In my blog on Nov 9th, I discussed the end-stage dementia issues and raised the question ‘Is dementia a terminal illness?’  When faced with terminal illness, seniors and their caregivers often choose palliative care.  Today, I’ll discuss that further.

What is a terminal condition?

In most states, a terminal condition is a status that is incurable or irreversible, and in which death will occur within a short time.  There is not a precise, universally accepted definition of “a short time,” but in general it is considered to be less than one year.  When looking at the hospice benefit, it will define “short term” as six months or less.

What is palliative care?

Palliative care is a comprehensive approach to treating serious illness that focuses on the physical, psychological, spiritual, and existential needs of the patient.  Its goal is to achieve the best quality of life available to the patient by relieving suffering, by controlling pain and symptoms, and by enabling the patient to achieve maximum functional capacity.  Respect for the patient’s culture, beliefs, and values are essential components.  Palliative care is sometimes called comfort care or hospice type care.

For more information: go to Caring Connections which is a program of the National Hospice and Palliative Care Organization (NHPCO), is a national consumer and community engagement initiative to improve care at the end of life, supported by a grant from The Robert Wood Johnson Foundation. Caregivers and seniors can find them online at www.caringinfo.org.

Caregivers and seniors can also visit the National Hospice and Palliative Care Organization (NHPCO) home page at http://www.nhpco.org/templates/1/homepage.cfm.
 

November is Alzheimer’s awareness month.  It is time to catch up with discussions about dementia and redefining dementia.  Dementia is often thought of as simply memory loss and/or a memory disorder.  While memory loss is the “hallmark” of dementia in its early stages, most caregivers treat it as illness and do not think of dementia as fatal. According to Catherine Elton at   time.com, “Experts in the field say dementia is more accurately defined as fatal brain failure: a terminal disease, like cancer, that physically kills patients, not simply a mental ailment that accompanies older age.”  Unlike other terminal diseases, as the older adult with dementia approaches the end of their life, they are often treated aggressively rather than with palliative care.  Read more about what experts are saying in Catherine Elton’s report: Experts Redefine Dementia as a Terminal Disease. 

if you're a caregiver, remember, when caring for an older adult with dementia always ask if the treatments are causing more distress AND if their pain being managed.  Check to see if the older adult has made their wishes clear regarding aggressive treatments, feeding tubes and CPR. Then advocate that their wishes are carried out. As a caregiver, if your parent or loved one is in the early stages of dementia and have not made their wishes clear, now is the time to talk to them and complete their advance directives/living will.  A geriatric care manager can help caregivers and their aging loved ones address these issues.

For more information on treating advanced dementia as a terminal illness requiring palliative care go to Catherine Elton’s report: Experts Redefine Dementia as a Terminal Disease.

The holidays are quicky approaching us!  That means traveling near and far to visit with family and loves ones.  This is such a great time of the year so I wanted to provide you with some tips to help traveling go smoothly when you are bringing along someone who has a cognitive impairment.   In addition, November is also National Alzheimer's disease Awareness Month so I wanted to address a topic related to Alzheimer's disease this month.  Below are some holiday travel tips from the Alzheimer's Association:

• Avoid having a rushed schedule.  This only increases anxiety.
• If traveling by plane, minimize stops and long layovers in the airport
• Travel at a time when the person is most alert
• Rely on familiar and comfortable destinations
• Carry identification such as the Safe Return/Medic Alert bracelet, which can be purchased through the Alzheimer's Association.

Following these tips will help the caregiver and the person with dementia have a safe and hopefully a great time when visiting families and friends.  In addition, vaccinations are also important for older adults when traveling.  For more information on vaccinations and traveling with older adults, please refer to Jean Bandos blog titled "Vaccinations and Travel Planning for the Elderly".

