Health 411: Aging mom may have dementia, and family doesn't know what to do

First, try talking to your mother's doctor. If that doesn't work, you'll need legal documents to gain medical access. There are many resources available for caregivers of aging parents.

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(Curtis Parker / For The Times)

My 82-year-old mother has been accusing family members of spying on her, listening in on her phone conversations and entering her home when she's not there, among other things, off and on for about 10 years. She told her doctor she won't talk with us. Is there anything we can do? Are there resources and/or free counseling services to help us work out issues with our mom so we can talk with her doctor?

You can try to contact your mom's doctor to discuss her condition, particularly given that you're concerned she may be suffering from dementia and unable to properly care for herself.

In some states, doctors will talk to a family member about a person's condition even without a legal release, says Garvin Reiter, a certified elder law attorney in Portland, Ore., and a member of the National Academy of Elder Law Attorneys. That's especially true if it is suspected or known that the patient is suffering from dementia.

But if the doctor is aware of a rift in the family, you're unlikely to get through, Reiter says. "They will definitely put up firewalls," he said. In that case, you'd need legal documents to gain access.

When it comes to planning for situations like these, you'll need four legal documents to be fully prepared, said Kathleen Kelly, executive director of the National Center on Caregiving in San Francisco.

The first document is a trust. This allows a family member or friend to manage a person's assets.

The second is a durable power of attorney for finances, which grants someone authority to make financial decisions on another person's behalf.

To make decisions about someone's medical care, you'll need a separate durable power of attorney for health. Finally, an advance healthcare directive allows someone to specify their wishes so they can maintain control over the type of treatment they do — or do not — receive. An advance healthcare directive may also designate a person to communicate those wishes on their behalf when they are unable to do so.

"Having all of those documents together is the biggest gift a person could [give] their family and friends," Kelly says.

Although it sounds like your mom may be tough to reason with, don't assume that setting up a power of attorney for health, which would give you access to her doctors, is out of the question, Reiter says. Dementia is progressive in nature. Until it reaches a stage where all cognitive function is lost, there are moments, albeit decreasing in frequency, when an individual retains the ability to reason. Depending on the stage of her dementia, you may be able to catch your mom at a time when she is lucid and clear-thinking.

To get the necessary legal papers in place, you'll have to demonstrate that she has transactional competency, meaning your mom understands the transaction in front of her at that moment she's carrying it out, Reiter says.

An attorney can help establish your mom's competency and get the legal papers in order. Since laws vary greatly by state, it's a good idea to work with a local attorney with experience in elder law. You can find one in the online directory of the National Academy of Elder Law Attorneys at http://www.naela.org. You can also search for attorneys with experience in this area on the National Elder Law Foundation's website. Go to http://www.nelf.org, click on "About NELF" and enter your state under the heading "Finding a CELA."

If it's too late to get these legal papers together for your mom, you can consider becoming your mom's legal guardian or, as it is known in California and some other states, a conservator, says Sarah Clingman, a certified elder law attorney in Columbia, S.C. Guardians have the authority to make medical, legal and financial decisions on someone's behalf.

But first, you'll need a physician to determine that your mom is incapacitated, Clingman says. Then an independent lawyer will be appointed to represent her interests. Finally, a judge will decide whether to make you her guardian. Keep in mind that this can be an onerous and expensive process. "Guardianship is a last resort," Clingman, says.

There are a number of places you can turn to for assistance in these matters.

Geriatric case managers, who plan and coordinate care for the elderly and disabled, can be very helpful in identifying and navigating the range of needed resources. You can find one through the Assn. of Certified Geriatric Care Managers by visiting http://www.caremanager.org and looking under the "About Care Management" tab.

For information about healthcare documents, estate planning and more, try Help4srs.org, operated by the Torrance-based nonprofit Healthcare and Elder Law Programs Corp.

Services can also be located through the Family Care Navigator on the Family Caregiver Alliance's website, http://www.caregiver.org.

