and don't really understand why they need help in the first place!  The way you respond to your loved one's concerns may eventually determine if your "golden" care plan is going to be successful or not.

Before you even begin to initiate your care plan, include your loved one in the "research project. "  Make sure they feel like they are a part of making the decisions as to who to hire, when the caregiver should come, and what type of care they may need. Even if they aren't completely sure they need the help, it may give them the added confidence they need to know that you still value their input and respect their opinions.

If your loved one is fearful of having strangers in their home, listen to their concerns and let them know you understand. When deciding who to hire, make sure you go to a reputable agency that does criminal background checks and has good referrals and testimonials. Reassure your loved one of those things when you make your final choice. Make sure the caregiver comes to meet them for the first time when you are there with them, and give them a chance to form an initial impression before you insist on keeping that particular caregiver. Usually after just a few visits, the apprehension dissolves into a cheery, trusting relationship that your loved one will truly enjoy.

If they just don't agree that they need the help, you have unfortunately entered into the greatest challenge of all, especially if your loved one is suffering from altered thought processes and is unable to identify with your concerns. This may be the time to be loving but firm with them, and let them know that there really isn't a choice when their safety is at stake. Reassure them that your motive is to help them live at home for as long as they can safely do that, and let them know you're on their side. Make compromises if you can safely do so; for instance, have the caregiver come the same number of visits per week, but maybe for shorter time periods. Try referring to the caregiver as the "cook" or the "housekeeper" . . .let them know you want to pamper them!  Make sure your loved one realizes they aren't expected to entertain their "guests", and they can go about doing whatever they would normally do if no one was there. On the other hand, if your loved one enjoys socializing, suggest a lively game of cards when their caregiver is there, or some other activity with them that your loved one would enjoy.   Persistence is the key. . .in time, your loved one will grow to accept their new lifestyle and the friction will dissipate.

Remember, in the midst of all these issues, your own health and lifestyle are also important. Caregiver burnout can be a real threat to you and your family if your loved one doesn't cooperate with the plan of care you have worked so hard to design for them. Don't allow yourself to be manipulated by a false sense of guilt if your loved one has difficulty making these adjustments.   In time, they will realize that you have their best interest at heart, and they may even grow to appreciate you for it!

PLOWING THROUGH THE PROBLEMS OF ELDER CARE

By:  Jo Nelson, RN, Administrator of Servant's Heart Homemaker/Home Health Services

As baby boomers watch the years fly by, one of their biggest concerns is sorting through the many problems of caring for their elderly parents. When is it no longer safe for our elderly parent to stay home alone?  How can we maintain our jobs, our home, our children, and care for our parents all at the same time?  What resources are available to help?  How do we approach the subject with them?  How can we help them keep their independence and dignity?  How do we deal with the stress of it all?
As our parents age, we need to stay diligent and aware of changes in their mental orientation and ability to care for themselves. Are they just a little forgetful at times, or is it something more worrisome than that?  If they are able to take their medications without being reminded, bathe alone, dress without assistance, prepare meals every day, and they are not experiencing frequent falls or sudden illnesses,  they are probably safe to be at home alone. There are monitoring systems and personal emergency alert systems that can provide added security by making help available to them in the event of an accident or sudden illness.

However, if you notice that your parent's health is declining, that they have increased weakness or weight loss, if they have had frequent falls, if they are not taking their medications, not eating properly, and not able to do their personal care without help, it may be time to look into other options. Sometimes the increased care is all they need to regain their strength and be able to continue living at home, avoiding placement in a nursing facility or some other major life change.

Finding the help you need is another obstacle. Knowing who to go to for help may seem to be an overwhelming task, but there are many resources available to seek information and counsel. Private duty organizations, home health agencies, and hospices are all viable places to start if you want to help your parent stay at home.

The Indiana Association for Home Care and Hospice (IAHHC) has a listing of all local agencies, both for private pay and agencies that accept Medicare and/or insurance payor sources. You can find them on their web site: www.ind-homecare.org.
When investigating which private agency to use, make sure they are licensed appropriately and that they do criminal background checks on all their employees. Their staff should be bonded and insured, and you should not have any of the burden for carrying worker's compensation, tax liabilities, or social security. A new law beginning in January of 2006 requires all private duty, non-medical services to be licensed through the state of Indiana. Make sure the agency you choose has gone through this licensing process, and you will be safer in trusting that they have taken all the appropriate steps in ensuring good care for your loved one.

There are many financial resources available to help pay for private duty care, such as reverse home mortgages. The Veterans Administration can give you valuable information on benefits for veterans who need care at home and  have served at least one day in the service during war time. These benefits are also available for spouses of veterans. Look on the web for more information regarding financial concerns; there's plenty of information available. You can also contact private duty agencies and request assistance in finding funds that are available.

Private duty agencies can provide any kind of non-medical care needed to assist the client in staying at home. They will provide personal care assistance, medication reminders, cleaning, cooking, laundry, running errands, and transportation to appointments, and a variety of other services. They are usually available twenty four hours a day, including holidays and week ends, and do not require any doctor's orders to initiate the care.

Home health care requires a doctor's order for services to begin, and the patient must be certified to be on "home bound status". This means that they can only leave home to visit the doctor, go to church, or to the beauty or barber shop. A nurse will visit on a regular basis, and a home health aide will assist with personal care. Some home health agencies also provide physical therapy, social services, speech therapy, and occupational therapy as well. Most home health care agencies are not available in the evening hours, on week ends, or on holidays. The majority of home health agencies accept insurance and Medicare payments.

Hospice care also requires a doctor's order, and the patient must have a life-limiting disease with expectations of six months or less to live. Patients can be re-certified for hospice every sixty days, and may live much longer than six months and still be in hospice care. Hospice care also provides nursing and home health aide services, along with extra support to the family and patient during this difficult time. Comfort measures are a priority in the plan of care, and they have a variety of services such as social services, pastoral care, and volunteer services as well. Medicare and insurance usually are accepted. There will always be a hospice nurse on call twenty four hours a day to assist with any emergencies or special problems during times when the office is closed.

Sometimes the best plan is a combination of home health or hospice along with private duty care. Many seniors are resistant to accepting any kind of help at first, and will require continual reassurance effort to help them maintain as much independence as possible.

When addressing these issues, never "speak down" to your loved one. Remember, even though roles are changing, they still deserve to be honored and respected. Sometimes calling a care giver "the maid" or "the butler" rather than a "caregiver" or "home health aide" will help them accept the situation with a little less anxiety. It's all in the attitude that it's presented to them - help them feel a sense of control in the situation whenever possible. Try to help them understand that these changes are happening in their home because you love them and want them to be able to stay at home as long as possible and not have to live in a facility to get the help they need.

Don't forget to schedule time for yourself during this intensely demanding season of your life. By succumbing to false guilt or unreasonable demands, you may be setting yourself up for a disaster later. Take time to enjoy your immediate family, your hobbies, and leisure time as well. Join in with other caregiver groups for extra support - you can find them at churches or on the web. You'll be safeguarding your own ability to handle this long term role as a caregiver with a healthy mind, body, and spirit.