Tuesday, September 6, 2011

Cognitive Therapy For People With Dementia

In March, 2010, I wrote a piece entitled "Can Painting Help Dementia Sufferers?" I was so impressed with this concept that I suggested to the person in charge of art for the library in Boynton Beach, Florida, that, considering the demographics in the area, she consider starting a program like this. Maybe it was budget considerations, but I never heard from her.

Now, along comes Cognitive Dynamics a website devoted to what they call "Bringing Art To Life." In my opinion, they are doing exciting work showing the potential of people with dementia to enjoy an enhanced quality of life and to find ways to express themselves that are not word-dependent.

See their video, "Bringing Art to Life in Beverly Hills" as well as their website and I bet you'll agree with me that they are onto something fabulous. And it's not just art therapy. Their program includes music, drama and poetry therapy as well as art.

They describe their mission as:"To improve the quality of life of patients with cognitive disorders (such as Alzheimer’s disease) and their caregivers through education, research, and support of innovative care models which promote human dignity, especially therapies employing the expressive arts."

So I suggest becoming familiar with the work of Daniel Potts, a Neurologist with a special interest in cognitive enhancement for dementia patients, and Ellen Woodward Potts, Co-author of A Pocket Guide for the Alzheimer's Caregiver, Managing Partner at Dementia Dynamics, LLC and instructor at the University of Alabama. These folks are shining a much needed light onto the darkness of our current knowledge of dementia.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
Paperback: http://dementia-diary.com
e-book: http://www.smashwords.com/books/view/9565

Sunday, August 14, 2011


This is an encore article originally published in January, 2009. The more we learn about memory and cognition, the more relevant this article becomes. See what you think–

I'll never forget the shock I felt when I first heard the following comment from a medical professional: "It's not about memory, it's about cognition."

He was talking about dementia and what, in his opinion, is a popular misconception that leads to a lot of unnecessary worry by people who are suddenly forgetting names and where they placed things like the car keys.

What did he mean, "it's not about memory?" After all, it was obvious to me that it was indeed about memory. I was closely monitoring my mother's symptoms as she sank deeper and deeper into the opaque fog of her multi-infarct dementia. She was forgetful about everything, including exactly who I was. I mean, the nurse asked her during one of my visits:

"Look who's here, Millie. Do you know who this is?"

Mom smiled and said, "Of course I do. He's my grandson."

"No Mom," I said. "I'm your son."

"I knew that," she said, still smiling.

So wasn't that about memory? Of course it was. What the medical professional meant was that it's more complicated than that.

Most of us have heard the expert statement that if you forget where you put your car keys, you don't have to worry about dementia. But if you forget what the car keys are for, that's serious. That could be dementia. That's not just a memory problem (although memory is certainly part of the picture), that's cognition, which the dictionary defines as: "the act or process of knowing; perception."

It's subtle but it's real. Mom didn't just forget me. In fact, she remembered me. She just didn't know who I was.

This isn't just semantics. As we age, most of us develop retrieval problems where we can't instantly recall something or someone that should be very familiar to us. According to my medical professional, that's a normal memory issue far removed from dementia.

But it's still darned annoying, isn't it?

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"
Paperback: http://www.dementia-diary.com
e-book: http://www.smashwords.com/books/view/9565

Thursday, June 16, 2011

Can Olive Oil Help Prevent Strokes

Yes, according to a French study reported today in Medical News Today that suggests a protective role for olive oil among older individuals. To read the full article click on: Medical News Today.

As with most such information, however, I suggest a dose of skeptical salt along with the olive oil as a good idea until the findings are proven or dis-proven through clinical trials. Still, olive oil is an enjoyable and tasty substitute for butter and most other vegetable oils. I will continue to dip my bread in it.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"

Wednesday, April 27, 2011

Generation Alzheimer's

This year, the first of the Boomer Generation turns 65. To bring urgently-needed attention to the risk facing the Boomers, Alzheimer's Association recently released a groundbreaking study Generation Alzheimer's: The Defining Disease of the Baby Boomers. The full text of the Alzheimer’s Association’s "Generation Alzheimer’s" report can be viewed at www.alz.org/boomers.

