A host of new technologies now makes it possible for adult children to monitor elderly parents and thereby permit them to remain safely at home. From tracking systems, medical monitoring, medication compliance checking and more, technology and the internet now offer new strategies for ensuring the safety of seniors living at home. Click the following link to read more: Monitoring Elderly Parents – NYTimes.com.
Over 40 million Americans have cared for a loved one with illness or disability during the past year. If you’re one of them, the holiday season may pose exceptional stresses. Why should the holidays, usually associated with joy and good cheer, be especially taxing for caregivers? » Continue reading “Holidays Pose Stresses for Family Caregivers”
Home care is a very fragmented industry with many small companies competing for business, especially in heavily populated urban areas. The quality and professionalism of home care companies varies greatly. To protect yourself or your loved one, you should do some advance screening before making a commitment to use any one company. Here is a handy list of important questions you should not fail to ask. » Continue reading “Checklist for Choosing a Home Care Agency”
Although many consumers are unaware of it, agencies that offer non-medical home care come in two very different “flavors”: those like Ready Hands that use bona fide employees to whom they issue W-2’s at the end of each year and those that use independent contractors. Because agencies of this latter type issue IRS 1099-MISC non-employee compensation forms to the workers, the agencies are often referred to as “1099 companies” or “registries.” » Continue reading “Home Care Choices: W-2 vs. Independent Contractor Agencies”
Communication with others is so essential to our lives that it’s hard to imagine existence without it. Yet even among adults with no cognitive impairment, achieving true understanding can be a challenge. When communicating with someone who has dementia, the challenge is much greater. » Continue reading “Optimizing Communication in Dementia”
Outpatient health care involves interactions with many different professionals, but at its center is the physician office visit. The effectiveness of an individual’s medical care depends in large part on how well this brief interaction proceeds. Yet many people give little thought to making their physician visits as productive as possible. Here are a few tips for getting the most out of your visits. (The tips also apply to physicians’ assistants, nurse practitioners and other office-based practitioners.)
Think Like a Doctor
Doctors approach medical diagnosis in a standardized way. First comes the medical history–the information learned by listening to a patient’s description of symptoms and by asking specific questions. Then comes the physical examination, often focused on the organ system(s) that appear to be involved. Finally diagnostic tests and possibly consultations may be requested.
You might think that examinations and tests are the most important in establishing a diagnosis, but in fact it is the history that provides the main clues. When good clinicians take a history, they listen for certain key information: your description of your symptoms, their location in the body, their severity, time of onset, and duration; any aggravating or relieving factors; and, the presence of associated symptoms. Therefore, it pays to come prepared with this information.
Let’s take the example of stomach pain. What does it feel like? Sharp? Stabbing? Gnawing? Where is the pain located in the abdomen? When did it start? Does anything make it worse or better, like eating, going to the bathroom or lying down? What else have you noticed since the stomach pain began? Weight loss? Loss of appetite? The answers to such questions will guide everything else your doctor recommends, so try to think about them in advance.
Take Notes
Covering even your chief issues in a 10-15 minute office call can be a challenge. It helps if you first write down the items you need to cover with your doctor, so that you can relate them accurately and avoid forgetting something important. Make sure you prioritize your concerns, however, and be sensitive to time limitations. If you have several problems to address, you may need to schedule a follow-up appointment.
In addition to bringing your concerns in writing, it may be a good idea to take notes during or immediately after your visit, so that you are clear on your doctor’s instructions and recommendations. If you are unclear about something, ask.
Bring a Family Member
Having a close family member (or trusted friend) in the exam room helps in several ways. First, your family member can relate observations that may not be as evident to you, or that you simply overlooked. Think of it like having two witnesses to an event. Their descriptions may differ in some respects, but together they paint a more complete picture.
Second, a family member can help you to remember what your doctor said after the visit is over. We all know people who return home from physician visits feeling uncertain about recommendations or next steps. Having a trusted second person in the examining room can improve communication significantly.
Finally, your family member can serve as your advocate, especially if he or she is politely assertive about making sure your concerns are addressed. This is especially important if you’re not feeling well yourself.
Watch the Chit Chat
Research shows that physician visits with older patients tend to involve more casual chatter than with younger adults. This may lead to a greater sense of trust and satisfaction with the physician, but it can also prevent older patients from having their health needs adequately addressed.
Yes, some chit chat builds rapport, but don’t just assume that if the conversation continues in an informal way, there will be plenty of time for dealing with your important medical issues later. There may not be. Better to turn the discussion toward matters at hand.
Bring Your Medications
Miscommunication about medication instructions and dosages is a huge problem responsible for thousands of preventable complications, hospitalizations and even deaths. Do not assume that because your medication records are “in the chart”, you don’t need to show your physician what you are actually taking.
Many people carry a list of their medications and dosing schedules, yet discrepancies are found when the list is compared against their pill bottles. Better to bring both the list and the bottles to each visit, so there is no confusion. Also make sure to include any non-prescription medications or supplements that you take.
If You’re a New Patient
The foregoing tips are applicable to any visit, but you will need to take some extra steps if you are seeing a doctor for the first time. The most important of these is to have accurate information with you about your health background. Bring any medical records that you possess. Also have a written list of your hospitalizations, medical procedures, surgeries, chronic medical problems, drug reactions and allergies, along with relevant dates.
Finally, if you are seeing a specialist to whom you were sent by your primary physician, be sure you can explain exactly why you are there. Ideally the specialist should have already received information about you from the referring doctor, but communication among health professionals is not always what it should be. A surprising number of specialty consultations end up being unproductive for this reason.
Alzheimer’s disease is the commonest form of dementia among the elderly. Approximately one half of individuals over age 85 have dementia. We all know that our population is aging, but the rate of growth in the over-85 group will be particularly rapid. Whereas the number of people 65 and older is expected to double by mid-century, the number of people 85 and older will rise almost five-fold, with a parallel increase in the prevalence of Alzheimer’s disease. This trend foretells a public health problem of tragic proportions unless better recognition and treatment can be accomplished.
Current management strategies all work best if dementia is recognized and intervention initiated early in its course. Even the limited treatments available today can afford significant benefits for patients with Alzheimer’s disease, delaying or preventing institutionalization, preserving functional capacity and improving quality of life.
Listed below are the seven warning signs of Alzheimer’s disease and the typical symptoms at each stage of the disorder. Someone who exhibits one or more of these symptoms may not necessarily have Alzheimer’s disease, but he or she should certainly be evaluated carefully by a competent physician.
The Seven Warning Signs
Common Changes in Early AD
Common Changes in Intermediate Stage AD
Common Changes in Late AD
The seven warning signs of Alzheimer’s disease are:
1. Asking the same question over and over again.
2. Repeating the same story, word for word, again and again.
3. Forgetting how to cook, or how to make repairs, or how to play cards – activities that were previously done with ease and regularity.
4. Losing one’s ability to pay bills or balance one’s checkbook.
5. Getting lost in familiar surroundings, or misplacing household objects.
6. Neglecting to bathe, or wearing the same clothes over and over again, while insisting that they have taken a bath or that their clothes are still clean.
7. Relying on someone else, such as a spouse, to make decisions or answer questions they previously would have handled themselves.
Common Changes in Early AD
• Loses spark or zest for life – does not start anything.
• Loses recent memory without a change in appearance or casual conversation.
• Loses judgment about money.
• Has difficulty with new learning and making new memories.
• Has trouble finding words – may substitute or make up words that sound like or mean something like the forgotten word.
• May stop talking to avoid making mistakes.
• Has shorter attention span and less motivation to stay with an activity.
• Easily loses way going to familiar places.
• Resists change or new things.
• Has trouble organizing and thinking logically.
• Asks repetitive questions.
• Withdraws, loses interest, is irritable, not as sensitive to others’ feelings, uncharacteristically angry when frustrated or tired.
• Won’t make decisions. For example, when asked what she wants to eat, says “I’ll have what she is having.”
• Takes longer to do routine chores and becomes upset if rushed or if something unexpected happens.
• Forgets to pay, pays too much, or forgets how to pay – may hand the checkout person a wallet instead of the correct amount of money.
• Forgets to eat, eats only one kind of food, or eats constantly.
• Loses or misplaces things by hiding them in odd places or forgets where things go, such as putting clothes in the dishwasher.
• Constantly checks, searches or hoards things of no value.
Common Changes in Intermediate Stage AD
• Changes in behavior, concern for appearance, hygiene, and sleep become more noticeable.
• Mixes up identity of people, such as thinking a son is a brother or that a wife is a stranger.
• Poor judgment creates safety issues when left alone – may wander and risk exposure, poisoning, falls, self-neglect or exploitation.
• Has trouble recognizing familiar people and own objects; may take things that belong to others.
• Continuously repeats stories, favorite words, statements, or motions like tearing tissues.
• Has restless, repetitive movements in late afternoon or evening, such as pacing, trying doorknobs, fingering draperies.
• Cannot organize thoughts or follow logical explanations.
• Has trouble following written notes or completing tasks.
• Makes up stories to fill in gaps in memory. For example might say, “Mama will come for me when she gets off work.”
• May be able to read but cannot formulate the correct response to a written request.
• May accuse, threaten, curse, fidget or behave inappropriately, such as kicking, hitting, biting, screaming or grabbing.
• May become sloppy or forget manners.
• May see, hear, smell, or taste things that are not there.
• May accuse spouse of an affair or family members of stealing.
• Naps frequently or awakens at night believing it is time to go to work.
• Has more difficulty positioning the body to use the toilet or sit in a chair.
• May think mirror image is following him or television story is happening to her.
• Needs help finding the toilet, using the shower, remembering to drink, and dressing for the weather or occasion.
• Exhibits inappropriate sexual behavior, such as mistaking another individual for a spouse. Forgets what is private behavior, and may disrobe or masturbate in public.
Common Changes in Late AD
• Doesn’t recognize self or close family.
• Speaks in gibberish, is mute, or is difficult to understand.
• May refuse to eat, chokes, or forgets to swallow.
• May repetitively cry out, pat or touch everything.
• Loses control of bowel and bladder.
• Loses weight and skin becomes thin and tears easily.
• May look uncomfortable or cry out when transferred or touched.
• Forgets how to walk or is too unsteady or weak to stand alone.
• May have seizures, frequent infections, falls.
• May groan, scream or mumble loudly.
• Sleeps more.
• Needs total assistance for all activities of daily living.
Where to Get Additional Information:
The foregoing information was adapted from the Alzheimer’s Disease Education and Referral Center (ADEARS), an excellent service of the National Institute on Aging. Contact ADEARS at (800) 438-4380 or online at www.alzheimers.org.
June 2004
