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The 4 Common Types of Dementia

Did you know that dementia is not one disease, but a name for many different brain diseases?

Before the late 1800s, dementia was an umbrella term for many types of unrelated mental illnesses, and there was very little medical understanding from ancient times. The haphazard developments in medical knowledge in this field are why we have many different conditions, lumped under one word. It is an unfortunate legacy, especially when combined with the social stigma and the wrongful association with natural aging.

Today, medical research endeavor to unravel the intricate web of dementia so we can have a better understanding of these diseases, in the hope of prevention and one day – a cure. Though there are many types of dementia, the most common ones are Alzheimer’s and vascular dementia, according to the Alzheimer’s Disease Association.

1. Alzheimer’s disease

Alzheimer’s is a “type of dementia that causes problems with memory, thinking, behavioral and other intellectual abilities serious enough to interfere with daily life”, according to Alzheimer’s Association. Alzheimer’s disease makes up some 50%-70% of dementia cases – there is a clear organic process of deterioration. The early symptoms of Alzheimer’s are difficulty remembering recent conversations, names or events, as well as apathy and depression. As it progresses, symptoms include impaired communication, poor judgment, disorientation, confusion, behavior changes and difficulty speaking, swallowing and walking.

 

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What are the common types of dementia?

2. Vascular dementia/ Multi-infarct dementia

Previously known as post-stroke or multi-infarct dementia, vascular dementia is caused by problems in the brain’s blood supply, often after a series of strokes or bleeding in the brain. The location, number, and size of the brain injury determine how the individual’s thinking and physical functioning are affected. The early symptoms of vascular dementia are impaired judgment or ability to make decisions, plan or organize. Memory loss is not a common initial-stage symptom in people with vascular dementia as it is in people with Alzheimer’s.

3. Dementia with Lewy Bodies (DLB)

DLB is a type of “progressive dementia that leads to a decline in thinking, reasoning and independent function because of abnormal microscopic deposits that damage brain cells over time”, as per Alzheimer’s Association. Medical science doesn’t know what causes DLB, but it is specific enough – there is cognitive decline and can only be confirmed by a post-mortem brain histology that shows Lewy bodies in the neurons. People with DLB often have early symptoms such as sleep disturbances, well-formed visual hallucinations, slowness, gait imbalance or other parkinsonian movement traits. Memory loss and thinking problems are also common symptoms in DLB as it is in Alzheimer’s.

4. Parkinson’s disease dementia/ Mixed Dementia

Alzheimer’s Association explains Parkinson’s disease dementia as an “impairment in thinking and reasoning that begins in a region that plays a key role in movement”. Changes in the brain gradually spread and initially affect mental functions, including memory and the ability to pay attention, make sound judgments and plan the steps needed to complete a task. An estimated 50 to 80 percent of those with Parkinson’s eventually experience dementia as their disease progresses, according to Alzheimer’s Association. The average time from onset of Parkinson’s to developing dementia is about 10 years. If dementia develops, symptoms are often similar to dementia with Lewy bodies.

Mentioned above are only some of the common types of dementia, and up-to-date there are over nine types discovered. As different types of dementia can have similar overlapping symptoms, it may be difficult to diagnose dementia just by the symptoms alone. Take note of the signs and early symptoms of dementia. People with deterioration in cognition and personality should seek medical help upon the onset of symptoms. Alzheimer’s Disease Association offers help through programs and support services for patients and their families.

Where Should You or Your Loved Ones Live Out the Golden Years?

It is often said that home is where the heart is, but how do you decide where home should be as you or your loved ones age and health decline? Whether you are facing the decision personally or helping an aging parent decide where to live out the golden years, there are many factors to consider. This article will review the key issues that must be addressed when making this decision and also look at how to find resources to support your decision.

First let’s take a look at your main options: independent living/remaining in one’s own home, living with family, or moving into a nursing care facility or assisted living facility.

