the hourlong “Frontline” documentary “Life and Death in Assisted Living,” airing Tuesday night on PBS stations across the country, doesn’t really break new ground on the subject. But it is important nonetheless.One reason is that families, who make most of the decisions about assisted living, don’t pore over gerontology journals or state regulations as they are looking for a place that is not a nursing home.
So they don’t always realize that these reassuring-looking residences may have no nurse on the premises most of the time, that health care in assisted living frequently consists of a 911 call, that the average length of stay — according to the Assisted Living Federation of America — is less than two years.
TORONTO – Studies show that Canada’s elderly are at a much higher risk of suicide than adolescents, and there is growing concern among mental health experts that psychological care may be out of reach for most seniors.
Dr. Marnin Heisel, a clinical psychologist and professor at the University of Western Ontario, says lack of public awareness of the issue is a key problem that affects not only the elderly, but their families and the public in general.
Although this article reports on the problem in Canada, depression among older adults is by no means confined to that country.
As pointed out here, there is a need for public awareness about the issue of older adults and depression. Family and friends should be aware of what signs to look for and should not hesitate to discuss the issue with older friends and family members.
One interesting point here is the observation that suicide might sometimes pass for death by natural causes in this age group unless coroners, alerted by reports of depression, know to look specifically for signs of suicide on autopsy.
This article describes a patient who benefited from early diagnosis of a rare form of Alzheimer’s disease. But for most people, early diagnosis of dementia only provides knowledge of a problem for which there is no effective treatment.
the push for ever-earlier dementia screening raises troubling questions for patients and their families. When the diagnosis is early Alzheimer’s disease, the medical profession has little treatment to offer. This month, researchers at an Alzheimer’s Association conference in Boston urged policy makers to think hard before recommending wider dementia screening, saying studies have found no evidence that early detection improves outcomes.
And the experts said that little, if anything, is known about the potential risks of early detection. The diagnosis may cause stress, anxiety, depression and even suicide in patients, and can have implications for employment, purchasing life and long-term care insurance, and one’s overall quality of life, sense of autonomy and self-image.
While there are no easy answers, the article concludes with an encouragement for older adults and their family members who begin noticing signs of cognitive impairment to get a thorough medical examination:
The physician should take a history, do a thorough exam, and rule out a number of potential causes of mental impairment: depression; thyroid, kidney and liver function; vitamin B12 levels; infections; and dehydration and electrolyte disturbances. . . . The physician should also do a careful review of medications, since many drugs can have adverse effects on cognition. . . . Reassuringly, many people who experience mild cognitive impairment do not progress to dementia, and many even return to normal, some studies suggest. A study of primary care patients seen at Wishard Health Services identified 130 patients with mild cognitive impairment. A year later, most were stable, and nearly one-third had reverted to normal.
Here’s a jolt: Mick Jagger turns 70 today.
Michael Dwyer, writing in Australian newspaper The Age, entertains with a historic look at The Rolling Stones and Jagger, who refuses to age gracefully.
Pain management needs to be tailored for older people. The British Pain Society and British Geriatric Society produced guidelines specifically for this client group
This link is to a page summarizing an article from the professional journal Nursing Times. The article lists five key points:
- Pain is a risk factor for falls in older people
- It is thought that 50% of older adults living in the community, and 80% of those living in care homes, experience chronic pain
- Few studies look at the effects of pharmacological interventions specifically on older people
- