Everyone changes physically and mentally with age, but there are some changes that can really put a loved one’s safety at risk.  If you think that a loved one may require a transition to assisted living or elderly care, then you must first assess whether they are undergoing a true functional decline.

Functional decline is sometimes difficult to diagnose as individual symptoms often go unnoticed. Below is a list of symptoms of functional decline to be familiar with.

• Misusing medication (over or under use and deviating from a schedule)
• Reports of inexplicable behavior from friends, neighbors or family members
• Poor personal hygiene
• Unpaid bills
• Changes in spending patterns
• inappropriate clothing
• Stains on clothing or upholstery from urine or feces
• Forgetting how to use simple tools
• Poorly cared-for pets
• Repetitive questioning
• Difficulty in communicating
• Confusion
• Unfinished tasks and chores
• Spoiled or poorly-prepared food

Studies have documented that functional decline, i.e., the loss of either complex or basic ADL functions is due to changes in one or more of six areas: physical, perceptual, cognitive, visual and hearing, falling and psychological.  Below I will describe the first three areas in more detail and I will discuss the latter three areas in the next blog post.

1. Physical Changes

It’s obvious to anyone: as the human body ages it loses physical strength, stamina, muscle coordination, and balance. Those of us who had aging grandparents or aunts and uncles saw firsthand how the natural aging process affected their abilities to perform commonplace tasks.

2. Perceptual Changes

Here we’re considering all the senses: vision, hearing, sensitivity to touch, taste – even smell. After all, each is important to overall well-being. If you can’t smell smoke, you may lose your life to a house fire; if your sense of touch is diminished by poor circulation, you may be burned by scalding water.

Many medications are responsible for changes in taste perception. When this happens, it’s easier to eat spoiled food, or even choose not to eat at all, as food no longer tastes like it used to. I have noticed that after older people are less able to use the telephone with ease. Warning alarms and buzzers may go unnoticed.

3.  Cognitive Changes

While our thinking may remain clear, the speed at which a human can process information slows considerably as we age. It’s not just the speed at which we perform tasks. It’s also our ability to multitask. Our ability to divide our attention fades as we age.

Those changes are within the range of normal and expected changes; but what of the complications of dementia and Alzheimer’s disease? With dementia and Alzheimer’s loss of memory, language processing skills and inability to solve problems greatly affects your loved one’s level of independence.

Look for these warning signs:

• Disorientation, fright or confusion when faced with a change of location, such as a doctor’s visit, visiting friends or family, or eating out at a local restaurant.
• Giving incorrect or evasive answers when asked simple questions. For example, “What day is it?” gets the response, “What, don’t you know?”
• Aggressive behavior or noticeable personality changes.
• An inability to concentrate on television programs, tasks or conversations.
• A gradual (or sudden) loss of memory.
• Disinterest in routine tasks, such as cooking or housekeeping.
• A decline in social skills, such as successfully engaging in conversation, or eating a meal with the correct utensil.
• A decline in judgment skills, or inability to recognize consequences. This could manifest itself in leaving the water running, not shutting off the stove, or leaving the front door unlocked.

There are three more areas to monitor in order to determine whether a loved one is experiencing a real functional decline: hearing and vision loss, frequent falling and negative psychological changes. In the next blog post we’ll discuss symptoms within these three areas and how these problems can lead to a functional decline and loss of independence in aging individuals.

Photo Credit: Flickr user e-MagineArt.com.

Dementia is a decline in memory and/or intellectual functioning severe enough to interfere with social or occupational functioning. Dementia is not a disease itself, but group of symptoms. It is characterized as a progressive decline in cognitive function due to damage or disease (such as Alzheimer’s) in the brain. Areas particularly affected include: memory, attention, judgment, language and problem solving.

Dementia is condition in which a person loses the ability to think, remember, learn, make decisions and solve problems. Symptoms may also include personality changes and emotional problems. Personality does not change with age in the absence of mental disease.