Independent Living/Remaining in One’s Own Home

This simply means continuing to live in your own residence or perhaps downsizing to a smaller, easier to care for dwelling, but enlisting minimal help, if any at all.

Living with Family

As they age, some people choose to move in with family members who can help care for them, or to have family move in with them.

Nursing Care/Long-term Care Facility

The care provided in a nursing home/long-term care facility care can vary and is usually most appropriate for someone whose needs exceed those that can be met by family and/or community supports.

“Often this is someone who has significant medical issues that need to be monitored and managed frequently by skilled nursing,” said Erin Frankenfield, a social worker with the Central Ohio Area Agency on Aging (COAAA). “Or, this might be someone who has significant memory impairment and requires special programming and supervision to ensure their safety is met, as well as activities tailored to their cognitive capacity. Nursing homes have some private rooms available, but those are more costly. Usually, you have a semi-private room that you share with someone else. Medicaid will only pay for a semi-private room.”

Assisted Living Facility

“An assisted living facility can be an appropriate choice for someone who can live in their own private room,” Ms. Frankenfield explained. “However, there are some facilities that are specific to memory care and severe dementia patients. Also, assisted living has regular nursing care but not as intensive as that provided in a nursing facility. Assisted living facilities often provide meals, homemaking and a living space that is more ‘homey’ rather than ‘medical’ (like you would find in a nursing facility). Often, assisted living facilities will be more selective about accepting patients with extensive medical issues, partly due to the capacity of the facility to safely and adequately care for the multiple health complications of someone who has several and severe health issues.”

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Where should you or your loved ones live out the golden years?

Making a Decision

Determining where you or a loved one should live in the autumn of life is a big decision and should not be made lightly.

“When figuring out how to choose the appropriate care setting for someone, it’s important to first determine how much assistance someone requires to complete their activities of daily living (ADLs),” Ms. Frankenfield said.

These include:

  • Managing medication
  • Handling environmental tasks such as shopping, laundry, cooking and cleaning
  • Heavy chores
  • Yard work
  • Home maintenance
  • Bathing, dressing, grooming
  • Toileting
  • Mobility – getting in and out of the shower/bath, up/down the stairs, in/out of bed, ambulation – getting from point A to point B
  • Making phone calls
  • Driving or arranging transportation
  • Managing finances/legal matters

“It is also important to consider whether there are any memory deficits or ongoing issues with confusion,” Ms. Frankenfield said. “For example, are they forgetful about whether or not they have eaten or taken their medication? When they leave the home alone, do they get lost? Do they get out of bed in the middle of the night and wander?”

After taking an honest and thorough look at how much help someone requires, next, it’s important to determine if there are enough family and/or community supports to sustain that person either in their environment or in a family member’s home.

“There are options for living in the community with assistance,” Ms. Frankenfield said. “There are private pay home health companies that supply trained personal care aides to assist with ADL tasks, cleaning and running errands. Paying privately for care in the home can be costly, and choosing a company is difficult as there are a lot of companies out there. The cost of private paying for a personal care aide can range, and most companies would like someone to commit to a block of time versus an hour.”

For those who opt to remain in their own home or live with a relative, many communities provide a plethora of senior services, which could include home-delivered meals, a homemaker and/or personal care aide, emergency response pendant, assistance with obtaining durable medical equipment such as hospital beds, wheelchairs, grab bars, shower chairs, etc.

“In Columbus, Ohio, for example,” Ms. Frankenfield said, “there is a program called Senior Options, or for someone who requires a lot of assistance with personal care and is Medicaid eligible, there’s a program called PASSPORT managed through the Central Ohio Area Agency on Aging. These two programs are designed to assist people who meet certain income guidelines and who require a certain level of assistance, so they can live in the community setting with supports. COAAA also offers a lot of other resources and assistance with information about long term care, and they are always available to take calls for such information.”

To find resources in your own community, try Google searching for “resources for seniors” in your city or state, or visit the Administration for Community Living website.

