 |
 |
 |
 |
|
|
|
|
Posts Tagged ‘
Alzheimer’s disease ’
Introduction
Dr. Geri Adler is Assistant Professor in the Graduate College of Social Work at the University of Houston. She has over twenty years of clinical experience working with individuals with Alzheimer's disease and their families. A Hartford Geriatric Social Work Scholar, Dr. Adler's funded research focuses on driving and dementia. She has multiple publications in this area including recent manuscripts in Dementia: The International Journal of Social Research and Practice, Traffic Injury & Prevention, The Gerontologist and Health and Social Work.
Q. Why is driving and dementia a concern?
Over five million Americans are estimated to have Alzheimer's disease (AD) and related dementias and 30% to 50% of persons with dementia continue to drive. Although some individuals with mild dementia can drive safely, for almost all, driving will become impossible at some point as the disease progresses.
Research has found that drivers with dementia have a higher crash rate, become lost in familiar areas, and make more frequent errors in performance than other older drivers. In addition, because of poor judgment, lack of insight and a loss of reasoning ability some drivers with dementia may not even realize they having any problems. Therefore, individuals with dementia continue to drive when they are no longer able.
Being unable to drive is a serious loss of independence and mobility. It is not unusual for drivers with dementia to become upset, angry and even depressed when driving concerns are raised.
The sheer numbers of persons with dementia who continue to drive, the seriousness of the issue, and its effect on mobility, underscores the importance of addressing driving and dementia.
Q. What are some warning signs of driving problems?
It can be difficult to determine when a driver with dementia is no longer safe to drive. However, there are several warning signs or red flags that may indicate driving skills are declining and need to be evaluated.
Warning signs to watch for include:
- becoming lost in familiar areas,
- incorrect signaling,
- improper speed – driving too slow or too fast for conditions,
- driving the wrong direction on roadways,
- decreased understanding of traffic signs,
- confusing the break and gas pedals,
- reliance on a co-pilot,
- making poor or slow decisions while behind-the-wheel,
- moving violations, tickets or police warnings, and
- crashes or near misses.
Another indicator of problematic driving occurs when family members refuse to ride with the driver or do not allow others, such as grandchildren, to ride with driver.
Q. What are some ways to assess driving fitness and resources for driving decisions?
It is important to discuss driving concerns with a physician and to also have the individual with dementia's driving evaluated. Many physicians are comfortable beginning the discussion about driving reduction and cessation and to start the driving assessment process. The physician may ask the driver and family questions about the frequency, distance, circumstances of travel, familiarity with roadways used, use of a co-pilot, and any recent crashes and episodes of getting lost. Family may also be asked if they have any concerns about their relative's driving.
If there is any question about the individual's ability to drive safety, he or she will benefit further from a formalized evaluation. Testing can be conducted by a certified driver rehabilitation specialist (CDRS), a professional trained in driver education and training, or the State Department of Public Safety. An assessment may include a knowledge test as well as a behind-the-wheel evaluation. There is usually a fee for an assessment completed by a CDRS. Unfortunately, Medicare and private insurance are unlikely to reimburse for this service.
If the evaluation shows that the individual with dementia is able to continue to drive safely, his or her performance must continue to be revisited. Because many dementias are progressive, ongoing management and discussions about driving are needed. Driving modifications may also be suggested such as limit the individual's driving to off-peak or daylight hours, in familiar areas or in less complex driving environments.
If serious driving errors are apparent, the driver will be advised to stop driving. Discussions about "retirement" from driving must be handled sensitively. In order to be successful, family need to be supportive and participate in creating a workable transportation plan for their relative.
If a driver is reluctant to quit driving, different approaches can be considered to facilitate voluntary cessation. First, it is important to explore with the driver, his or her reasons for resistance. A conversation with a person whom the driver respects, such as a clergy or a police officer, may be able to persuade the driver to quit. Insurance ramifications are also important to consider. For some drivers, individual or group support can diminish the loss and provide opportunities to discuss concerns. For others, a prescription stating that the individual should no longer drive can add leverage.