There are many causes of dementia, including Alzheimer’s disease, brain cancer, and brain injury. Some Parkinson’s patients experience dementia at later stages of disease progression

Enter Validation Therapy

The idea behind validation therapy is to “validate” or accept the values, beliefs and “reality” of the person suffering from dementia. The key is to “agree” with them, but to also use conversation to get them to do something else without them realizing they are actually being redirected. So, if an 87 year old woman says that she needs a phone to call her grandmother, validation therapy says, “OK.” Here is an example for a caregiver working with someone with dementia in an adult day care:

Older adult: “I have to find my car keys.”
Caregiver: “Your car keys…” ( Don’t mention he doesn’t have a car and he hasn’t driven for years)
Older adult: “Yes, I need to go home – lot’s of work to do!”
Caregiver: “You are busy today?” (Don’t mention he is at adult day care and isn’t going home for hours)
Older adult: “Hell, yes! I’m busy every day.”
Caregiver: “You like being busy?” (Trying to find a topic of conversation that they might accept discussing)
Older adult: “Are your kidding? I didn’t say I LIKED it. I just have to work  like the rest of the world.” (He’s getting a little frustrated, but seems to have forgotten about the keys.)
Caregiver: “I know about work. I do some of that myself. In fact, I’m getting ready to fix some lunch for us. Care to join me?”
Older adult: “Lunch, huh? What are you having?”

Why Validation Therapy Works: The Pros

The number one reason why validation therapy works well is because it is not confrontational. Never is a person belittled, yelled at, or told “no.” Remember dementia is a group of symptoms, not a disease. It is easy to misdiagnose. For example, people suffering from UTIs (urinary tract infections) are said to demonstrate characteristics of dementia if the infection goes undetected.

Criticisms of Validation Therapy: The Cons

The biggest criticism of validation therapy is that it promotes lying. These lies weigh heavy on the consciouses of caregivers and family members. For example, validation therapy says that a family member should just accept their aging parent calling them someone else’s name, not correct them. When family stories are switched around, the family is suppose to just listen to the stories as they are told. While there seems to be significant emotional harm to caregivers and family members, very little harm is done to the person with dementia; but isn’t it the well-being of the person with dementia that is most important.

Photo credit: jam343

About the Author: Ryan Malone is the founder of Inside Elder Care and author of the By Families, For Families Guide to Assisted Living. He regularly speaks and advises families about how to improve their aging loved one’s quality of life. Ryan is also the president of SmartBug Media, a content marketing agency that helps companies increase leads, customers and influence. You can read more from Ryan on the SmartBug Media blog or follow him on Twitter.

In the days leading up to Memorial Day, I found myself reflecting on the true meaning of the day.

Memorial Day is commemorated differently. To some it is simply the beginning of summer and an opportunity to gather with friends and family around a BBQ , a beach or park. To others it’s a time to be particularly grateful and honor those who have fought for country and freedom, paying the ultimate price.

I found myself thinking how fragile life is and how for veterans it must be a very personal time to think of friends and shipmates that have gone by, that were lost. It then hit me how fewer and fewer World War II and the Korean War veterans are left and how, because of the current war on terrorism,  there now are also young faces of men and women added on a daily bases to our collective memory of those who have fallen.

One common thread seemed to repeat as I watched veterans and civilians alike line up across the nation to pay homage to heroes: Memorial Day is a day of remembering those who are no longer here, a time of memories replayed loud and clear and in full in our minds. Suddenly I was gripped by a sadness as I wondered how many of those faces maybe slowly suffering from yet another loss in front of my eyes, a loss of exactly those special life shaping memories. How many of these valiant veterans this time next year might not even remember enough to commemorate Memorial Day?

My local involvement with the Institute for Memory Impairments and Neurological Disorders (UCI MIND) at the University of California, Irvine (www.mind.uci.edu)  and the Alzheimer’s Association (www.alz.org) this year have helped me start to understand more the disorders of the brain, particularly those that are age-related.

5.3 million people have Alzheimer’s.  It’s the 7th leading cause of death in the United States and it has an annual health care cost of 172 billion dollars! From 2000-2006, Alzheimer’s disease deaths increased 46.1 percent, while other selected causes of death (Breast and Prostate Cancer, Heart Disease, Stroke, and HIV) decreased.

The time I have spent involved with these amazing and pioneering organizations came to the forefront of my mind on Memorial Day weekend as I asked myself a few questions regarding how I can, in my professional capacity, perhaps assist those suffering from memory loss through proper design and home modifications.  This becomes especially important in the case where an Alzheimer’s diagnosed loved one remains and is being cared for at home.

Keep in mind that each person suffering from Alzheimer’s is unique in both their stage of the disease and how it unfolds in their specific circumstance. As such, each case may require its own personalized approach when it comes to adaptations intended to help ensure safety and independence.