“Living in the community can also be enhanced by using an adult day program,” Ms. Frankenfield said. “Usually, they provide transportation. These type of programs are convenient for a working family that needs to have their older adult family member in a safe environment during the day while the working members of the family are not able to be home with them.”

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Assisted living has regular nursing care but not as intensive as that provided in a nursing facility.

To find information on adult day programs, residents in Central Ohio can contact the COAAA. In other areas, you can conduct a Google search for your city and state plus “adult day programs.”

National Church Residences also has several programs in Columbus and throughout the United States.

Funding the Care Scenario of Your Choice

Whether you and your family choose care at home or in a facility, there will be a significant cost involved.

“Older adults and their families need to look honestly at what they can afford as far as time and money to safely and reliably support the care needs of the family member concerned,” Ms. Frankenfield said. “The cost of private pay for a nursing facility or assisted living is very expensive, and both the cost and quality of the facilities range widely. There is a useful link on the Medicare.gov website: ‘Find Nursing Homes.’ It links to different nursing facilities, including their ratings and is a good place to do research.”

There are four different sources for funding a stay in a nursing facility or assisted living facility. These are:

1) Private pay

2) Long-term care insurance

3) Medicaid

4) Veterans’ benefits

“Medicaid is state-funded insurance, and eligibility is based on income and assets,” Ms. Frankenfield explained. “If someone has several assets and would like to explore qualifying for Medicaid, they could consult an elder law attorney for assistance in determining how or if these assets could be protected.”

Regardless of the decision you make, it should not be arrived at lightly. Take your time to really consider all of the key issues and research your options so you can make the best decisions for you and your loved ones.

Fall and Injury Prevention in the Elderly

The medical journal American Family Physician reports that falls are the leading cause of injury-related emergency department visits and the primary cause of accidental deaths in adults ages 65 and older. In fact, according to the National Council on Aging, approximately one in three adults ages 65 and older falls every year. It is no surprise that fall prevention in the elderly has become a priority for most caregivers.

“Injury from a fall is definitely a concern as we age,” said Timothy Kirkpatrick, MD, an emergency department physician. “The core becomes weaker, balance degenerates, reaction time slows, vision dims, and we cannot compensate quickly when off-balance. Falls can have serious repercussions, including hip fractures and head trauma.”

Some signs that you are or a loved one is at risk of falling include an unsteady gait or a gait that includes a lot of shuffling. You also want to pay attention to how many steps can be taken without assistance. This may be the primary step to assess any fall-related risks for injury prevention in the elderly.

Fortunately, there are a number of risk factors that can be modified or managed.

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Fall and injury prevention in the elderly can save lives.

“It’s important to have your vision checked frequently, including assessing for potential cataracts and macular degeneration,” Dr. Kirkpatrick said.

He continued: “You also want to be aware that certain medications can make you dizzy. Pain medications, especially if new to you, can make you loopy, fatigued and less aware of your surroundings. Pay careful attention to how you feel any time you start a new medication such as antibiotics, blood pressure medications or blood thinners, or any time the dosage of one of your medications is adjusted. Even some over-the-counter medications can affect how steady you are on your feet, such as antihistamines like Benadryl or medications marketed as sleep-aids.”

Additional risk factors, according to the United States Centers for Disease Control and Prevention, include:

  • Lower body weakness (one sign of this is needing to push with your hands when standing up from a chair)
  • Vitamin D deficiency (that is, not enough vitamin D in your system)
  • Foot pain, numbness in your feet or poor footwear
  • Needing support – such as from a cane or walker – when walking
  • A history of falling – people who have already fallen once are more likely to fall again.
  • Home hazards or dangers such as
  • broken or uneven steps,
  • throw rugs or clutter that can be tripped over,
  • no handrails along stairs or in the bathroom, and
  • dimly lit doorways, steps and stairwells.

Most falls are caused by a combination of risk factors. The more risk factors a person has, the greater their chances of falling.