All states have an agency on aging, and the federal Department of Health and Human Services offers an Eldercare Locator at http://www.eldercare.gov to connect families to services for older adults. The department can also be reached at (800) 677-1116.

Article care of Los Angeles Times
For more info: Health 411: Aging mom may have dementia, and family doesn't know what to do

A Look At The New Guidelines For Diagnosing Alzheimer's Disease

Question: What is the difference between dementia and

Alzheimer’s disease?

Answer: Dementia is the umbrella term for brain disorders

that cause a person to lose their ability to function normally

in daily life. Alzheimer’s disease is the most common, but

there are other dementias, such as vascular, Lewy body, etc.

Although we know Alzheimer’s dementia is distinct from

these other forms, in the early stages it may be difficult to

differentiate among them. Additionally, many older people

may have more than one condition, such as Alzheimer’s

disease combined with vascular disease and sometimes small

strokes. 

That is one of the reasons why researchers hope one day to

develop an easy-to-administer, reliable and inexpensive

biomarker—a test that indicates harmful changes taking

place in the brain—that can be used in a doctor’s office. For

example, eventually there may be a simple blood test to help

diagnose Alzheimer’s disease.

Question: How was dementia diagnosed before these new

guidelines and what has changed? 

Answer: The new guidelines do not dramatically alter the

current process doctors use to diagnose Alzheimer’s disease.

Dementia is still diagnosed based on significant and chronic

changes in a person’s thinking processes, or as a professional

would state, cognition. Healthcare providers speak with the

patient and family or caregivers, seeking observations about

changes in how the patient thinks, learns and remembers and

taking into consideration other potential causes of cognitive

decline—for example, medications, malnutrition,

dehydration, depression. 

However, the new guidelines ask doctors to look beyond

just memory loss for additional symptoms that may mark

onset of the disorder, such as problems with judgment.  And

the revised guidelines outline ways the healthcare provider

should approach evaluating the causes and progression of

cognitive decline. For example, healthcare providers are

made aware that mild cognitive impairment (MCI) may in

many cases progress to Alzheimer’s disease and that memory

impairment is not always the first symptom of Alzheimer’s. 

Question:  Where and how are biomarkers and new imaging

tests being used?

Answer: At this time, they are being used by researchers

investigating how brain imaging and body fluid analysis relate

to the changes taking place in the brain and whether the

tests can predict who is at risk for developing the clinical

symptoms associated with the disease. For clinicians in

research centers or with access to large medical centers,

fluid biomarker and imaging tests may be used in certain

cases. For example, they may be used to increase or

decrease the level of certainty about a diagnosis of

Alzheimer’s dementia and to distinguish Alzheimer’s

dementia from other dementias. But at this stage, the tests

are not available to primary care doctors because

investigators are still standardizing and evaluating their use.

Question: Why were the diagnostic criteria for Alzheimer’s

disease revised and who led the effort? 

Answer: The diagnostic criteria had been in place for more

than 27 years and did not reflect the new knowledge that has

been gained regarding the progression of the disease. Thus,

the National Institute on Aging (NIA) at the National

Institutes of Health and the Alzheimer’s Association brought

together experts in clinical neuro- and behavioral science to

revise the criteria. 

The new guidelines will help guide research and hopefully

speed the discovery of treatments to delay and/or prevent

Alzheimer’s disease. The guidelines also explain to clinicians

and the public our deeper understanding of the disease—that

it develops over decades, long before the first signs of

dementia appear; and for that reason, clinicians need to be

sensitive to early changes that may be associated with the

development of mild cognitive impairment. 

Question: How will doctors use the updated guidelines to

better diagnose Alzheimer’s disease? 

Answer: For the most part, doctors will consider Alzheimer’s

disease in an office setting pretty much as they have in the

past, but with updated knowledge about what to look for. A

major change for physicians is the consideration of mild

cognitive impairment, or MCI. People with MCI have

problems with memory or other cognitive functions that are

greater than normal for their age and education. 