Apart from some of the aging in place suggestions made in previous articles, there are many things that can be done though the main ones that applies here revolves around Safety.  Here are some simple things that can be done immediately:

• Place decals on glass patio doors to help prevent them from walking into the glass
• Lock up medications, matches, razors, lighters, household cleaners and detergents to avoid accidental poisoning or overdosing
• “Accident-proof” your fridge, cabinets and closets
• Eliminate all furniture with straight or sharp corners or attach corner pads to them
• Maintain a consistent furniture layout in the rooms to help avoid disorientation anxiety and agitation due to changes in environment
• Consistency in all things provides a sense of safety; change on the other hand can be traumatic
• Use plastic covers for your seating to allow for quick cleaning in case of incontinence, or replace your upholstery with one specific for dealing with this possibility
• Hang clocks in easy to see areas around the house to help loved ones orient themselves during the day to the passing of time and what time it is
• Use visual aids like pictures and creative signs to help them associate with areas, functions and objects around the home
• Avoid using shiny, reflective or flickering objects since they cause confusion and depth perception problems
• Remove items that look like fake food, such as food or fruit shaped magnets on fridges
• Use sturdy plastic plates to help avoid breakage and wipe able table clothes for ease of cleaning
• Plan your meal / food selections so as to allow your loved one ease of independent, safe eating
• Make sure your trash can has a lid or is in a lockable cabinet to deter dumpster diving. This also helps avoid having loved ones throw away something valuable by mistake
• Consider removing the dials on the stove or installing stove knob covers to avoid your loved one turning it on and starting a fire or burning themselves
• Lower the hot water temperature on your water heater to 120 degrees to prevent scalding injuries
• Hide car keys to avoid your loved one going for a ride and consider a hide-a-key in case your loved one locks you out of the home
• Seal off outlets and plugs to avoid electrocution
• Keep fire extinguishers handy in every room
• Don’t leave lying around items like coffee makers toasters, space heaters that can be a danger to touch
• Post in a clear place important information like doctors, 911 emergency, local police, fire and ambulance numbers in case you are not around. Other family members or even neighbors may need to intervene and call for help. Ideally this should be near a main easy to find telephone.

These are but a few things we can start to do to better care for loved ones suffering from memory impairment and Alzheimer’s–all the while working hard towards a cure for this debilitating and fatal disease.

Remember, memory loss that disrupts daily life is not a typical part of aging and slow decline in memory, thinking and reasoning skills can be a symptom of Alzheimer’s. (Go to www.alz.org  to learn about the 10 Signs of Alzheimer’s )

So as Memorial Day weekend comes to a close and as we are enjoying that last hot dog or burger around the BBQ, let us make a mental note to educate ourselves about this disease and commit ourselves to helping find a cure for it. After all, it is our precious and priceless memories and our lives that are at stake.

About the Author: Raad Ghantous is the principal of Raad Ghantous & Associates and is an expert in luxury hospitality, wellness centers, and medical & day spa developments.  He is also the owner of Your Home For A Lifetime, an A.D.A/ Barrier-free/ Universal design/Aging in place, full service design/build firm with over 15 years of experience  specializing in developing integrating elegant and seamless designs/modifications to new or existing structures.

Early-onset Alzheimer’s disease is one of 38 degenerative conditions included in the Social Security Administration’s new Compassionate Allowances program.  This fast-tracking system is designed to aid younger patients and their families in moving quickly from diagnosis to benefits.  Expediting this process aids in reducing stress associated with waiting for the lengthy approval process, and trying to plan the next stages of life while in a state of limbo.  Many of these younger patients–most in their 30s and 40s–are still working and have more extensive financial responsibilities than the traditional Alzheimer’s patient.  More typical Alzheimer’s patients are in their mid-to-late 60s, retired, and also too young to be receiving Social Security retirement benefits in some cases.

Effective March 1, 2010, the Administration will be able to electronically target and make prompt decisions in the best interest of the disabled patients.  In the past, when a younger patient began experiencing the cognitive limitations, they were not traditionally tested for Alzheimer’s disease. Instead, they were thought to be suffering from job and life-related stress.  This issue added to the lengthy process of identifying the correct diagnosis and than being approved for disability benefits.  With this new program, it is estimated that tens of thousands of younger Alzheimer’s sufferers will now qualify in a matter of days rather than the traditional months or years it often took in the past.

According to the Administration, approximately 200,000 people under the age of 65 currently suffer from the symptoms of early-onset Alzheimer’s disease.  Due to the sheer volume of potential benefit applicants, the Administration will also benefit from this new program as it will reduce the time and effort of the appeals process that in the past would contribute to slowing down the system for every patient.

