Demystifying "ObamaCare"

With uncertainties surrounding the health care reform bill and with the Medicare Annual Enrollment date approaching November 15th, you might feel like you have more questions than answers. Until a health care reform bill is passed, it is uncertain how the final product will affect Medicare, but here’s what we do know:

• The Future of Medicare Advantage
  
  Don’t be overwhelmed by some of the proposals to reduce Medicare Advantage reimbursements. While there may be changes to MA plans down the road, the 1997 Balanced Budget Act includes a provision assuring Medicare beneficiaries a smooth and uninterrupted transition in their healthcare coverage should Congress mandate any program changes in the future.
  
  
  
• Separate Fact from Rumor
  
  Many senior citizens have been deeply upset set regarding the end-of-life counseling proposed as part of the Obama health care reform. This voluntary counseling has proved extremely controversial and may not be part of a final reform package. Currently there is no legislation to make the end-of-life counseling mandatory and seniors are increasingly making their opinions on the subject known to their elected representatives.
  
  
  
• Decreasing the “Doughnut Hole”
  
  The “Doughnut Hole” is reached when the full retail cost of covered medication purchased for a Medicare beneficiary exceeds $2,700 during one year. At this point, beneficiaries are forced to pay 100% of drug costs during this calendar year until they have surpassed $4,350 in covered out-of-pocket drug expenses or a new calendar year begins. Some health care reform proposals would gradually close the gap of this “doughnut hole” with a 50 percent price cut for brand-name drugs if a Medicare patient reaches the donut hole in coverage.
  
  
  
• A Focus on Preventative Care
  
  The proposals by Senator Max Baucus and others call for expanded preventative care benefits, including a free annual wellness visit for Medicare recipients. As stated in The Wall Street Journal article “Q&A: How Baucus’s Health Bill Would Impact Consumers”, Medicare beneficiaries also would not pay out-of-pocket fees for recommended services. Some proponents of health care reform have suggested instating a new Medicare commission that would control costs, but rest assured – they would not be allowed to change eligibility or benefits.
  
  
  

It is hard to say what will be in the final bill, but for now the best thing you can do is stay informed and let your representative know what your opinions are.

This article, was written by Jenny Rose of PlanPrescriber at 800-819-6906

Anxiety Disorders

Many of us have suffered from anxiety from time to time due to the pressures we may experience, managing family and professional lives so we understand that anxiety disorders are fairly common.  But there are some anxiety disorders that can give symptoms which are intense and create a painful experience of anxiety, often accompanied by feelings of guilt or worthlessness.  The person with this type of anxiety disorder typically feels nervous and afraid, and may appear frightened or terrified for no apparent or logical reason.  Persons with these disorders may try to defend against the anxiety by denying, rejecting, fixating or repeating behaviors.  One of my elderly clients just recently went through a combination of depression and anxiety disorders right after the passing of her spouse of 60 years.  She cancelled every appointment both socially and professionally.  Her neighbors finally decided to take matters in their own hands and contacted me for help when she began experiencing physical symptoms such as trouble breathing, headaches, bowel distress, stomach upset, and insomnia. But hyperactivity, fatigue, trembling, palpitations and dizziness may also be experienced.  Individuals with anxiety disorders may additionally experience flushes or chills, sweating, frequent urination, and / or sleep problems.

Anxiety disorders include conditions such as panic attacks, obsessive-compulsive disorder (OCD), post-traumatic stress disorder, and generalized anxiety disorder, as well as general and specific phobias.  When a person has a panic attack, he/she experiences intense fearfulness and terror which is often associated with feelings of impending doom. 

We've all seen the Monk TV show (left) which depicts the recurrent obsessions of this detective character which are intrusive and cause distress to his co-workers.  The person with OCD may respond to such compulsions aimed at either preventing an event or situation, or directly in response to the obsessive thoughts.  For example, a person may have intrusive thoughts or images about whether or not he/she has locked all the windows and doors in the house.  In response to these thoughts, the person gets up hourly during the night to check all the windows and doors. 

Post-Traumatic Stress Disorders (PTSD) follow psychologically disturbing events that are beyond the usual human experience.  Veterans of combat and victims of childhood sexual abuse often experience this type of disorder.  This disorder typically creates intense fear, helplessness, avoidance of reminders of the event, and increased arousal.  Individuals with PTSD may have difficulty falling asleep, may re-experience the event (flashbacks), or have recurring nightmares, and often maintain a state of watchfulness.  They may also startle easily and unexpectedly.  In addition, they may have difficulty concentrating and often become depressed.  

Someone with a generalized anxiety disorder may experience persistent and excessive anxiety and can worry about a number of events for at least six months.  Minor tranquilizers often are used to help reduce anxiety, agitation, aggression, and hyperactivity associated with anxiety disorders.  Several practical techniques may be also used to help reduce anxiety such as: providing a calm and quiet environment where a person can go and sit quietly, listen to music or relaxation tapes; establishing daily routines that are structured as much as possible, scheduled every day at the same time to alleviate some of the anxiety; using non-threatening affirmations of worth or recognition of positive personality traits or accomplishments; acknowledging fears or anxieties experienced and never dismissing them as "silly"  or unsubstantiated; and using activities to divert attention.  Soothing music or massage may reduce a person's fears and anxiety.  Others may benefit from involvement in a focused activity such as gardening or arts and crafts.  Yoga and deep breathing exercises are also helpful as well as participating in insight and/or behavior therapy modes. In my client's case, we formed a team, collaborating with the psychiatrist, psychotherapist, medical doctor, and care manager to match competent, compassionate and professional caregivers to the client's personality.  Once the right medication was prescribed and with good nutrition and counseling, she rejoined her neighbors in daily activities.  Sometimes it just takes a village. 

More Than 35 Million People Have Alzheimer's - World Alzheimer's Report

According to a press release issued two days ago by Alzheimer's Disease International (ADI), a London-based, nonprofit, international federation of 71 national Alzheimer organizations, more than 35 million people worldwide will have dementia in 2010.  This report was released on World Alzheimer's Day to raise awareness for this disease that will have a dramatic impact on individuals and healthcare systems globally.  Methadology used to prepare the 2009 World Alzheimer's Report is explained in the full printed report and can be found online at: http://www.alz.co.uk/worldreport 

The report contains eight recommendations for the World Health Organization and national governments.  The research shows that the number of people with Alzheimer's and other dementias is rising substantially worldwide and that the impact on families, governments, and national health care systems will be immense.  Following are their recommendations:

1. The World Health Organization (WHO) should declare dementia a world health priority.
2. National governments should declare dementia a health priority and develop national strategies to provide services and support for people with dementoia and their families.
3. Low and medium income countries should create dementia strategies based first on enhancing primary healthcare and other community services.
4. High income countries should develop national dementia action plans with designated resource allocations.
5. Develop services that reflect the progressive nature of dementia.
6. Distribute services with the core principle of maximizing coverage and ensuring equity of access, to benefit people with dementia regardless of age, gender, wealth, disability, and rural or urban residence.  
7. Create collaboration between governments, people with dementia, their caregivers and their Alzheimer Associations, and other relevant Non-Governmental Organizations and professional healthcare bodies.
8. More research needs to be funded and conducted into the causes of Alzheimer's disease and other dementias, pharmacological and psychosocial treatments, the prevalence and impact of dementia, and the prevention of dementia.  

Examining Bipolar Disorder

LaFave: I don't want to blur the lines between doing something as heinous as what I did, and being bipolar. But, yes, symptoms of bipolar [disorder] definitely contributed to my mind frame.  These were her words during the Sept 12, 2006 exclusive interview by Matt Lauer on the Today Show regarding a 2004 criminal case making Debra LaFave one of the most infamous school teachers in  America after a sexual affair with her 14 year old student in Florida.  