If all fails authoritarian approaches are needed. In those situations, family members may need to disable the vehicle, move it to another location, hide or replace the keys, or even the sell the vehicle.
When an individual can no longer driver, resources for alternative transportation must be identified. Often friends and relatives can provide necessary transportation or can help to locate other options. Conversations with a social worker to identify community supports can be helpful, too. Finally, the person's driver's license should be replaced with an identification card.
Online Resources:
Several helpful booklets and online resources, designed to help family, friends and caregivers of older drivers with driving discussions and decisions include:
###
Related Articles:
Tags: Alzheimer's disease, dementia, Dr. Geri Adler, driving, driving and dementia, driving problems, Geri Adler, social work, social workers, social workers and alzheimer's disease, Three Questions About Driving With Dementia
Posted in
Alzheimers Disease/Dementia, Seniors And Aging, Tip Sheets |
No Comments »
Introduction
The fastest growing segment of the population in the United States are seniors over the age of 85. Older persons in the United States are faced with many challenges.
According to The Merck Manual of Geriatrics, Americans over age eighty-five account for about 12 percent of all elderly. This figure is expected to rise to 18 percent by the year 2040. The average number of years a person can be expected to live fairly free of physical or cognitive disability is 77 for men and 81 for women. This has many implications for the needs of or increasing older population.
Due to innovations in medicine, pharmacology, and other healthcare services, mortality and morbidity rates are declining. As a result, hospital stays have been sharply reduced, prompting an expansion of needed community-based services. This includes skilled and home-attendant, social work and psychiatric supports, senior centers and adult day health care programs, medical care, hospice care and more.
Due to increased longevity, seniors are often faced with inadequate savings and income because of increasing cost of living expenses. This is a stressful situation as well a serious threat to independence. High insurance co-payments, spend-downs (jargon), and prescription costs can be an obstacle to needed medical care.
The following illustrates an example of the special needs of the older client:
Mrs. R. is a 79-year-old divorced immigrant. She had been hospitalized several times to treat depression. Because she was feeling stressed by immigrating to this country and also felt depressed, she sought help at an outpatient clinic. Mrs. R. told the psychotherapist that she had been having trouble getting out of bed and carrying out her normal daily routine.
Mrs. R. received individual psychotherapy and medication management to address her depression and enable her to resume the tasks of daily living. Although she became psychiatrically stable with improved daily functioning, her medical health deteriorated. Mrs. R. was diagnosed with hepatitis C, high blood pressure, and asthma.
Since beginning chemotherapy treatment for hepatitis, her depression worsened. This is a common problem in the elderly where medications can have psychiatric and physical side effects. This can further impair functioning and complicate diagnoses and treatment. In this case, Mrs. R. stopped taking her psychotropic medication, her severe depression returned and a prolonged psychiatric hospitalization followed.
How Social Workers Help
A social worker helped Mrs. R. in the following ways.
- Collaborated with the patient's various medical and psychiatric providers.
- Monitored Mrs. R's medications and made sure she took them correctly and on schedule.
- Linked Mrs. R. to a Medical Day Program who could provide daily medical and social and support as well as attend to her activities of daily living.
Collaboration and coordination was key to the success of this individual. Social workers routinely assess, intervene, and link patients like Mrs. R. to the services they need.
A Look Toward the Future Needs of the Elderly
Increased Adult Day Medical as well as Social Programs can improve the provision of daily medical oversight, bathing, and meals to insure proper nutrition, cognitive remediation, and social supports. They also serve as respite care for caregivers. Spirituality is often overlooked. Exploration into clients’ beliefs and faith can be an excellent source of support and can be incorporated into the social work interventions
Cognitive Remediation is a growing need as well. For the elderly the three D’s are “Delirium," “Dementia” and “Depression." Each is prevalent, and negatively impact on daily functioning and quality of life, emotionally and physically. Services in medical and mental health programs need to increase focus on improving cognitive skills and helping clients cope and adapt to declining cognitive functioning.