Photo: benprks

In this Leaders in Elder Care interview, I had the privilege to speak to Dr. Kevin O’Neil.  I first met Dr. O’Neil at Brookdale’s Brain Symposium a few months ago at UCLA, where I left quite impressed with the his approach to brain fitness and brain health.  Dr. O’Neil combines a deep understanding of both the science behind brain health and the practical advise that non-doctors require to do something about.  Congratulations, Dr. O’Neil, for being a Leader in Elder Care.

I hope you all enjoy the interview.

About Dr. Kevin O’Neil

Dr. Kevin O’Neil is the Medical Director for Brookdale Senior Living (BSL), the largest senior housing provided in the United States. Dr. O’Neil practiced and taught geriatric medicine for over 27 years (seven years in Massachusetts and 20 years in Sarasota, FL).  A graduate of Boston College and Georgetown University School of Medicine, he completed his internship in Internal Medicine at the Washington Hospital Center and his residency at the University of Massachusetts Medical Center.  He was formerly an assistant professor of medicine at the University of Massachusetts Medical Center and is currently a Clinical Professor in the Department of Aging at the University of South Florida.

He is certified by the American Board of Internal Medicine and holds a Certificate of Added Qualifications in Geriatric Medicine. He is a Fellow of the American College of Physicians and is a member of the American Geriatrics Society and the American Medical Directors Association.

Dr. O’Neil is co-editor and a contributing writer to Optimal Aging Manual, which Art Linkletter has called “the great master book for the boomers.”

A fascinating interview appeared in Scientific American this morning.  Mind Matters editor Jonah Lehrer interviews P. Murali Doraiswamy, the head of biological psychiatry at Duke University and a Senior Fellow at Duke’s Center for the Study of Aging. He’s also the co-author of The Alzheimer’s Action Plan, a guide for patients and family members struggling with the disease. In this interview, Lehrer discusses with Doraiswamy some of the recent advances in Alzheimer’s research and what can be done to prevent memory loss.

Some highlights from the article:

• The two biggest misconceptions are “It’s just aging” and “It’s untreatable, so we should just leave the person alone.”
• There are four FDA-approved medications available for treating Alzheimer symptoms and many others in clinical trials.  Strategies to enhance general brain and mental wellbeing can also help people with Alzheimer’s.
• A population study from Finland has developed a fascinating scale that can predict 20-year risk for dementia – sort of a brain aging speedometer.  Obesity, smoking, lack of physical activity, high blood pressure, and high cholesterol are some of the culprits this study identified.  So keeping these under control is crucial. Depression is another risk factor for memory loss, so managing stress and staying socially connected is also important.
• By using a combination of biomarkers, genetic tests and new brain scans, we are inching very close to predicting not only who will develop Alzheimer’s but the exact age when they may start developing symptoms.  This offers huge opportunities for conducting prevention trials.
• The interactions between vascular disease and memory loss suggest that at least some aspects of Alzheimer’s may be modifiable through diet and exercise.

Read the complete article in Scientific American.

Photo: Les Todd, Duke Photography

A dear friend of Inside Elder Care, Kim McRae, just shared a wonderful opportunity to learn more about the second leading type of demntia after Alzheimer’s.

Betwixt and Intermixed – Dementia With Lewy Bodies

Three members of the Lewy Body Dementia Association Scientific Advisory Council (SAC) are participating in an upcoming free webinar on dementia with Lewy bodies (DLB), the quintessential overlap disease between Alzheimer (AD) and Parkinson diseases (PD).

This live discussion, hosted by the Alzheimer Research Forum, will take place on Monday, 15 June 2009, from 12 noon to 1 p.m. EST and will feature short slide presentations by Drs. Ian McKeith, Brit Mollenhauer, James Galvin, James Leverenz, and Walter Schulz-Schaeffer, with audio provided via a telephone line. (Drs. McKeith, Galvin and Leverenz are members of LBDA’s Scientific Advisory Council.)

Questions for the panel can be submitted in advance and during the live event. An interactive chat session will follow the webinar.

Click here to learn more and register for the event.

Picture: Balazs Simon

From Indystar.com:

A third set of clinical trials to seek a drug to delay the progression of mild to moderate Alzheimer’s disease is about to get underway, drugmaker Eli Lilly and Co. said today.

The Indianapolis company will begin enrolling patients this month in two separate but identical Phase III clinical trials of Solanezumab, an antibody that may hold the key to preventing the disease that affects 5.3 million people in the United States alone.

Lilly also is in the process of testing out a different type of Alzheimer’s treatment, also geared to help those with the disease, which is known to cause dementia.