Some doctors may use the guidelines to better inform

patients with MCI about their increased risk for developing

Alzheimer’s disease.  For clinicians with access to researchers

conducting biomarker and/or imaging studies, such

tests—while experimental—may be used to affirm suspicions

of Alzheimer’s disease. 

Question: Can doctors use the guidelines to diagnose other

kinds of dementia besides Alzheimer’s disease?

Answer: The guidelines are specifically for Alzheimer’s

dementia.

Question: Should these new guidelines be used to

“re-diagnose”—that is, for those who already have a diagnosis

of Alzheimer’s disease?

Answer: As a physician, I do not see a role for the guidelines

being used to re-diagnose an individual who already has a

confirmed diagnosis. People who currently have the diagnosis

of Alzheimer’s disease are those with evident functional and

cognitive impairment. With lesser impairments, patients and

doctors might ask about mild cognitive impairment.

In any case, if you or a family member is worried about

changes in cognition, you may want to see a healthcare

professional such as a geriatrician, geriatric psychiatrist or a

neurologist. Early diagnosis aids in planning for the future,

from learning about available drugs that treat the symptoms,

to making financial decisions, to exploring ways to get

involved in clinical trials. 

Question: Will these criteria impact current or future treatment?

Answer: It is the hope that these criteria will guide future

research and advance our discovery of the changes taking place

in the brain that lead to the development of Alzheimer’s disease.

With that discovery, we should be better positioned to develop

effective treatments.

Question: Are these the only guidelines doctors will be using now?

Answer: The NIA-Alzheimer’s Association guidelines have been

developed based on evidence by leading scientists in the

behavioral and clinical neuroscience fields. Thus, it is hoped

that clinicians will become aware of them and utilize them to

enhance how they think about patients with cognitive

impairment. 

Question: Should primary care clinicians refer their patients to

a neurologist for a preclinical evaluation?

Answer: There currently is not a role for biomarkers in routine

care. The guidelines for preclinical Alzheimer’s disease are

exclusively for research purposes. Researchers will use new

advances in imaging and biomarkers to evaluate research

participants for buildup of abnormal proteins.

Primary care clinicians should consider referring patients who

wish to volunteer for research projects related to Alzheimer’s

disease.  Research centers can be identified through the

Alzheimer’s Disease Education and Referral (ADEAR) Center

Web site maintained by NIA, at http://www.nia.nih.gov/Alzheimers/. 

Question: Will insurance companies pay for biomarker tests?

Answer: Currently, it is common for Medicare to compensate

for a CT scan or MRI to help establish a clinical diagnosis of

Alzheimer’s disease and rule out other causes of dementia.

Testing for preclinical disease is only being conducted in

research settings. Looking ahead, a component of the new

Medicare Annual Wellness Visit (AWV) allows the clinician

compensation for an assessment for cognitive impairment on an

annual basis, along with multiple other preventive health

assessments. As better screening procedures are developed and

the guidelines become better [distributed] we expect clinicians

will increasingly recognize and monitor patients with MCI

during AWVs-- especially those patients who report memory

loss problems that often progress to Alzheimer’s disease.

Hopefully, this will be accompanied by counseling regarding

long-range planning, and education regarding available

community resources.

For more info go to: http://www.afacareadvantage.org

Part-time Work, Volunteering Help Keep Seniors Active, Fight Frailty

Seniors who keep busy working or volunteering may have discovered a fountain of youth. Research says there are benefits to both employment and volunteering. Staying healthy longer is one of them.

Q. I’m a 66-year-old retiree who had a successful 40-year career. I thought I’d really love retirement, but I find I miss working. Do you have any suggestions? Also, is there evidence that continuing to work harms seniors in any way?

You’re not alone in your desire to continue to put your skills to use. Some studies have indicated that as many as 70 percent of Americans plan to work past the traditional retirement age.