Bipolar disorder (formerly called manic-depression) is an affective disorder which involves alternating mood swings of depression and mania.  A person with bipolar disorder experiences episodes of mania and depression, usually with periods of relative stability in between.  The symptoms of this disorder may range from very mild to severe. Some of these symptoms are depressive episodes very similar to those found in clinical depression.  The difference is that depressive episodes alternate with manic episodes separated by intervals of relatively normal behavior.  In the manic periods, a person's mood is elevated or irritable.  Manic periods may begin suddenly, and involve an increase in talkativeness and activity and a decreased need for sleep.  A person may be able to get by with only a few hours of sleep or go days without sleep (without loss of energy). Another symptom you may encounter is the person's speech may become loud, rapid and difficult to interrupt.  

Mania often involves occasional outbursts of irritability, particularly in disagreements with others.  Someone who is in the manic phase may experience an inflated sense of self esteem or grandiosity, and tends to engage in activities that have a high potential for risk or undesirable consequences (for example, shopping sprees, extreme exercise, sexual indiscretions, and/or reckless driving.  Knowing that, would you agree that behind her good looks, Debra LaFave was a deeply troubled woman suffering from bipolar disorder, or was it a too convenient excuse  used in court systems these days?  

Lithium carbonate is one of the most commonly used medications for treating manic depression.  This medication is generally effective in stabilizing mood swings and lessens the severity of the cycling between manic and depressive episodes.  This medication however is not effective for all persons who have manic-depression and some persons who do get symptom relief do not like the side effects because of the tendency to blunt emotions.  Some persons with bipolar disorder miss the emotional highs which they experience during their manic episodes. A medication review by a psychiatrist is advisable if the side effects are intolerable to the person.  

Following are some practical strategies that may help someone with the manic episodes:  Reduce activity and/or movement around the individual.  Bright lights should be dimmed and extra noise should be eliminated; use a non-threatening approach by watching your own speech and body language; be careful of placing undue restrictions on their behavior (unless harmful to the person or others); and observe the person's behavior and language in order to detect any increase in risk-taking behaviors which could be harmful to them or others.  As a family member or professional caregiver, you will learn that as you become familiar with the person's disorder you will anticipate their mood swings into depression and mania, adjusting your behavior accordingly.  

What are Mood Disorders?

Mood disorders are also known as "affective disorders" usually occurring when the mood (affect) of an individual is impaired usually involving extremes of two basically normal moods, happy and sad.  Abnormally low moods are called "depression" and abnormally high moods are called "mania".


There are three main types of depression.  The first (situational) is temporary, usually caused by an event, such as the loss of a loved one, stress, or an illness.  This type of depression typically lasts only a short time and is resolved when the situation returns to normal.  But be aware that this may also turn into clinical depression.  Clinical depression is more enduring and /or recurring and requires treatment.  This type of depression is usually not triggered by external event but if associated with situational factors, the emotional reaction to the event may be exaggerated.  Individuals with clinical depression often withdraw from their usual activities and may become passive and dependent.  In addition, such persons may have difficulty experiencing or expressing pleasure, may become preoccupied with physical health, may frequently report difficulty concentrating or making decisions and thoughts of death are common.  Dysthmia is a low grade, chronic depression.

A person with depression may experience considerable lethargy and fatigue or engage in pacing, wringing their hands, and/ or pulling or rubbing their hair, body, or clothing.  A stooped posture and slow gait can also be a sign of depression.  Sometimes the person who is depressed may speak in a low voice and in a slow or monotonous manner.  In addition, he or she may not talk very much or may pause significantly before responding to questions from others. Sleep difficulties are common as well as problems falling asleep, staying asleep, sleeping too much or waking early.  Changes in appetite are also common.  Weight loss or weight gain often accompanies clinical depression.  Sometimes they may report a decrease or increase in their sexual drive.  In extreme cases, a person may exhibit a history of self mutilation.  Individual and group therapy are most commonly used for treating depression.  Antidepressants are used in the treatment of clinical depression and are often effective in stabilizing mood swings.