Dr. Kirkpatrick recommends taking the following actions to help the risk of a fall or injury from a fall:

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Assess all fall risks to prevent falls in the elderly.
  • Remove throw rugs.
  • Provide good lighting.
  • Remove or secure carpet and treads on stairs.
  • Ensure all cords are out of the way/never crossing a footpath.
  • Refrain from rearranging furniture, as people are more likely to bump into or trip over things if the layout they are familiar with changes.
  • Eliminate clutter – keep kids’ toys picked up, and don’t stack things like magazines and papers near a doorway or stairway where they might be knocked over into the footpath.
  • Install hand rails where needed – ensure they are secure and don’t wobble by bolting them into studs rather than anchoring into drywall.
  • In the winter, ensure all outdoor walkways are kept thoroughly shoveled and well salted.
  • Get rid of any glass-topped tables
  • Install non-slip tread strips or bath appliques on bathtub and shower floors.

It is important to note that some fall-related injuries actually occur when people are struggling to get back up from a fall, Dr. Kirkpatrick said, and can even occur without a fall.

“When a hip breaks,” he said, “it is often not the fall that breaks it but the act of getting back up or twisting/turning when standing, and hips can even break from the simple action of getting up from a seated position. To reduce the risk of breaking a hip, chairs for the elderly shouldn’t be too soft and deep, and of course they should not be unstable. Also consider installing handrails to help get off the toilet or out of the shower.”

It is possible to reduce the risk of breaking a hip as described above and to modify the overall risk of a fall/fall injury by developing or improving good self-care habits.

Dr. Kirkpatrick recommends eliminating or reducing alcohol consumption, and exercising regularly to improve balance and strengthen the core. The CDC especially recommends Tai Chi to improve balance. You also can talk with your doctor/advise your loved one to talk with his or her doctor about fall prevention.

How are You Sleeping?

March has been designated National Sleep Awareness Month. One part of sleep awareness is knowing how our sleep may be affected by changes in the environment.

Most of the United States returns to Daylight Saving Time beginning at 2 a.m. local time on Sunday, March 8. As we spring forward and advance our clocks one hour, it is important to consider how this small change can affect our sleep.

Moving our clocks, watches, and cell phones in either direction changes the principal time cue—light—for setting and resetting our 24-hour natural cycle, or circadian rhythm. This makes our internal clock out of sync with our current day-night cycle.

In general, “losing” an hour in the spring is more difficult to adjust to than “gaining” an hour in the fall.  An “earlier” bedtime may cause difficulty falling asleep and increased wakefulness during the early part of the night.

If you have insomnia or are sleep-deprived already, you could experience more difficulties. In this situation, you could see decreased performance, concentration and memory during the workday, which is common to sleep-deprived individuals.  You also may experience fatigue and daytime sleepiness. All of these are more likely if you consume alcohol or caffeine late in the evening.

In general, people adjust to the change in time within a few days. You can help this by decreasing exposure to light in your home during the evenings, exercising, trying to have a consistent sleep schedule, and reducing or eliminating alcohol and caffeine

Visit https://news.vanderbilt.edu/2015/03/04/national-sleep-awareness-month/ for more about sleep, insomnia and work-life balance resources.

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The importance of Patient Safety

Prevention of Falls in the Elderly

How many of you are caring for the elderly, or looking for someone who can? It’s not easy. There are so many things to look out for, and so many challenges to face.

One of the biggest challenges is prevention of falls in the elderly. There are many other things to talk about when it comes to caring for them but accidental falling can be a nightmare. So how do we prevent falls in the elderly?

We know that falls, and the resulting complications, can be very dangerous but they are also one of the most common risk factors-it’s just too easy to let them happen. According to the National Center for Injury Prevention and Control, “One out of three older adults (those aged 65 or older) falls each year but less than half talk to their healthcare providers about it.” So this problem is not only widespread, it is also hidden. Caregivers end up in a difficult position of having to prevent things before they can happen.