Sometimes, it is human nature to focus on what “is lost.”   The focus can be on tangible things such as a job, a sporting event, a favorite item or it can be on intangible things like a train of thought, youth or innocence.  When there is an Alzheimer’s diagnosis it becomes very easy to focus on what is lost, for example  when your parent forgets how to get dressed, how to use the phone and how to pay their bills.  Yet, focusing on what is lost isn’t helpful to anyone.  It causes extreme frustration for the senior and sadness within the family.  I’d like to suggest a new frame of reference for caregivers – to focus on things that are “still here” like a sense of humor, a smile returned and a love for movies and chocolate. 
Earlier this week I participated in an activity with my Mother and her fellow neighbors at a memory care unit.   The game was called Penny Ante and began with everyone receiving 25 pennies and a pot holding pennies in reserve.  Everyone took turns drawing cards from a deck and following the instructions.  For example –  “Take a penny from the pot if you have ever seen the Golden Gate Bridge” or “Give every player a penny if they have blue eyes. “ There was a lot of laughter as pennies were lost and gained.  To be honest there was some confusion too.  One player drew a card – “Take a penny if you have ever visited New York City,” but could not remember if she had been to NYC or not.  This is when my Mother shined.  For her response was “I bet you have, you should take a penny.” 

When it was my Mother’s turn, she had to give a penny to everyone wearing blue.  I happened to be the only one at the table wearing blue…which meant she had to give me a penny.  She hesitated for a minute or two and I teasingly reminded her she needed to give me a penny…thinking she had forgotten that part of the game.  She looked at me and said – “I know, I am looking for a shiny one for you.”  A few seconds later, she pushed  a shiny penny towards me, the best of the ones she had before her.   My eyes filled as I realized she wanted to give her daughter the best she had….just as she had always done. In that moment, her love shined through the memory loss, the dementia, the falls and the frailty, to remind me that the Mother I know is “still here” shining bright as a new penny. 

Many adults question their memory as they get older and wonder if losing their keys is a part of normal or healthy aging.  Recently, the Alzheimer’s Association came out with a list of 10 signs to help distinguish between what is normal and what is not with your memory as you age. 
So, what is normal and what isn’t?

Typical/Normal
1. Sometimes forgetting names or appointments but remembering them later
2. Making small errors sometimes when balancing a checkbook
3. Sometimes needing help with recording a TV show or help with microwave settings
4. Getting confused what day of the week it is but later figuring out what day it is
5. Visual changes due to cataracts or other eye problems
6. Sometimes having a difficult time coming up with a word while in conversations
7. Misplacing things once in a while such as the remote control or eyeglasses
8. Sometimes making a bad decision
9. Sometimes feeling of weary of family, work or other obligations
10. Developing a routine of how to do certain things and getting irritable when the routine is done a different way

What could be signs of Alzheimer’s?
1. Memory changes that disrupt life – Asking information repeatedly
2. Challenges in planning or solving problems – May have difficulty following a familiar recipe 3. Difficulty completing tasks at home or work – May have trouble finding the location of a     place or remembering the rules of a favorite game
4. Confusion with time or place – Sometimes they forget where they are or how they got there
5. Trouble understanding visual images and spatial relationships – They may have trouble reading or judging distances
6. New problems with words with speaking or writing – May have trouble following or joining a conversation
7. Misplacing things and losing the ability to retrace steps – A person with Alzheimer’s may put things in unusual places and not remember where they put it
8. Decreased or poor judgment – They may use poor judgment when dealing with money such as giving large amounts of money to telemarketers
9. Withdrawal from work or social activities – They may have trouble remembering how to do their favorite hobby
10. Changes in mood and personality – They may become confused, suspicious, depressed, etc.

For more information on differences between normal and healthy aging vs. dementia, please visit the Alzheimer’s Association at www.alz.org or call their 24 hour helpline at 800-272-3900.

