CMK Home Care

Confronting a new diagnosis can be frightening — and because research changes so often, confusing. Here are some questions you may not think to ask your doctor, along with notes on why they’re important.

How can we be sure my symptoms aren’t the result of a stroke, mental illness or another treatable condition?

There is no definitive test for Alzheimer’s disease, and it can be misdiagnosed in patients suffering depression, memory deficits because of normal aging, arterial blockages or even certain vitamin deficiencies. Doctors generally rule out other possibilities, then apply criteria developed by various medical organizations to arrive at the diagnosis.

What stage of Alzheimer’s disease am I in? What comes next?

Clinicians classify the progressive deterioration of brain function in Alzheimer’s disease into seven stages. By the last stage, patients require round-the-clock care. In the first, second and third stages of this slow moving illness, symptoms are minimal, and many patients work and live independently.

What can I do to preserve my health and mental abilities for as long as possible?

Although there are no treatments to halt or cure Alzheimer’s disease, recent studies have suggested that exercise, a healthy diet and mental stimulation may delay the onset of disabling symptoms.

What physical symptoms should I anticipate?

Patients typically complain of problems with memory and organizational ability, but Alzheimer’s disease also attacks the brain’s motor centers, resulting in problems with balance, coordination, bladder and bowel control, and certain reflexes, including the ability to swallow. Patients and their caregivers should prepare for mental and physical disabilities.

Should I undergo brain neuroimaging?

Imaging of the brain occasionally can help differentiate Alzheimer’s disease from other potential causes of dementia in new patients; however, imaging is rarely useful for determining the severity of the disease.

My children are worried about inheriting this illness. Would it be useful for our family to undergo genetic testing?

Scientists have identified several gene mutations associated with an increased risk of developing Alzheimer’s disease, but the predictive value of each mutation is low. As a result, genetic testing is useful only for individuals who have several close relatives suffering from early-onset forms of the disease.

What drugs are currently available for Alzheimer’s disease, and how well do they work?

Two types of drugs are currently prescribed for treatment of Alzheimer’s disease. Cholinesterase inhibitors, such as donepezil and galantamine, regulate acetylcholine, a neurotransmitter influential in learning and memory. The only NMDA receptor antagonist on the market, memantine, tamps down excessive brain activity. Both types have been shown to delay brain deterioration for a brief period (6 to 12 months) in about half the people treated.

My family is afraid to let me drive. Would you refer me for a driving evaluation so we can have an objective opinion of my ability?

Driving is often a focal point of familial controversy. Diagnosis of Alzheimer’s disease doesn’t always require that a patient immediately stop driving. An objective medical evaluation can be helpful in clarifying the extent of a new patient’s disability.

What can I do to make things easier on my family?

Because Alzheimer’s erodes cognitive ability, it’s important for patients to plan for a day when they can no longer take care of their affairs. Newly diagnosed patients should execute medical and durable powers of attorney that authorize spouses or other family members to deal with banks, insurance companies, doctors and others on their behalf.

BY IRENE M. WIELAWSKI

More than two thirds of Americans aged 55 or older have had an eye exam in the last year to maintain their vision, yet 80 percent do not know that age-related mucula degeneration, or AMD, is a leading cause of vision loss in people over 60, according to a new national survey. The survey, conducted by Opinion Research Corporation, found that only 46 percent of the 1,169 respondents could correctly identify the risk factors for this serious, progressive eye disease and just half could identify any one symptom. Of the 24 percent who are familiar with AMD, only 31 percent were aware that treatment options exist for the disease.

AMD occurs when the macula—the central portion of the retina that is important for reading and color vision—becomes damaged. There are two forms of AMD-wet and dry. All cases begin as the dry form, but 10 percent to 15 percent progress to the more serious wet form, which can result in sudden and severe central vision loss. Without treatment, central vision can be lost over time, leaving only peripheral, or side, vision.

In its early stages, AMD may not cause any noticeable symptoms. As the disease advances, symptoms may occur in one eye or both, and can include blurred vision, difficulty reading or recognizing faces, blind spots developing in the middle of the field of vision, colors becoming hard to distinguish and distortion causing edges or lines to appear wavy, according to research by the AMD Alliance and the University of Michigan Kellogg Eye Center.

If a person develops any of these symptoms, an eye exam is crucial and early diagnosis and treatment is essential to help avoid severe vision loss. A retina specialist should be consulted if there is a diagnosis of wet AMD, to ensure the most appropriate care.

Approximately 15 million people in the United States have AMD, and more than 1.7 million Americans have the advanced form of the disease. About 200,000 new cases of wet AMD are diagnosed each year in North America. Due to the aging baby boomer population, the National Eye Institute estimates that the prevalence of advanced AMD will grow to nearly 3 million by 2020.

The greatest risk factor for AMD is age. Other risk factors include gender (women tend to be at greater risk), race (Caucasians are more likely to lose vision from AMD) and family history. Living a healthy lifestyle can help reduce the risk of developing AMD. Several risk factors can be managed with your healthcare provider’s help, including obesity and smoking.