Some of the symptoms of depression and dementia are similar but be aware that significant differences do exist.  A person who exhibits dementia-like symptoms should be thoroughly evaluated.  With the elderly patient, geriatric care managers routinely assess their clients for depression using a tool known as the "geriatric depression scale".  On another post, we will explore the symptoms of depression which mimic dementia. Stay tuned....

Schizophrenia

When I think of Schizophrenia I think of  Nancy Spungen girlfriend of Sid Vicious (Sex Pistols) who on October 12, 1978 died at New York's Chelsea Hotel. Sid and Nancy became the stuff of tragedy, the punk Romeo and Juliet.  As a child, Nancy who by age 11, had been expelled from public school and was receiving psychotherapy, reportedly attempted suicide numerous times before the age of fourteen and suffered from some form of mental illness, mostly paranoid schizophrenia disorder.

Schizophrenia is the disorder that most frequently comes to mind when one thinks of mental disorders.  Schizophrenia is a general name for a group of mental disorders where symptoms include disturbances in thinking, behavior and mood.  Persons with schizophrenia may experience major distortions of reality, along with disorganized and fragmented thoughts, perceptions and emotions.  They also may experience delusions or hallucinations which, in addition to other severe symptoms, can affect their ability to complete daily activities, relate to other people, and cope with difficult situations.  Many people with schizophrenia recover and lead normal lives however.

Schizophrenia typically originates in childhood, although symptoms may not become clearly evident until the teens or early twenties.  Schizophrenic disorders are not usually diagnosed for the first time beyond middle age.  However, persons with schizophrenia do grow old and may become or remain residents in sheltered environments.  Symptoms can range from mild in some, to severe in others.  Primary symptoms include delusions of grandeur, delusions of persecution, delusions of beliefs that other people or events have a particular significance, usually negative, delusions of control, and delusions of sin or guilt.  Pych professionals believe it is best to avoid talking to the person about the delusions.  Debating or arguing about delusional ideas is likely to increase the person's anxiety.  Some people will readily share their delusional ideas, while others will only share these ideas with a few people they trust.  It is important that families working with someone experiencing delusions communicate using active listening skills and attend to their concerns.

Some persons experience hallucinations, if they are hearing voices. Some people are reassured when you inform them you cannot hear the voices, while others may react in a fearful or hostile manner.  If hallucinations are a new symptom, they should be communicated immediately to the person's health care provider, and if applicable, case manager.  Not all persons with schizophrenia have delusions and /or hallucinations and not all persons who have these symptoms are schizophrenic.  It is the disturbance of thinking which is central to this disorder.  Individuals with schizophrenia typically have distorted perceptions, false ideas, and lack clarity and logic in their thoughts.

Today, when schizophrenia is mentioned in the news, it is almost always in connection with some alarming crime. Some stories that have been popular in the media and which have added to the public view that schizophrenics are violent and dangerous include the case of Andrea Yates, who drowned her five children in a bout of postpartum psychosis, David Berkowitz, the serial killer infamously known as the Son of Sam who claimed his dog spoke to him and urged him to kill, Mark David Chapman, the man who killed Beatle John Lennon, and John Hinckley, who attempted to assassinate President Ronald Reagan. Symptoms of schizophrenia vary greatly and may come and go over the course of a person's life.  However, for some people, their symptoms can completely disappear.

The most common treatment for schizophrenia is drug therapy.  Antipsychotic drugs are often used to help individuals manage their symptoms.  Unfortunately, many antipsychotic drugs have unpleasant and/or serious side-effects.  Consequently, individuals may not want to take their medications.  But persons need to be encouraged to take their medications as prescribed, especially when it is critical to their ability to live successfully in the community.

Tomorrow, we'll look at depression.....