We know so much, yet so little about Alzheimer’s Disease.  And what we do know can be very, very discouraging.  Today we know that ….there is no cure, the disease worsens as it progresses, and while the drugs available may slow down the progression, they do not stop the disease.  I find myself wondering – “Where is the hope?” “What does the future hold?” …… and most importantly “Where is the research?” 

To learn more about the disease and what is being discussed for the future – visit HBO online and view the documentary “The Alzheimer’s Project” (http://www.hbo.com/alzheimers/).  The series is divided into four segments.  Each segment focuses on a different aspect of the disease including:  The Memory Loss Tapes, Grandpa Do You Know Who I Am?, Momentum in Science, and Caregivers.

As an active caregiver for a Mother with Alzheimer’s, I found the series difficult to watch at times.  Yet, I felt an instant bond with the other families I saw struggling with the same disease and, who like me; don’t seem to have all the answers.  It was also comforting to learn about the research being done and the minor discoveries made to date.  Hopefully the research will lead to a significant breakthrough to help better understand and eventually cure Alzheimer’s Disease.

At a recent appointment with a new doctor, I revealed my family’s history of Alzheimer’s Disease.  To date, the cases I am aware of are Grandmother, Mother and Aunt.  Of course I wonder if the next generation – me and my sister- will inherit this insidious disease.  My doctor counseled that inflammation may seem to contribute to the disease.  So, I left with advice to take a daily low dose aspirin and  fish oil capsules.  How much happier I would have been to receive a vaccine like the ones available for mumps, measles, shingles, etc.   Maybe this will happen in the future – I certainly hope so.   

Likely you have seen some variant or another of this article "Helping the Elderly Keep Their Driving Skills" talking about helping seniors keep their mind sharp.  Whole companies have cropped up like the one mentioned in this article, Posit Science, around the idea computers and software can help. 

Certainly games like these are interesting and often fun, but their claims are largely unproven.  Comments like the brain is "the most important muscle in the body" is, at best, metaphorical.  The brain is, of course, nerve tissue not muscle tissue.  "Exercising" the brain has little impact on senior memory loss brought on by Alzheimer's or other serious forms of dementia. 

Driving is one of the big safety issues with seniors and for those people who are not facing serious cognitive decline, they may find these games fun and somewhat beneficial.  Of course, physical limitations such as immobility are not impacted.  At a minimum, I would expect some gains in driving skill just from the heightened awareness.  Likely most of us could gain from that lesson.

See more on Posit at http://www.positscience.com/. 

The final installment of the SCANS 1.3 rolling release is complete.  The July release includes some 22 new and revised tools and resources.  The list includes:

• Medicare Summary
• Medicare A Information
• Medicare B
• Insurance Resource
• SHIP
• Medigap
• Medicare C and Advantage Plans
• Earwax
• Visual Impairment Websites
• Hearing Impairment Websites
• Visual Impairment Devices
• Optometrist vs. Ophthalmologist
• Bladder Training
• Foley Catheter Care
• Urinary Continence Education
• Incontinence Supplies
• Catheter Education and Support
• Brain vs. Bladder
• Incontinence – Foods to Avoid
• Tips to manage Incontinence with dementia
• Continence Bladder Diary
• Modify Environment to Assist with Continence

Thanks to the SCANS research team for this successful (and popular) release which included some 74 new tools!  You can read more about these topics from a caregiver's perspective directly from one of our researchers Karen Witt Kelsey.  Click here to read more in her Caregiver Support blog.  Karen is a key member of the research team as well a caregiver for her own mother.  You'll enjoy her unique perspective on senior health care.

Last week I had the opportunity to present a paper at the Human-Computer Interaction International Conference.  This was the 13th occurrence of the conference and the event was well attended by key researchers and companies concerned about how computers interact with people. 

Jean Bandos co-authored the paper titled "Impacting the Continuum of Caregiving through Innovation in Informatics: Senior Care Navigation System (SCANS)".  Other members of the SCANS team contributed, as well.  You won't find the paper in the conference proceedings however, due to Intellectual Property concerns with the conference publisher's copyright requirements.  In spite of those restrictions the paper and the presentation were well received.