By Senior.com

Self-neglect, the most common mistreatment among Houston’s elderly, is a growing threat as baby boomers age

Ronald Fleming keeps a bed pallet on the floor next to the back door of his Houston home. The Texas Elder Abuse and Mistreatment Institute is making an effort to help Fleming get what he needs for a better life.

When caseworker Karen Edward arrives at her client’s northwest Houston home, the 74-year-old woman is sitting outside her front door complaining of vision problems and feeling sick to her stomach.

“Do you need care?” Edward asks. “Did you take your insulin?”

“No,” Clara replies in a faint voice.

It takes about 15 minutes for Edwards to persuade Clara, a diabetic, to get out of the midafternoon heat and indoors to take her medicine. Clara lifts her weak body from an old lawn chair and shuffles into her home of 49 years.

Loose electrical wires hang outside the front door of the three-bedroom house. The lawn has gone from lush green grass to dry dirt.

Inside, the carpet is worn and the walls need painting. Two weeks ago, neither was fully visible because they were covered floor-to-ceiling with Clara’s belongings. She had so much clutter, she couldn’t get around without falling.

Self-neglect common

Clara, who asked that her last name not be published, was referred to the Adult Protective Services agency about a month ago. Edward determined that Clara had fallen into self-neglect — the most common form of mistreatment among the elderly and a risk factor for early death, according to geriatric research.

In the Houston area, more than 60 percent of 1,500 cases handled each month by Adult Protective Services deal with elderly people who no longer can protect and provide for themselves, APS officials said.

People tend to dismiss odd behavior in the elderly as eccentricity, or they don’t want to get involved in someone else’s affairs, experts say. But self-neglect is likely to increase as baby boomers grow older, they say, making intervention and prevention more important than ever.

“We’re trying to educate the public and people dealing with the elderly about the services available to them,” said James Booker, director of Region 6 of APS, which oversees Harris County and 12 surrounding counties.

Focus of TEAM

In many self-neglect situations, the person just needs a little help to stay independent, Booker said. Most of the clients are women and most live alone, he said.

Self-neglect can be physical, medical or both. Some elderly people can’t cook, clean house or bathe themselves. Some don’t eat properly; some lack running water or air-conditioning. Their houses might be filthy and in disrepair.

Others lack access to medical care. They may have stopped taking their medicine or they haven’t seen a doctor in years and they’ve developed a serious illness, such as cancer or diabetes.

The breakdown in their ability to plan and carry out tasks can be caused by issues such as a stroke, dementia or depression, according to researchers.

To address self-neglect, Region 6 has collaborated with the University of Texas Health Science Center at Houston and Baylor College of Medicine for the past 15 years. The partnership is called the Texas Elder Abuse and Mistreatment Institute, or TEAM, which consists of clinical care, education and research. Region 6 is the only APS agency in the state to use such a multidisciplinary approach.

Worst case recalled

Self-neglect is a focus of the team because it is a factor in so many untreated medical disorders, said Dr. Carmel Dyer, a geriatric specialist at UT-Health Science Center and founder of TEAM.

“That’s why the risk of death is so high,” she said, noting that the mortality rate is substantial during the first year after a report of self-neglect.

Sabrina Pickens, a geriatric nurse practitioner and researcher at UT-Health Science Center, said the worst case of self-neglect she had seen involved an elderly man who lived in a garage apartment.

Neighbors reported that he poured his urine out the window. He had not bathed in six months. His hair and beard were matted, and his toenails had grown into his shoes. The man agreed to go to the hospital for a checkup. Doctors discovered he had untreated throat cancer, and he died within a month, Pickens said.

Caseworkers say the problem cuts across all socioeconomic backgrounds, but surfaces more often among the poor. In Texas, it’s mandatory to report any signs of abuse or neglect of child, a person 65 years or older, or a disabled adult.

APS investigates every report. When one is validated, caseworkers conduct a 52-question assessment and determine how to best help the client. The agency provides short-term assistance such as food, rent payments or transportation. It also will pay for medicine, home repairs and cleaning.

Once the immediate needs are met, the caseworker refers the client to social service providers for long-term help before closing the case.

Clients have the right to refuse help if they have decision-making capacity, said Angela Goins, an APS supervisor. The biggest challenge is getting them to understand the consequences of their behavior and that assistance is in their best interest, she said.

Clara refused help the first time APS received a referral about her.

Home decluttered

In the most recent referral, Edward, who wasn’t assigned to the first case, managed to gain Clara’s trust over several visits. Clara eventually agreed to let a crew clean her house and cart away many of the belongings she had been hoarding, a common problem in self-neglect cases.

APS paid for the cleaning, which took six days. It also paid for some electrical repairs because one side of Clara’s house had no electricity.

“She’s helped me a lot, caring and checking on me,” said Clara, feeling better after taking her insulin. “I would have been lost without her.”

When caseworkers suspect there’s a serious mental capacity or other medical issue, they call in a doctor or nurse from TEAM to visit the client’s home and do a geriatric assessment. If the assessment shows the client lacks capacity, TEAM can petition the Harris County Probate Court to appoint a legal guardian.

Only a handful of cases reach that point, APS officials said. TEAM also can get a court order to force the client to go to the hospital for treatment.

“We have to make sure their rights aren’t breached, but we also cannot abandon them,” Dyer said

By RENÉE C. LEE