Mental Health Disorders

Some seniors living in their own homes may be afflicted with a mental disorder.  Mental disorders are conditions involving emotions, behavior, or thought which produce significant problems for the person experiencing them or which interfere with the person's ability to function in their home with their caregivers, family members, or in their relationships with others.  It is believed that many mental disorders have a organic origin.  A person's character has nothing to do with the development of a mental disorder.  Mental illness strikes persons of all backgrounds and with all kinds of temperaments, beliefs, and morals.  Many of our great works of art, music, and literature were produced by persons with mental illness.  A surprising number of high level jobs are filled by persons who have experienced a mental disorder.  While only 40-50% of persons with heart disease will recover, 80% of persons afflicted with depression will recover, and 60% of persons afflicted with schizophrenia will recover given proper treatment.  Furthermore, violence among persons with mental disorders is not common.  In fact, persons with mental disorders are more often victims of violence than perpetrators of it.  In the cases where violence does occur, the occurrence typically results from the same reasons as with everyone else.  These reasons may be feeling threatened, or excessive use of alcohol and/or drugs.  Because there are so many caregivers who may be working with a person who has a mental health disorder, we are going to examine the different aspects of mental disorders beginning with schizophrenia and ending with how to handle a crisis if confronted by a friend or family member who is experiencing his or her own crisis.  Stay tuned.  

PBS Special "Retirement Revolution" Airs tonight

I just received an announcement from the Alzheimer's Association that says:


Even if you're not a regular public television viewer, you should tune into PBS' "Retirement Revolution," which premieres this Tuesday, September 16, 2009.

"Retirement Revolution" focuses on the stories of seniors who are planning for their futures in the wake of the financial collapse of 2008. The broadcast also highlights living with Alzheimer's disease, featuring interviews with Alzheimer's Association staff members Bill Thies, Beth Kallmyer and two former Early Stage Advisors, Mimi Steffen and Gary Shelton.

Find out what time your local PBS station is broadcasting "Retirement Revolution."

When the Doctor Says It's A Stroke

My mother was in her late 80s when she suffered her last stroke. This time it was not a mini stroke but a pretty lethal one.  By then Mom's memory was obviously having problems as she also had been diagnosed with Alzheimer's related dementia disorder. So, to make sure caregivers understand what to expect with a stroke, I'd like to provide the following information.

Stroke is the term used to describe the loss or change in neurological function caused by sudden blockage or rupture of an artery of the brain. Damage to brain tissues can be temporary or permanent.  Symptoms of stroke may appear suddenly or gradually.  Transient ischemic attacks (TIAs), also referred to as “little strokes”, are strong indicators of an impending stroke. TIAs occur when a blood clot briefly clogs an artery, blocking part of the brain from receiving the blood it needs.  Symptoms/Signs of Transient Ischemic Attack

q       Sudden temporary weakness, clumsiness, or loss of feeling in the face, leg, arm, or leg on one side of the body.

q       Sudden, temporary blindness, or dimming or double vision.

q       Dizziness.

q       Staggering.

q       Loss of speech, slurred speech, trouble talking or understanding speech, particularly with weakness on right side.

q       Mental confusion.

Most TIA symptoms occur and disappear quickly, usually in less than 5 minutes. Occasionally symptoms last several hours, but never over 24 hours. The short duration of symptoms and the lack of permanent damage are the main differences between TIA and strokes.  The cause of a stroke determines treatment. Aspirin and medications for depression and heart disease are often indicated for stroke recoveries.  Stroke changes the rules of daily life for individuals. The consequences and complexity of a stroke cause frustration for everyone concerned.  Recovery from a stroke depends on the amount of permanent brain damage and rehabilitation efforts. Rehabilitation can help a stroke recovery regain function, adjust to changes, and prevent another stroke.

At first, when loved ones make rapid improvement, relatives expect full recovery. For example, a daughter said, “At the rate Dad was improving, I thought he would be his old self again.” Later, when the rate of progress slows, some family members believe it is because the client wants to be “taken care of.” They often feel problems are out of proportion to the stroke.  In fact, I heard this just today from a long distance family member. Stroke affects each person differently. For example, two people the same age, sex, and physical condition, which have a stroke on the same side of the brain, may experience entirely different neurological changes. Recovery and rehabilitation depend on a large extent on the location and amount of brain damage.