What struck me about the conference on a general level was the amount of attention being given internationally to the challenges of older adults and senior health care.  Conference attendees came from China, Japan, UK, Germany, India, Spain, and many other places - representing some 49 countries in all.  Support for seniors living independently and dealing with challenges like immobility, well-being, and cognitive decline surfaced as a major sub-theme to the conference.  World wide researchers are examining how computers can help with aging parents.  

The specifics were wide ranging from topics like augmented navigation for assistive mobility devices to ontologies for adaptive user interfaces to cope with the specific needs of the elderly. 

I was genuinely encouraged that so many top brains are looking for ways to improve eldercare services.

A colleague handed me a flyer today from a local cardiac physician group for cool little wallet sized CD they provide their patients with key medical information on it. 

The idea is that you carry this card in your wallet and in an emergency situation you can hand the card to a provider who can then view it on a computer capable of reading a data CD.  Even if you are unconscious, medical personnel can find the card style CD and view it.

The CD contains things like:

• medication lists
• current diagnosis
• current allergies
• discharge summaries
• diagnostic test results
• and even educational materials

All in all this is a good thing.  It also points out some of problems with "high tech" solutions to emergency information. 

• First, not all emergencies will allow time for medical staff to leave the patient in order to find a PC with a CD drive and review a set of unfamiliar computer documents.   
• Second, in order for this information to be easily read in an emergency situation, it is also easily read by anyone who steals or even simply has access to a person's wallet.  Because it's a CD, it's also not clear exactly what data is on the record; leaving seniors and families caring for aging parents to wonder what information is potentially disclosed.
• Additionally, the currency of the data may be questionable.  Frequent health and medication changes are common in older adults and this approach requires notification back to the provider, payment of an update fee, and the reissuing of the wallet CD.  Allowing reasonable times for such activity, it could be very difficult to keep this up to date.
• Even small scratches from "wallet wear" on the CD can render it unreadable.  Something that wouldn't be readily apparent until the CD was checked in a computer drive.  Often, I fear, at the time the information is most needed. 
• Lastly, the completeness of the data may be in question as it relies on the patient, often a senior with depression or memory loss, to report the activities of the disjoint senior health care system.

My Health Care Manager approaches this problem differently.  Our geriatric care managers collect, review, and update information across all of a client's health providers.  This Personal Health information (PHI) is then used to inform all providers engaged in the client's health.  For example, each of the client's physicians receives the medication list initially and then again for every medication update. 

For emergency situations, clients are given a Ready Reference Card which contains all the key medical information and alerts.  This PHI easily folds to the size of credit card for wallet use and multiple copies can be kept in other key areas, for example in a specially identified pocket on the client's refrigerator where emergency personnel are trained to look. 

Because the Ready Reference is a paper record it is immediately available to emergency personnel in settings where a CD reader may not be at hand such as the senior's home, as shopping center, and so on.  It is also quick and very inexpensive to reprint when updates are needed.

The point here is not that technology is bad.  On the contrary, technology enables both of these solutions.  We should put it to work in the most effective ways we can devise for seniors and their families.

Not to be out done by the Navigator development team, the SCANS team is continuing their "rolling release" of V1.3.  SCANS is the Senior Care Navigation System that provides geriatric care managers with expert advice, best practices, and practical tools to help families with the well-being or their parents.