Here are some facts the Alzheimer's Association has published about this issue:

* Many baby boomers will spend their retirement years either with Alzheimer's or caring for someone who has it.
* An estimated 10 million baby boomers will develop Alzheimer's.
* Starting this year, more than 10,000 baby boomers a day will turn 65. As these baby boomers age, one of out of eight of them will develop Alzheimer’s – a devastating, costly, heartbreaking disease. Increasingly for these baby boomers, it will no longer be their grandparents and parents who have Alzheimer’s – it will be them.
* "Alzheimer’s is a tragic epidemic that has no survivors. Not a single one," said Harry Johns, president and CEO of the Alzheimer’s Association. "It is as much a thief as a killer. Alzheimer’s will darken the long-awaited retirement years of the one out of eight baby boomers who will develop it. Those who will care for these loved ones will witness, day by day, the progressive and relentless realities of this fatal disease. But we can still change that if we act now."
* According to the new Alzheimer’s Association report, "Generation Alzheimer’s," it is expected that 10 million baby boomers will either die with or from Alzheimer’s, the only cause of death among the top 10 in America without a way to prevent, cure or even slow its progression. But, while Alzheimer’s kills, it does so only after taking everything away, slowly stripping an individual’s autonomy and independence. Even beyond the cruel impact Alzheimer’s has on the individuals with the disease, Generation Alzheimer’s also details the negative cascading effects the disease places on millions of caregivers. Caregivers and families go through the agony of losing a loved one twice: first to the ravaging effects of the disease and then, ultimately, to actual death.
* "Most people survive an average of four to six years after a diagnosis of Alzheimer’s disease, but many can live as long as 20 years with the disease. As the disease progresses, the person with dementia requires more and more assistance with everyday tasks like bathing, dressing, eating and household activities," said Beth Kallmyer, senior director of Constituent Relations for the Alzheimer’s Association. "This long duration often places increasingly intensive care demands on the nearly 15 million family members and friends who provide unpaid care, and it negatively affects their health, employment, income and financial security."
* In addition to the human toll, over the next 40 years Alzheimer’s will cost the nation $20 trillion, enough to pay off the national debt and still send a $20,000 check to every man, woman and child in America. And while every 69 seconds someone in America develops Alzheimer’s disease today, by 2050 someone will develop the disease every 33 seconds - unless the federal government commits to changing the Alzheimer’s trajectory.
* "Alzheimer’s – with its broad ranging impact on individuals, families, Medicare and Medicaid - has the power to bring the country to its financial knees," said Robert J. Egge, vice president of Public Policy of the Alzheimer’s Association. "But when the federal government has been focused, committed and willing to put the necessary resources to work to confront a disease that poses a real public health threat to the nation – there has been great success. In order to see the day where Alzheimer’s is no longer a death sentence, we need to see that type of commitment with Alzheimer’s."

Here's a brief video that you may find interesting.

Please support your Alzheimer's Association to help them with the great work that they do.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"

Friday, April 15, 2011

What Do Elderly Patients And Astronauts Have In Common?

Today's post is a guest essay written by a distinguished physician, Dr. Harold Rodner, a doctor of Internal Medicine, with a sub-specialty in geriatric medicine. He has an active clinical practice in Southeastern Michigan, and is an outspoken advocate of quality health care for the elderly.

Here is Dr. Rodner's essay—

"What does my 92 year old mother-in-law share with an astronaut? They both have had a gravity free experience, the astronaut in space, my mother-in-law in a hospital bed.

"The deconditioning that occurs in space also occurs in a hospitalized patient. On earth, we are constantly exposed to the mechanical stress of gravity when we are up and about. In space or in bed this effect is reduced or lost. As a result, muscle and bone mass is diminished. For the elderly patient this is added to the loss that occurs with aging. Inactivity also decreases flexibility which an older patient can least afford. Bed rest increases the risk of pneumonia, blood clots to the legs and lungs and bed sore.

"In space, sensory disorientation can occur during the first few days. In the elderly who are prone to developing delirium this is a concern. Prolonged bed rest can be a contributing factor for an extended hospitalization and increases the chance of being discharged to a rehab unit in a nursing home. To quote an associate, “One day in bed, two days in rehab.” As a former Medical Director of a nursing home, I saw this first hand.

"In many hospitals, the dedicated nursing staff is over worked and understaffed. As a result, mobilizing a patient is a time consuming event and not a top priority. According to Dr. Angela Gillis writing in the The Journal of Continuing Education in Nursing in 2008, “ Today’s nurse lacks gerentological preparation in deconditioning prevention and are unable to understand and meet the needs of older adults entrusted to their care.”

"Recently, an eighty year old patient’s wife described her experience in the hospital. She said “She didn’t want him to lose what he had.” She requested that the staff walk him. Their response was ” They would do it when they had time.” She then described to me a positive experience she had during a prior hospitalization at another hospital. Therapists dedicated to walking patients assisted in his ambulation.

"Physicians are so preoccupied with the complexity of their patient’s needs they quite often forget to mobilize them or aggressively enforce their order for increased activity. They are not alone in not fully appreciating the risks of bed rest. I reviewed the index of the geriatric review syllabus I used to prepare for my geriatric recertification in 2008. There is no reference to risks of bed rest in the elderly. The syllabus was published by the American Geriatrics Society.

"With all this in mind, I went into high gear with my mother-in-law’s admission for pneumonia. I had the hospitalist write an activity order, “Ambulate in the hall daily with assistance.” I requested a physical therapy consult, hoping that this would lessen the burden on the nursing staff. I also enlisted members of the family to walk her. After six days she was discharged to her senior citizen apartment at her baseline activity level.

"Many things are beyond the control of a family when a loved one is admitted to the hospital. Avoiding deconditioning is one area where they can be proactive. Finally, think of the additional cost to the health care system that could be avoided if the professional care givers were proactive."

That ends Dr. Rodner's essay. If you enjoyed reading it, please feel free to post your comments.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"

Sunday, April 3, 2011

Genetics & Alzheimer's--Is There A Connection?

An article in today's New York Times reports on two studies that have discovered five new genes that seem to make Alzheimer's Disease more likely, although only slightly. This is being called an important breakthrough in the research seeking causes for the dementia, but there is no intention to use these genes as a diagnostic or prognostic tool. For more information, see the article by clicking the NY Times

The study results are being hailed as a big step in progress toward understanding Alzheimer's Disease. As we all hope, success at beating it will finally come from the cumulative effect of all the research being done now and yet to be financed. It's a slow but steady pathway to this goal.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"

Sunday, March 6, 2011

This is Read an E-Book Week

All my e-books, including Dementia Diary are available for a 25% discount during Read an E-book Week—March 6 to 13. Go to Smashwords for details.

Monday, February 28, 2011

More on Coconut Oil and Alzheimer's—Is it true?

See my post of March 12, 2009, entitled, "CAN COCONUT OIL HELP ALZHEIMER'S?" But...is it true? I've been following it and, so far, can find little or no mention of real research being done by any of the main authorities in aging, dementia, Alzheimer's, medical care, medical research, etc. If any of my readers know of such research, please let me know.

I've long believed that if something is too good to be true then, generally, it is likely to be untrue. Nevertheless, this is an intriguing pathway that just cries out for legitimate research. The October 5, 2010 article, "Coconut Oil and Alzheimer’s Disease," published on-line by the Alliance for Natural Health (http://www.anh-usa.org/coconut-oil-and-alzheimer%E2%80%99s-disease/) is noteworthy. However, everything I can find is based on the one anecdote concerning Dr. Mary Newport and her husband Steve's apparent improvement from the use of coconut oil.

This may—or may not—be something to give hope to Alzheimer sufferer's and their caregivers. How cruel if it gets up their hopes only to be one more false pathway. But how horrible, too, if it turns out to be a meaningful way to ease their suffering but few know about it. Time will tell. Stay tuned.

And, again, please let me know of new developments about coconut oil and Alzheimer's Disease.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"

Monday, February 21, 2011

What Does "Entitlement" mean?

This topic has been bothering me for a long time. People speak about a "Culture of Entitlement" as though it is something dreadful to be avoided. How has the word "entitlement" become derogatory? Are beneficiaries of programs such as Social Security and Medicare unworthy of the benefits they receive? What's in a word, anyway? Can such words actually influence national policy?

Wikipedia, The Free Encyclopedia on-line, defines a "Culture of Entitlement" as an expression "often used to criticize perceived abuses ..." Wikipedia goes on to say that "critics of a culture of entitlement often believe that the free market...is the most responsible approach to correcting these inequities...The phrase often implies that the recipients of government entitlements are individuals that do not deserve to receive such benefits or entitlements."

In my view (and I don't think I am alone in this), two of the most successful Federal programs of all time are Social Security and Medicare. They have helped to end poverty among American seniors. To me, they reflect the best of what America is all about–because, when all the noise dies away, Americans are among the most generous of peoples.