Stroke recoveries commonly experience problems in the following areas: motor functions, sensation, vision, communication, automatic function, cognition, and emotional expression.  Stroke recoverees often lose the ability to perceive or conceptualize their environment accurately. They may have difficulty understanding abstract ideas, as well as reality.  The once carefully groomed, self-sufficient, and kind person may become sloppy, demanding and rude. It may seem as though a loved one has been transformed into a stranger.

Dramatic mood swings are common. A recoveree may laugh and then cry for no reason. The emotion displayed may not reflect mood. For example, a person who cries spontaneously may not, in fact, be sad. To determine the person’s mood, it may be helpful to ask how he or she is feeling.  Depression is commonly experienced by stroke recoverees. When a recoveree cannot live up to demands to be more independent, responsible, and helpful, depression may deepen. Family members, therapists, and providers sometimes expect performance and behaviors beyond a recoveree’s capabilities. It is important to remember that a recoveree may be more impaired than appearance suggests.

Recoverees of a stroke experience unexpected bursts or loss of energy. A person may be able to dress independently on Monday, but need help on Tuesday. This problem is not caused by laziness and usually does not represent a change in health. Fluctuating moods and energy levels affect the level of performance.

Many may fail to recognize pangs of hunger, forget they just ate, or tell relatives you are not feeding them. Poor control of muscles of the face, tongue, and throat may cause drooling and difficulty in swallowing. Food may be stored in the cheek. These factors increase the risk of choking.  The effects of stroke, combined with wearing dentures, reduce the ability to taste. Poor fitting dentures pose a serious problem because recoverees may not feel the pain of pressure areas. Use of the non dominant hand to eat, plus vision problems, causes food spillage and feelings of distress.

As a caregiver, you need to maintain a positive attitude. For example, a recoveree may put clothes on wrong-side out. This may be humorous to you, but embarrassing to the client. Respond in a manner that protects the person’s dignity and self-esteem.

Communicating with a stroke recoveree may be difficult, particularly if the person suffers from aphasia (word finding problems). Other barriers to communication are poor hearing and eyesight, mental confusion, depression, and withdrawal. Recoverees may turn away or respond without turning when people talk to them on their affected side. They may appear to ignore the speaker and be uninterested in what is happening around them. They may recall only bits of information from what they have seen or heard. Communicating with recoverees is important because it reduces their feelings of isolation and depression.  What to do as a family member?  At the minimum demand that the doctor refer your loved one to a neurologist and exercise patience. I have personally seen clients with very good outcomes following a good rehabilitation experience.

Readers are encouraged to offer comments and suggestions.  See the comments link below.  If you are an out of town family member with a parent in South East Florida who has suffered a stroke, care managers with A Good Daughter Elder Care can provide a comprehensive evaluation of the following areas:  Medical, Mental, Financial, Legal, Environmental (Safety), and Social areas.  Once the assessment is complete we prepare a complete plan of care going forward to provide all of the benefits, entitlements, options available for your loved one's care.  Call: 1-800-963-3877 for our FREE REPORT revealing how we can keep our loved ones at home safely.  

Remembering 9/11

Even all these years later, the memory of that awful morning  watching the events unfold on NBC with my colleagues at work, then listening to my daughter call from California hysterically sobbing about what had just happened to our country, still sends chills down my spine. My thoughts and prayers are with our country on this day remembering the tragedy of lost family and friends on this day.

Are Psychiatric Hospital Admissions Always Needed for the Person With Alzheimer's Behaviors?

I received an email from an adult child of a client recently who is "at the end of the rope with a parent's behaviors, suggesting an admission to a psychiatric hospital so she could be seen by a doctor daily who will manage medications on site".  Sometimes adult children have simplistic solutions that don't always work out for their parents.  Case in point......At the beginning of my work with Alzheimer's patients of a local psychiatrist, I witnessed a delusional episode which proved just how the system worked against an elderly individual with an Alzheimer's related disorder.