Related Articles:
Susan Winston, LCSW, is a social worker. Ms. Winston has been practicing social work as a clinician and program director since 1978 in a variety of community based mental health and substance abuse programs. Currently she runs a large mental health program in Queens, New York that serves a significant elderly population.
Tags: Alzheimer's disease, social work
Posted in
Alzheimers Disease/Dementia, Current Trends, Seniors And Aging |
No Comments »
Introduction
Over the past few years, Alzheimer’s Disease screening tests have become available to consumers. Licensed clinical social workers who have special training in genetic counseling can help individuals or family members who are interested in these tests. Below is a fact sheet from the Alzheimer’s Association briefly describing the various screening tests.
A screening test is a preliminary procedure administered to distinguish individuals who may need further evaluation for a disorder from those who are less likely to need additional testing. Familiar examples of screening tests include Pap smears, mammograms, and kits for collecting small stool samples to be examined for hidden blood. Most such tests are administered under the supervision of a health care professional who orders the test, communicates the result, and discusses appropriate next steps.
Test developers, health care facilities, and other sources are marketing a growing number of screening tests directly to consumers. Some of these tests are offered on a "self-referred" basis—individuals taking the test do not need a physician's order for it, and the testing facility reports the results directly to the examinee. Self-referred testing is a controversial practice. It is lucrative for facilities administering these tests because consumers must pay for them directly. Insurance plans generally do not pay for self-referred procedures, so facilities offering them can set their own price and require payment in advance.
The Alzheimer's Association has received numerous questions about two dementia screening tests recently marketed directly to consumers. One is the Early AlertAlzheimer's Home Screening Test, available in pharmacies and from a Web site. The other is the Minnesota Cognitive Acuity Screen (MCAS), sold by telephone and through a Web site.
The Alzheimer's Association believes that no single dementia screening procedure is a meaningful substitute for established diagnostic criteria for Alzheimer's disease administered by a skilled physician. Although these screening tests do not claim to offer a definitive diagnosis, any test that may plant the idea of a serious illness in a test-taker's mind has the potential to cause great psychological distress. The whole process of assessment, diagnosis, and diagnostic disclosure should be carried out within the context of an ongoing relationship with responsible health care professionals. Here are some relevant facts about each of the tests currently generating frequent questions:
- This test, marketed by FMG Innovations, Inc., sells for around $15 – $20 in pharmacies and on the Internet.
- It is packaged in a small box that contains an instruction sheet, a pencil, and a booklet with 12 "scratch and sniff" odor strips. Examinees are instructed to scratch each strip to release the smell, then circle one of four words that best describe the odor. Choices include "cinnamon," "dog," "soap," "garlic," "motor oil," fruit and floral fragrances, and a variety of other scents.
- Correct answers are provided in an answer key at the back of the booklet. Examinees with four or more incorrect choices are advised to consult their physician.
- The instruction sheet states, "Smell loss is among the first signs of Alzheimer's disease. Experts recommend screening for smell loss once a year after the age of 65." It is true that there are legitimate scientific investigations exploring a possible link between smell loss and Alzheimer's disease, but the relationship has not been confirmed or quantified. No currently accepted diagnostic criteria for Alzheimer's include evaluation of smell, and there is no recommendation for annual smell testing from any recognized authority involved in establishing clinical guidelines.
- Many factors other than Alzheimer's disease can impair smell, including current smoking or past smoking, certain drugs, a wide variety of medical conditions, and individual differences in sensitivity to odors.
- Medical and diagnostic equipment, including products marketed directly to consumers, is regulated by the Center for Devices and Radiologic Health (CDRH) of the U.S. Food and Drug Administration (FDA). According to a CDRH spokesperson, the Early Alert smell test has not been cleared or approved for marketing.