And yet, Social Security and Medicare are now viewed by many Americans as "entitlements." How did this happen? And why should we care?

Among, a growing segment of our citizens, these programs offend the deeply held belief that government should keep its grubby hands off such things. Folks with this ideology have been trying for decades to destroy these programs.

They have done this, and are doing this, by undermining public confidence in Social Security and Medicare whenever and however they can. Inventing and promoting the phrase "Culture of Entitlement" is an important part of this strategy.

And it is working. Think about it. These kind and benevolent programs, totally in keeping with the Judeo/Christian value system, have been branded with a term that has pejorative connotations. Instead of a gift from one generation to the next, the word "entitlements" somehow smacks of undeserved and unearned greed. And much of the media has stampeded to the use of the word “entitlements” in all of its printed and electronic output.

How thoughtless can these journalists and, yes, of many of our politicians be, in planting the seeds of doubt in the minds of fellow Americans. In so doing, they play right into the hands of those seeking to destroy Social Security and Medicare.

These programs may or may not really need a financial fix. Its hard for most folks to cut through the decibel levels and emotion of whoever is speaking loudest each day on the topic. Some say that the financial crisis for these programs is just trumped up noise by those opposed for ideological reasons—that they can be rendered fiscally sound for many generations to come with a rather minor tax increase. Others shout about the coming deluge that failure to fix these programs will foist upon American citizens, and that reduction in benefits is the answer. Who is right?

I'm not in position to get past the daily propaganda and make a proper judgment. However, if we start with the attitude that senior citizens are somehow not really “entitled” to the benefits of these programs, and if we buy into the notion that they are hurting the general economy, then heaven help our younger and middle-aged citizens when they too, inevitably, get old.

Friday, January 21, 2011

Encore: Is Long Term Insurance Worth The Price?

This is an encore article originally published April, 2009. I thought I should repeat it because, recently, interest in this topic from my readers has increased. So...is long term insurance worth the price?

That depends. It seems to me that if you've seen one long term care policy (ltcp), you've seen just ONE. While many of the features are becoming more standardized among insurers, there may still be important differences in benefits from policy to policy.

Here's what happened with my mother. She had a bias against anything that contained the words: "nursing home." Not an unusual bias among aging loved ones. Anyway, Mom decided to let a salesman sell her a home care policy, one that limited benefits to services delivered to her in her home. In return for a rather substantial premium (she was in her 70's when she purchased this policy--a time when premium rates become exhorbitant), Mom thought she'd receive skilled nursing care, PT/OT/Speech, custodial, incontinence, and related services (if she ever needed them) IN HER HOME.

Try as I might to persuade her to buy a broader policy for only a litte bit higher premium, she balked. "I'm never going to a nursing home," she said. "So why pay for something I'll never need."

Fast forward a few years to when Mom, in the early flowering of her dementia, moved into a home for the aged. Not a nursing home, but congregate housing for seniors. Gradually her ability to independently dress, toilet, be medication compliant, transport herself, and so forth, decreased and she needed fee for service assistance from specialized caregivers. Guess what? After years of paying premiums, her insurer refused to pay for these services. Why? They took a very narrow definition of the word "home" and decreed that a "home" for the aged did not qualify. To collect on her policy, Mom would have to be housed in her own house.

Turned out there was nothing we could do. I complained that her "home for the aged' was, in fact, her current home and that it was not a nursing home. The insurer didn't care. They had found a loophole to avoid paying and they weren't going to budge.

And, of course, she ended up in a nursing home anyway, long after her original nursing home insurance policy had been invalidated for obscure reasons only understood by the company and its lawyers, and at a point in her dementia when she no longer knew where she was, or cared.

The lesson, I believe, if you are interested in "ltcp's" for yourself or a loved one, is to carefully read, analyze and compare policies from many insurers, and especially to study the small print. Easier said than done but not impossible. Very time consuming, but well worth the time.

This kind of coverage is not for everyone. There are some good sources of information on the web, in Consumer Reports, and elsewhere that will help you decide if it's right for you. My message, though, (and my mother's, if she were able to do it over again) is to be very, very careful and to make sure you know exactly what it is you may be buying. As with everything else, let the buyer beware.

Bob Tell
Author, "Dementia-Diary, A Caregiver's Journal"