“Current therapies available to treat Alzheimer’s disease may help with symptoms, but they haven’t been proven to change the disease progression,” said Eric Siemers M.D., medical director for Lilly’s Alzheimer’s disease research, in a news release. “Biomarker results from a Phase II solanezumab trial give us hope that Lilly is on a path toward a treatment that may slow the rate of progression of Alzheimer’s disease.”

Lilly expects to enroll a total of 2,000 patients age 55 and over from 16 countries, including the U.S., in the Phase III “Expedition” trials.

Patients or caregivers interested in learning how to enroll in the Expedition trials (or a companion trial for a different treatment, known as “Identity” trials) should visit www.clinicaltrials.gov or call (877) 285-4559.

Photo credit: Sam Catchesides

This morning I went to the gym, just like I’ve done 3-4 times a week for years.  I really try to push myself at the end of each workout.  My motivation comes from my desire to be healthy, active and have the longevity to spend many, many years with my wife and daughter.

But did you know your brain is a muscle?  What if I told you your brain could even have its own personal trainer?

It’s true, and it’s called Dakim BrainFitness.

A Brief History of Dakim

In the late 1990s, Dakim CEO and founder Dan Michel became very frustrated with the cognitive stimulation tools available to his father who suffered from Alzheimer’s Disease.  Taking matters into his own hands, he built a collection of rudimentary games to exercise his father’s brain. Over time, Dan’s creations become more complex and challenging.

When it became clear Dan’s analog tools had reached their potential, he realized it was time to go digital.  Dakim was born and Dan was driven with the thoughts of his father’s progress to create a memory training system that could be used over the long-term to create the type of improvement many scientific studies had promised.

Dakim’s Promise

A number of studies exist (read them at Dakim’s website) that correlate consistent mental stimulation with a decrease in Alzheimer’s and dementia.   One such study in the New England Journal of Medicine(1) found that seniors who consistently particpated in highly mentally stimulating leisure activities had a 63% reduced risk of dementia.

The Dakim BrainFitness system provides a mechanism through which seniors can regular exercise their brains in a way that is fun, non-repetitive and interactive such that they look forward to playing every day.

How it Works

Dakim BrainFitness is a purpose-built computer with a touch screen.  Headphones are optional depending on your location.  Dakim BrainFitness combines medically-proven brain exercises with a user interface that is so incredibly simple.  Combining audio, visual and eye-hand coordination, the games are played at a pace that is both fun and challenging.

Dakim BrainFitness trains across six cognitive domains and game takes about 20 minutes to complete.  As players improve on one domain or the other, the system increases the difficulty, enabling users to both play at their own pace yet still be challenges.  Dakim recommends the games be played 20 minutes per day, 3-5 times per week.

When you get it right, you get nothing but encouragement.  And when you get it wrong, you get nothing but encouragement.  Incorrect answers were communicated in a way that inspired me to continue, rather than frustrated me to quit.  And the content of the game was set in the era most relevant to the players – two examples of the little details that make the difference between a good idea and a effective, well-thought product.

Software updates and new game content is update via the Internet automatically — typically at night when nobody is playing.  Dakim Brain Fitness is maintenance free and require no computer skills to operate, clearing a huge usability hurdle for many seniors.

Pricing and How to Buy

Dakim BrainFitness comes in two models – a model designed for elder care communities and a home model.  Dakim shared with me only the pricing for the home model which was $2,499.  Dakim also charges a monthly $50 fee for software maintenace and the downloading of new games and lessons.   Dakim offers a 30-day moneyback guarantee – a testament to their confidence in their product.

My Throughts on Dakim BrainFitness

During Brookdale’s Brain Symposium, I spent nearly a day next to Dan Michel and his head of sales, Rick Sill.  On a perosnal and professional level, these are good guys who have the right intentions for elder care — a personal experience and the drive to help others benefit from a good idea.  From a product perspective, I was very impressed with the Dakim BrainFitness system.   It was easy to use, fun to play and based on sound science.  I thought the pricing for the device was quite reasonable – it was about the same as the cost of the Mac I am writing on now and my monthly gym membership.

Surely that is a small price to pay for a 63% reduced risk of dementia?

I recommend you take a look at Dakim BrainFitness.  Spend some time on their live product demonstration.  Their website is packed full of good materials and plenty of videos for those of you who hate reading page after page of web copy.

Sources:

1. Verghese J, Lipton RB, Katz MJ, Hall CB, Derby CA, Kuslansky G, Ambrose A, Siliwinski M, Buschke H.  The New England Journal of Medicine, 348: 2508-2516.