- The MCAS is sold by telephone and over the Internet for $95 by Nation's CareLink, a care management firm specializing in geriatric assessments.
- The test consists of a 15-minute question-and-answer telephone interview administered by a registered nurse who asks test-takers such questions as their name, address, and birthday, what day it is, and how they would handle an emergency such as a fire in their home. Examinees are also asked to repeat a six-digit number, to remember 10 words, and to tap on the telephone when instructed. Nurses score each examinee, and those whose scores fall below certain levels are considered to need monitoring or to have "failed" the test.
- The test's developers recommend annual testing. This recommendation does not reflect a policy established by any recognized clinical guideline.
- The chief use of the MCAS has been for commercial rather than clinical purposes—the test was developed by Nation's CareLink as a risk management tool to help insurers avoid issuing long-term care policies to individuals judged likely to develop dementia.
- The MCAS Web site describes the test as "98.1 percent effective in identifying cognitive function." In support of this statement, MCAS cites an article published by the test's developers in the October 2000 edition of the journal Neuropsychiatry, Neuropsychology, and Behavioral Neurology. The abstract of this article on PubMed, the on-line literature database for the U.S. National Library of Medicine, concludes with the developer's own statement that "The Minnesota Cognitive Acuity Screen (MCAS) should undergo further study in unselected elderly populations to better understand its value as a screening tool." The PubMed database contains no additional articles about the test.
To receive information about other important issues related to Alzheimer's disease, please call our Contact Center at (800) 272-3900 or visit the Alzheimer's Association Web site at www.alz.org.
Related Articles:
Tags: Alzheimer's disease, dementia, screening
Posted in
Alzheimers Disease/Dementia, Current Trends, Seniors And Aging |
No Comments »
Introduction
Over the past few years, Alzheimer’s disease screening tests have become available to consumers. Licensed clinical social workers who have special training in genetic counseling can help individuals or family members who are interested in these tests. Below is a fact sheet from the Alzheimer’s Association briefly describing the various screening tests.
What is a Screening Test?
A screening test is a preliminary procedure administered to distinguish individuals who may need further evaluation for a disorder from those who are less likely to need additional testing. Familiar examples of screening tests include Pap smears, mammograms, and kits for collecting small stool samples to be examined for hidden blood. Most such tests are administered under the supervision of a health care professional who orders the test, communicates the result, and discusses appropriate next steps.
What Screening Tests Are Marketed Directly to Consumers?
Test developers, health care facilities, and other sources are marketing a growing number of screening tests directly to consumers. Some of these tests are offered on a "self-referred" basis—individuals taking the test do not need a physician's order for it, and the testing facility reports the results directly to the examinee. Self-referred testing is a controversial practice. It is lucrative for facilities administering these tests because consumers must pay for them directly. Insurance plans generally do not pay for self-referred procedures, so facilities offering them can set their own price and require payment in advance.
What Consumer Screening Tests Are Marketed for Dementia?
The Alzheimer's Association has received numerous questions about two dementia screening tests recently marketed directly to consumers. One is the Early Alert Alzheimer's Home Screening Test, available in pharmacies and from a Web site. The other is the Minnesota Cognitive Acuity Screen (MCAS), sold by telephone and through a Web site.
The Alzheimer's Association believes that no single dementia screening procedure is a meaningful substitute for established diagnostic criteria for Alzheimer's disease administered by a skilled physician. Although these screening tests do not claim to offer a definitive diagnosis, any test that may plant the idea of a serious illness in a test-taker's mind has the potential to cause great psychological distress. The whole process of assessment, diagnosis, and diagnostic disclosure should be carried out within the context of an ongoing relationship with responsible health care professionals. Here are some relevant facts about each of the tests currently generating frequent questions:
Facts about the Early Alert Alzheimer's Home Screening Test
- This test, marketed by FMG Innovations, Inc., sells for around $15 – $20 in pharmacies and on the Internet.