A number of years ago, while visiting a client who was obviously in a delusional state, I called the client's power of attorney, her primary care physician, psychiatrist, therapist who all advocated that she voluntarily sign herself into a local psych hospital.  One thing I have observed throughout the years is that the person afflicted by Alzheimer's who has an emotionally negative experience, will remember it forever.  This was the case with this client.  I drove her to the psychiatric hospital and as I said earlier it was a  voluntary admission, but as soon as my back was turned she was brought before a judge who changed it into an involuntary admission, keeping her there for two weeks against her will as my daily visits bore out.  It was an awful experience for her.....multiple doctors who changed her medications so many times that even after discharge nothing seemed to work, keeping her with the general psych population which consisted of males, females, young, and older persons who needed psychiatric intervention, and managed by staff who weren't experienced with the word-finding problems that a person afflicted with Alzheimer's sometimes has and the exasperation that  it brings.  On her return home, she was far more agitated than she was on admission.  She never forgave me because I was the one who drove her "to the crazy house".  I went from being her loving advocate to "the enemy".  Her disdain for me made my life a living hell (again, because of the emotional connection she made to that memory).  I vowed never to recommend a psych admission to another client (unless they are a threat to themselves or others) as it served no purpose.  My client eventually went through a series of psychiatrists before finding a geropsychiatrist who put her on gradual increased doses of Seroquel which finally seemed to work.   She is now at home with live-in caregivers and the love of her small puppy, is peacefully managed, and will remain in her home until the end.

Even with the most highly credentialled psychiatrist, medications are not always a one-size-fits-all solution.  After many years of working with dementia behaviors, I have observed that not all agitation is resolved with a change of medication.  Sometimes an inexperienced caregiver can accidentally trigger behaviors and it takes gentle patience and training to get to the heart of the problematic behavior.  When you have caregivers working different shifts and one caregiver gets easily agitated while the other more mature and experienced caregiver elicits cooperation from her patient without reported incidents, you can surmise that more training may be needed.  Persons suffering from Alzheimer's disorders can also be affected by changes during a particular time of day (i.e,. sundowning), so careful monitoring of progress notes in the home can give the information necessary to determine if that is the case.

So, I close with the following advice: If sudden confusion or sudden changes in behavior are apparent with a parent, check with the primary care physician to rule out a urinary tract infection or push fluids if you suspect dehydration; follow trends with caregivers to see who may need more training; have them keep progress notes documenting their observations, finally report new behavior changes to the psychiatrist to see if medication adjustments are warranted.  Alzheimer's disease presents extreme challenges not only to the affected individuals and their families, but also to care providers.  The nature of the disease is such that our healthcare system sometimes fails to function in an appropriate manner.  As the baby boomers age and more persons are afflicted with dementia, our health system will not be in a position to handle the anticipated influx of Alzheimer's patients over the next decades.  I hope this post helps examine some of the challenges presented by this disease and has suggested several possible methods to improve our response to observed behaviors.  A Good Daughter Elder Care Management helps provide high quality resources for family members who have parents afflicted by Alzheimer's disease.  We provide advocacy, caregiver supervision and training, medications management, medical coordination, mediation, and host a free monthly dementia support group for families and caregivers.  We are available to our clients and their families for emergencies 24 hours a day 7 days a week, 365 days a year.  Please feel free to leave a comment below or contact: olga@agooddaughter.com  for more information.

Should European Advocates lobby to Remove film by French Alzheimer's Association?

Unfortunately, as a person who deals with Alzheimer's every day of my life and one who knows all too well that the faces of  real life persons afflicted by this disorder are often very much like the images represented by the film makers in this case, I ask myself "why are we so afraid of to confront the reality of what is?"  While I am extremely compassionate of my clients and can understand the behaviors of my former nursing home residents and some of our clients who are in declining stages of this disorder, I feel we need to see the face of Alzheimer's as it really is (or can be) because there are too many adult family members who are in complete denial of what is happening to mom or dad as they fly back to the safety net of their homes and we are left to pick up the pieces on a daily basis.  See a clip of this film for yourself and leave your comment.