The June edition of V1.3 includes 26 new resources, process, or tools.  The list includes items like these:

• Death in the Home – Information for Caregivers
• Tips for Alzheimer Caregivers
• Delirium vs. Dementia
• Transitioning an Individual with Dementia into a Facility
• Member Portal Instructions
• Continence Education – Constipation
• Urinary Incontinence – When to Seek Immediate Medical Attention
• Crime Prevention Education for Older Adults
• IADL (Independent Activities of Daily Living) Education
• Physical Therapy and Occupational Therapy
• My Medicare Matters
• Advance Directives for Mental Health Treatment
• Drug Review and Side Effects
• Geriatric Friendly Pharmacy
• Medicine Reconciliation:  Brown Bag Consultation
• Feeding Tube Education
• Special Diet Needs Education
• Defibrillator Education
• Diabetes Education
• Fibromyalgia Education
• Pacemaker Education
• Physician Planner Case Note
• Alternative Living Options Education
• Speech Therapy Education
• Social Participation Barriers
• Social Support Plan

These tools are available to the clients of My Health Care Manager and our affiliates.  Some of the content is also discussed in our blogs and can be accessed for free.  Check out Natalie Langley's blog titled "Healthy Aging".  Natalie is one of the principle researchers and authors of the tools in SCANS.  Her blog covers a holistic look at healthy aging and senior well-being.

As a caregiver, the responsibility for decisions regarding your parent’s care falls to you.  Often you wish you could discuss the options, choices and next steps with your parent, just as you discussed so many choices in the past…where to go to college, where to have your wedding reception, which neighborhood to select.  But parents with Alzheimer’s cannot help with current decisions as their ability to reason, compare and choose has been ravaged by the disease.  Sadly, dementia robs them of their ability to chart their own course.

So, what should caregivers do when faced with a variety of paths – how do you know how to choose what is best for your parent? How do you know when a parent’s living environment is no longer safe? How do you know when a parent needs more assistance? 

Here are a few suggestions:

• Pay attention to your parent – they may be confused, but they will give you clues when things aren’t going well.  They may seem more agitated, confused or disoriented.  Their routine may change and a situation that has worked well in the past, now poses problems.  For example, they may no longer want to eat dinner because they either can’t remember where the Assisted Living Dining Room is located, or they are afraid to leave their apartment.  
• Check in with their caregivers – have other family members, a companion, assisted living staff or adult day care workers noticed a change in your parent?  Are they concerned? 
• Take your parent in for a check-up – have the Doctor evaluate your parent and review their medications and mental and physical health. 
• Review your parent’s ability to complete Activities of Daily Living – things like bathing, dressing, continence, mobility, feeding.  Has there been a change in their ability to do these things?
• Engage a Geriatric Care Manager – have them conduct an independent assessment to provide an unbiased view of the situation.

Once you have gathered the above information, spend time thinking and talking to others you trust about the findings.  Choose the next step based on what you think is best for your parent at this moment in time.   For instance, if you determine that they need more assistance, think about the pros and cons of providing additional assistance in their current environment vs. moving them to a new environment such as a Memory Care Unit.   There is no “right” decision.  Take comfort in the fact that you have been both thorough and thoughtful when you made the decision.  Always remember that your parent is better off when you address concerns as they arise vs. postponing decisions until a crisis arises.

The SCANS content team headed by Jean Bandos along with the development team announced today that the SCANS Version 1.3 - May release is now available.  SCANS Version 1.3 is a major content release to the SCANS Knowledge Base.

In order to make more real-world tools for eldercare available more quickly, Jean and the team have devised a "rolling release".  For 3 months beginning in May another group of resources, processes, and tools will be made available to geriatric care managers at My Health Care Manager and our affiliates.

The May release contains 57 new and/or revised resources, processes and tools.  Some sample items include: 
 