- It is packaged in a small box that contains an instruction sheet, a pencil, and a booklet with 12 "scratch and sniff" odor strips. Examinees are instructed to scratch each strip to release the smell, then circle one of four words that best describe the odor. Choices include "cinnamon," "dog," "soap," "garlic," "motor oil," fruit and floral fragrances, and a variety of other scents.
- Correct answers are provided in an answer key at the back of the booklet. Examinees with four or more incorrect choices are advised to consult their physician.
- The instruction sheet states, "Smell loss is among the first signs of Alzheimer's disease. Experts recommend screening for smell loss once a year after the age of 65." It is true that there are legitimate scientific investigations exploring a possible link between smell loss and Alzheimer's disease, but the relationship has not been confirmed or quantified. No currently accepted diagnostic criteria for Alzheimer's include evaluation of smell, and there is no recommendation for annual smell testing from any recognized authority involved in establishing clinical guidelines.
- Many factors other than Alzheimer's disease can impair smell, including current smoking or past smoking, certain drugs, a wide variety of medical conditions, and individual differences in sensitivity to odors.
- Medical and diagnostic equipment, including products marketed directly to consumers, is regulated by the Center for Devices and Radiologic Health (CDRH) of the U.S. Food and Drug Administration (FDA). According to a CDRH spokesperson, the Early Alert smell test has not been cleared or approved for marketing.
Facts about the Minnesota Cognitive Acuity Screen (MCAS)
- The MCAS is sold by telephone and over the Internet for $95 by Nation's CareLink, a care management firm specializing in geriatric assessments.
- The test consists of a 15-minute question-and-answer telephone interview administered by a registered nurse who asks test-takers such questions as their name, address, and birthday, what day it is, and how they would handle an emergency such as a fire in their home. Examinees are also asked to repeat a six-digit number, to remember 10 words, and to tap on the telephone when instructed. Nurses score each examinee, and those whose scores fall below certain levels are considered to need monitoring or to have "failed" the test.
- The test's developers recommend annual testing. This recommendation does not reflect a policy established by any recognized clinical guideline.
- The chief use of the MCAS has been for commercial rather than clinical purposes—the test was developed by Nation's CareLink as a risk management tool to help insurers avoid issuing long-term care policies to individuals judged likely to develop dementia.
- The MCAS Web site describes the test as "98.1 percent effective in identifying cognitive function." In support of this statement, MCAS cites an article published by the test's developers in the October 2000 edition of the journal Neuropsychiatry, Neuropsychology, and Behavioral Neurology. The abstract of this article on PubMed, the on-line literature database for the U.S. National Library of Medicine, concludes with the developer's own statement that "The Minnesota Cognitive Acuity Screen (MCAS) should undergo further study in unselected elderly populations to better understand its value as a screening tool." The PubMed database contains no additional articles about the test.
Where Can I Get Information About Other Alzheimer-Related issues?
To receive information about other important issues related to Alzheimer's disease, please call our Contact Center at (800) 272-3900 or visit the Alzheimer's Association Web site at www.alz.org.
Related Articles:
Tags: Alzheimer's disease, dementia, genetic screening
Posted in
Family Genetics, Health And Wellness, Your Options |
No Comments »
As we age, most of us will experience temporary memory lapses. We may forget names or telephone numbers and have difficulty finding the right word, which can be annoying, but certainly not life threatening. More serious memory problems and behavioral changes that interfere with daily life are not normal and may indicate a brain disease called dementia.
Dementia is a group of symptoms caused by changes in brain function, according to the National Institute on Aging. Alzheimer's disease, the most common form of dementia that is seen in older adults, is a progressive brain disorder that affects memory and reasoning and the ability to learn and communicate.