So what can we do?

Many risk factors and prevention have been identified in medical and healthcare literature. This might go a long way in saving the lives of our loved ones. Some of these risk factors are intrinsic and you may need professional help before you can notice them, for example, examination for back problems. Other factors are environmental and to some extent cannot be controlled easily. But there are other factors that are within the power of caregivers-both formal and informal-to deal with.

Medication

Forewarned is forearmed. Some medicines can make a person dizzy or drowsy, of affect balance and co-ordination. This applies to everyone, not just the elderly. Caregivers might not always be in a good position to know this-medical confidentiality and lacking pharmaceutical knowledge might hinder this. But the elderly or their legal representatives should be able to ask their doctors/pharmacists to identify those medicines that increase the risk of falling. The doctors especially, should be able to tell you whether any particular medicine is a risk to any particular patient.

Footwear

Remember that awful, horrible feeling when you wrench an ankle wearing thick soles on uneven ground? Think of this, only much worse, if an elderly person’s feet wobble too much wearing high heels with no ankle support. Backless shoes, even slippers with smooth soles, all pose a variety of footwear-related risks. In Asia, another type of footwear to worry about are the communal slippers used for bathrooms. There are many ways footwear can be unsafe-they can interfere with a safe and proper gait, they can be too slippery, or they can be too large and be a tripping hazard. We should ensure our elderly not only have proper and safe footwear for going out, but also for using within the home-this is especially important for bathroom slippers since the elderly may need to access a potentially wet floor late at night, possibly without wearing glasses, while urgently rushing to answer the call of nature.

Tripping/Slipping Hazards

We already mentioned smooth-soled shoes as a slipping hazard. But there’s more. The bathroom is a particularly dangerous place for elderly when it comes to a fall risk. The floor can be smooth and wet, and placing loose rugs may do nothing to solve this problem-they might even increase the risk of slipping. Bathrooms often also have little curbs, especially at the shower areas. Try to use rugs with a rubberized underside, to prevent elderly users from slipping to them, and of course try to keep the floors dry. Rough surfaces or rubber mats are another potential safety measure.

But that’s just the bathroom. Falls can happen anywhere in the house or outside it, so watch out also for objects cluttering the floor, uneven ground, slopes, and smooth surfaces.

Assistance

Now, this might be a bit difficult. So far, we’ve talked about removing problems. That’s not expensive. But sometimes we may need to make some investments for long term. We don’t need to wrap our loved ones in tons of cotton wool everywhere they go, but it would help if grab rails or other supports and installed in the important areas of the home (bathroom for example). Walking aides should also be chosen carefully. It should not be too heavy, and should be adjusted to the correct height so that a cane-assisted walking posture does not itself turn out to be a falling risk.

Diet

Protein, calcium, essential vitamins and water. All these sound very commonsensical. However, what an elderly person needs for a suitable diet may not be the same as what healthy middle-aged adults need. Some changes are common to all elderly-for example, switching to softer foods. Moreover, a healthy diet can go a long way to prevent numerous other problems that increase the risk of falling. Diet also needs to cater to a person’s specific medical issues.

If you or a loved one are looking into home care options please visit http://www.CaregiverUSA.com or call 614-408-9939.

Did you know 1 in 3 American adults are at risk for kidney disease? Take Two Simple Tests to Know Your Kidney Numbers

March is National Kidney Month, so let’s focus on the importance of education and prevention!

Anyone can get kidney disease at any time. If kidney disease is found and treated early, you can help slow or even stop it from getting worse. Most people with early kidney disease do not have symptoms. That is why it is important to be tested. Know your kidney numbers!

Your kidney numbers include 2 tests: ACR (Albumin to Creatinine Ratio) and GFR (glomerular filtration rate). GFR is a measure of kidney function and is performed through a blood test. Your GFR will determine what stage of kidney disease you have – there are 5 stages. Know your stage. ACR is a urine test to see how much albumin (a type of protein) is in your urine. Too much albumin in your urine is an early sign of kidney damage.