• Behaviors and Alzheimer's Disease
• Grief Education
• Activities of Daily Living Education
• Depression and Alzheimer's disease
• Early Stages and Impact on Health
• Memory & Cognition Questions
• Memory Care Unit Checklist
• Memory Care Unit Education
• Mild Cognitive Impairment
• Sobriety Programs Resource
• Handyman Resource
• Private Handyman Contractor Checklist
• Smoke & Carbon Monoxide Detectors
• Daily  Money Management Education
• Financial Planning Education
• Trust Education
• Verifying Funeral Arrangements
• Veterans Benefit Information
• Elder Law Resource & Checklist
• Medication Management Procedure
• Medication Reconciliation
• Polypharmacy
• How to Find a Pain Specialist
• Pain Education
• Pain Resources
• Pain Visual Analog Scale
• Arthritis
• Heart Failure
• Hypertension Education
• Family History - Cancer Education
• Family History - Dementia
• Family History - Diabetes Education
• Family History - Heart Education
• Seat Belt Education
• Cataracts Education
• Glaucoma Education
• Hearing Aid Education
• Sensory Changes
• Assistive Devices
• Hospice Education
• Spiritual Connections

Stay tuned; the June release will include resources on incontinence, cognition, supporting services, and more processes.

Be sure to visit Jean's blog, click here.

As a follow up to my last blog, if you missed “The Alzheimer's Project", the groundbreaking HBO documentary series aired May 9 – 12, the films are available online at www.alz.org/HBO and also at http://www.hbo.com/alzheimers/. They will also air again throughout May on HBO and HBO2.

If you were able to watch, please share your thoughts about ‘The Alzheimer's Project’ at http://alzheimers.infopop.cc/eve/forums and here on my blog.  The Alzheimer’s forum page has several opportunities: not only can you discuss the project, but it also has forums for those who have Alzheimer’s Disease, questions about medication treatments, caregiving, and forums in Spanish.

Remember that Alzheimer's is not a normal part of aging – it's a progressive and fatal disease.  Every 70 seconds someone develops Alzheimer’s and now Alzheimer's disease is rated the seventh-leading cause of death.

If you are assisting someone with memory loss or Alzheimer’s Disease, speak with your loved one’s health care provider and visit www.alz.org to learn more on how to support yourself and your loved one.

HBO is doing a documentary series on Alzheimer's starting this Sunday, May 10.  Titled 'The Alzheimer's Project', the series is comprised of four parts.

1. The Memory Loss Tapes
2. Grandpa, Do you know who I am? (with Maria Shriver)
3. Momentum in Science
4. Caregivers

There is also an accompanying book and DVD, as well as supplemental series of 15 videos focusing on the research and medical side of Alzheimer's available to stream online.

A national survey completed in conjunction with The Alzheimer's Project found that 54% of the US population has been affected by some way in Alzheimer's.  With such a huge impact on our society, I encourage health care providers, caregivers, seniors, and anyone else affected by Alzheimer's or a loved one's cognitive decline to watch this series.

The website has great information, but please make sure to ask your health care provider if you have questions.  A geriatric care manager can also help caregivers and seniors address issues associated with Alzheimer's and cognitive decline.

For more information on the series, visit http://www.hbo.com/alzheimers/index.html.
To watch the supplemental series, visit http://www.hbo.com/alzheimers/the-supplementary-series.html.

Caregivers for those with cognitive decline or Alzheimer's can find free help from their local Alzheimer's Association.  Whether you're looking for ways to better communicate with someone with Alzheimer's, ways to reduce your caregiver stress, or even seeking other local resources, the Alzheimer's Association is a great place to start your search.

Local Alzheimer's Associations often give conferences for caregivers.  Topics often covered include communication, home safety, and well-being.  Presenters have extensive experience in geriatrics and caregiving topics.  In addition, you can connect with other caregivers for support.

There will be a caregiver's conference on May 15th in Indianapolis, and I encourage you to attend.  For more information, visit the local Alzheimer's Association website. 

For information on events in your city and state, visit the national Alzheimer's Association website.