The onset of the disease is gradual, so older adults, their families, and even their doctors may not initially consider early symptoms as a possible form of dementia. Once diagnosed with the illness, people with Alzheimer's live an average of eight years, although they can live as long as 20 years with the disease, depending on the age at diagnosis and the severity of other health problems.
Alzheimer's is most common in people over age 65. An estimated 4.5 million people in the United States have been diagnosed with Alzheimer's.
The Alzheimer's Association estimates that by 2050, the number of people with the disease could increase to range from 11 to 16 million.
The disease is often categorized into early, middle, and late stages. Not everyone with the disease will develop all of the symptoms or experience a decline in the same amount of time. The Alzheimer's Association describes the stages in terms of symptoms.
- Frequent memory loss: forgetting recent events and conversations
- Problems with language: forgetting simple words or making up words as substitutes
- Difficulty performing everyday tasks, such as cooking or paying bills
- Disorientation to time and place: forgetting where they are, how they got there, and how to get home
- Mood changes: rapid mood swings for no apparent reason
- Personality changes: becoming unusually angry, irritable, quiet, or confused
Difficult behaviors: paranoia, wandering, repeating questions, hallucinations, agitation
- Loss of reading and writing abilities
- Loss of coordination
- Difficulty recognizing family and friends at times
- Progresses from needing reminders regarding personal care to needing assistance with personal care
- Loss of ability to walk, communicate, and to recognize people and objects
- May lose ability to swallow
- Incontinence
- Spends majority of time sleeping
Alzheimer's disease cannot be diagnosed with a single test or procedure. Instead, the disease is diagnosed through comprehensive neurological assessments and a medical evaluation. Physicians will rule out other potential causes of dementia symptoms, including depression, malnutrition, or side effects from medications.
There is no known cure for Alzheimer's, but several medications have been developed recently for people in the early stages of the disease to aid in slowing down the progression of the disease. However, the new medications are not effective for everyone.
Depression, anxiety, unpredictable behavior, and other emotional and behavioral symptoms can also be treated with medication to help improve the quality of life of people with Alzheimer's and their caregivers.
According to the Alzheimer’s Association, early-onset is a diagnosis of the disease when the person is younger than 65. A small percentage of individuals are diagnosed in the 40′s, 50′s and early 60′s. Individuals with early-onset may be employed, have children living at home and face issues such as ensuring financial security, obtaining benefits, and helping children cope with the disease.
Watching a loved one slowly deteriorate from one stage of Alzheimer's to the next can be devastating for family members. Caregivers must adjust over time as the needs of the person with Alzheimer's disease change, cope with challenging behavioral changes, and experience the heartache when their loved one no longer recognizes them.
Nearly all Alzheimer's caregivers report that they frequently experience high levels of stress, and nearly half suffer from depression, according to the Alzheimer's Association. Caregivers often ignore their own health needs due to the demands of their caregiving role.
To reduce caregiver stress, the Alzheimer's Association offers these suggestions:
- Learn about the disease: symptoms, behavioral changes, and stages
- Find classes that will teach you how to control unwanted behaviors and improve communication
- Find a support group in your community for information and emotional support
- Establish a social and emotional support network of people you can count on to help in times of need
- Plan ahead for legal and financial issues
- Take care of your own physical and emotional needs
Social workers who work in health care settings, social service organizations, and private practice are trained to assist caregivers with family needs during this difficult time. They can arrange for in-home services, coordinate care among medical professionals, and direct caregivers to various community resources, particularly respite care, which is necessary to reduce caregiver stress.
When caregivers care for themselves, seek help, and participate in support groups and classes, they are more equipped to provide better care and to care for their loved one at home through the later stages of the disease.
Related Articles:
Tags: Alzheimer's disease, dementia
Posted in
About, Alzheimers Disease/Dementia, Seniors And Aging |
No Comments »
|
|
|
|
 |
 |
 |
| |
| | |