  • Urine Test called ACR. ACR stands for “albumin-to-creatinine ratio.” Your urine will be tested for albumin. Albumin is a type of protein. Your body needs protein. But it should be in the blood, not the urine. Having protein in your urine may mean that your kidneys are not filtering your blood well enough. This can be a sign of early kidney disease. If your urine test comes back “positive” for protein, the test should be repeated to confirm the results. Three positive results over three months or more is a sign of kidney disease.
  • Blood Test to estimate your GFR. Your blood will be tested for a waste product called creatinine. Creatinine comes from muscle tissue. When the kidneys are damaged, they have trouble removing creatinine from your blood. Testing for creatinine is only the first step. Next, your creatinine result is used in a math formula with your age, race, and sex to find out your glomerular filtration rate (GFR). Your GFR number tells your healthcare provider how well your kidneys are working. Check with your doctor about having a GFR test.

 

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10 Early Warning Signs of Parkinson’s Disease

From our friends at the National Parkinson Foundation,

Sometimes it’s hard to tell that you might have Parkinson’s Disease. The symptoms arise when your brain stops making an important chemical called dopamine. This chemical helps your body to move, and helps your mood. If you have Parkinson’s, you can feel better by taking medicine that helps your body to replace that chemical.

Parkinson’s disease will get worse slowly over time, and your doctor can help you to stay healthy longer. If you or a loved one show any of these warning signs, you should tell your doctor about them and ask about the disease.

  1. Tremor or shaking
  2. Small handwriting
  3. Loss of smell
  4. Trouble sleeping
  5. Trouble moving or walking
  6. Constipation
  7. A soft or low voice
  8. Masked face
  9. Dizziness or fainting
  10. Stooping or hunching over

 

If you or a loved one develop any of these signs and need assistance in the home call 614-408-9939 or visit http://www.CaregiverUSA.com for an evaluation.

For more information about Parkinson’s Disease visit http://www.Parkinson.org or call the helpline 1-800-4PD-INFO.

 

 

February is National Age-Related Macular Degeneration and Low Vision Awareness Month

Understanding AMD
AMD is the gradual but persistent breakdown of the part of the eye that provides sharp, central vision needed for seeing objects clearly. Over time, this can affect the ability to read, drive, identify faces, watch television, navigate stairs and perform a suite of other daily tasks. For many adults, this visual deterioration occurs in one eye and may eventually form in the other.

There are two types of AMD – “dry” and “wet”. The majority of people with AMD have the “dry” form, which is less severe and develops gradually. It is important to carefully monitor central vision when diagnosed with AMD, because it can quickly develop into a more serious condition – wet AMD.

Risk Factors
According to vision experts, the top five risk factors for AMD are:

  • Being over the age of 50
  • Family history
  • Smoking cigarettes
  • Obesity
  • Hypertension

Unfortunately, many people don’t realize they have a macular problem until they notice blurred or distorted vision. If you or someone in your family is at an increased risk for AMD, see an eye care provider as soon as possible to undergo an eye exam. Early detection of AMD is the most important step to preventing serious vision loss.

Treatment Options
There is no treatment for dry AMD but doctors have found a link between nutrition and the progression of dry AMD. Introducing low-fat foods and dark leafy greens into your diet can slow vision loss and may even increase your overall wellness.

If wet AMD is detected early, laser treatment is a popular method to help prevent severe vision loss.

As we observe National AMD/Low Vision Awareness Month, take this opportunity to reduce your risk of developing AMD. Avoid smoking, exercise regularly, maintain normal blood pressure and cholesterol, and eat a healthy diet that includes green leafy vegetables and fish. For extra motivation, find a friend, partner or neighbor to engage in healthy habits with you.

 

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Credits: http://whatislowvision.org/2014/02/19/february-is-national-age-related-macular-degeneration-and-low-vision-awareness-month/