Indiana could soon pass a new law.  Silver Alerts are similar to Amber Alerts, but are for missing and endangered adults/seniors.  This proposition was put forth by Senator Pat Miller.  It would require the law enforcement training board to provide training in interacting with missing and endangered adults, including seniors with Alzheimer's Disease or dementia.  Silver Alerts could help thousands of Indiana seniors who become lost.  The Silver Alerts would be issued by the police and broadcast among media outlets.  Currently, there are 10 other states who have a similar law.  House Sponsors include Rep. Dennis Avery (D-Evansville) and Rep. Mike Murphy (R-Indianapolis).  The House of Representatives passed the legislation 98-0.  It is now on its way to Gov. Mitch Daniels for consideration.

**The following post is from my guest blogger, Natalie Langley, MSW.  She is a Geriatric Care Research Analyst for SCANS (for more on SCANS, please see Eric Tinsley's blog by clicking here).**

There are several barriers that can impact the older adult’s ability to achieve good nutrition.  The following checklist can help to ensure older adults are getting the proper nutrition. 

Determine if there is a problem that impairs their ability to eat:

1. Have a physician/pharmacist review side effects of medications.
2. Are their teeth/dentures in proper condition?
3. Are there any physical limitations relating to pain and arthritis?
4. Is there a decrease in a sense of smell and taste?
5. Are finances a barrier?
6. Is their eyesight failing?
7. Do they have weakness and are not able to carry grocery bags?
8. Is forgetfulness or dementia present?

As a caregiver or an older adult, make sure to enlist people and programs within the community to help with meal assistance.  One way is to contact your local Area Agency on Aging for meal programs for older adults, such as Meals on Wheels.  This program offers deliverable meals for older adults in their homes.  For a list of local Area Agencies on Aging, you can visit www.n4a.org. 

Another good resource for meal assistance is Seattle Sutton's.  This is an Illinois based company, but they have locations everywhere.  They offer healthy, prepared meals for a reasonable price.  To find a location near you, please visit their website at http://www.seattlesutton.com/.
 

In working with seniors and their families, end of life care issues always come up.  It is a hard decision for the senior and families to make end of life care decisions, for example, whether to continue treating an illness or disease, implementing palliative care, or inserting a feeding tube.  These difficult decisions can often be made ahead of time by the individual via a Living Will.  Living Wills allow individuals the ability to document their end of life wishes, treatment preferences, and care options.  Any person over the age of 18, who is considered competent to make their own decisions, is able to complete a Living Will.  Living Will forms can be found at your local library, the internet, or an attorney's office.  Some states develop and recognize state-specific Living Will forms.  To download your state's specific advance directives form, check out Caring Connections.

The most difficult end of life decision to make is whether to insert a feeding tube or not.  A recent article from Health Behavior News Science, addresses recent studies on this issue.  For people with Advanced Dementia or degenerative dementia, the body is unable to metabolize food properly due to the brain damage.  The biggest fear for families is wondering if their loved one is "starving to death" or experiencing pain from hunger and thirst.  Hospice studies have indicated that few people experience this type of pain.  And if pain is exhibited it is often alleviated with palliative care and pain management.  In my career, I have had several physicians state that due to the brain damage and with the body going through the end of life process, that our bodies do not feel hunger or thirst.  But will we really ever know the answer to that question??  My motto as a geriatric social worker has always been, if I've made someone as happy and as comfortable as possible while they are here with us then I've done my job.  What I do know is that the decision to place a feeding tube is an individual decision and each person's situation should be considered separately.

For more information on studies, reviews of health care interventions, and evidence of clinical trials, check out the Cochrane Collaboration.

According to the latest report from the Alzheimer’s Association, the total health care costs are more than three times higher for people with Alzheimer’s and other dementias than for other people age 65 and older. It is reported that there are 5.3 million Americans living with the disease and every 70 seconds someone in America develops Alzheimer’s disease. By 2010, it is estimated that there will be nearly a half million new cases of Alzheimer’s each year. Currently we know that Alzheimer’s is the sixth leading cause of death in the country, surpassing diabetes; it is the fifth leading cause of death among individuals 65 and older.

My next blog will cover the newest focus for Alzheimer’s: early detection and intervention.