What’s more, your field of expertise may be missing your skills as much as you’re yearning to put them to good use. The retirement of today’s seniors, with the Baby Boomer generation soon to follow, will leave a void of experience and skills in the workplace. There’s no reason why you shouldn’t continue to work, if that’s what you enjoy.

Have you thought about putting your talents to work as a self-employed contractor or consultant, perhaps in a home-based business? Technological advances and the Internet have made it easier than ever to work from home as an independent free agent. Part-time work also may be an option for older adults.

Among the advantages of self-employment are a flexible schedule and an independent work environment. On the other hand, as a consultant you could end up working more hours than you want. And remember that you must be responsible for your own taxes and other benefits, since you are basically your own boss. So you’ll need to carefully weigh the pros and cons. Contact AARP atwww.aarp.org  for more information about being a contractor.

Part-time work also is something to consider and some experts say that type of employment may generate health benefits. Those seniors who work temporary or part-time jobs have fewer major diseases and will enjoy better day-to-day function than their contemporaries who choose to stop working altogether, according to a national study.

And, the researchers say, the findings are significant even after controlling for people’s physical and mental health before retirement. The study’s authors refer to this transition between career and complete retirement as “bridge employment,” which can be a part-time job, self-employment or a temporary job. The findings are reported in the Journal of Occupational Health Psychology, published by the American Psychological Association.

Over the course of the study, the researchers considered only physician-diagnosed health problems, such as high blood pressure, diabetes, cancer, lung disease, heart disease, stroke and psychiatric problems. They controlled not only for baseline physical and mental health but also for age, sex, education level and total financial wealth. The results showed the retirees who continued to work in a bridge job experienced fewer major diseases and fewer functional limitations than those who fully retired.

Employment isn’t the only way to put your skills to work. Perhaps you would be just as happy volunteering. If you’re a member of a professional organization, or if you were affiliated with organizations during your career, contact them for information about how to use your background to serve in your community.

According to a 2004 survey conducted by Independent Sector, a leadership forum for charities, foundations and corporate giving programs, almost 44 percent of all people 55 and older volunteer at least once a year. More than 36 percent reported that they had volunteered within the previous month. These older volunteers give on average 4.4 hours per week to the causes they support.

Volunteerism can come in many forms. One common way seniors give back to communities is by putting the skills they honed in the work force to use in the organizations and causes they enjoy. Some seniors just become more active in their churches or the charities they belonged to when they had less time to give. Why not consider doing something totally different from your occupation? How about working with seniors? Volunteer at a local hospital or care facility.

If you are looking for volunteer activities, check to see if your area has the “2-1-1” telephone service. The 2-1-1 service connects individuals and families seeking services or volunteer opportunities by telephone with the appropriate community-based organizations and government agencies.

There are other ways to learn about how to volunteer in your area. Contact your local senior center or the Area Agency on Aging. And here’s another resource: log on to www.volunteermatch.org ; by simply entering your ZIP Code, VolunteerMatch can list many volunteer opportunities in your area.

Another study confirms the premise that keeping the mind and body active appears to slow many of the signs and consequences of aging. This research finds that volunteering seems to produce the best results, however, paid work was a benefit as well.

UCLA researchers followed 1,072 healthy adults aged 70 to 79 between 1988 and 1991 to determine if productive activities – specifically volunteering, paid work and child care – prevent the onset of frailty. At the beginning of the study, 28 percent of participants volunteered, 25 percent performed child care duties and 19 percent worked for pay.

After three years, participants in all three activities were found to be less likely to become frail. After accounting for levels of physical and cognitive function, however, only volunteering was associated with lower rates of frailty. Frailty is a geriatric condition marked by weight loss, low energy and strength, and low physical activity.

If you would like to know more about how to prevent frailty, visit www.getmommoving.com , the Home Instead Senior Care® network’s public education campaign that is geared toward keeping seniors active and healthy.

For more information: http://www.caregiverstress.com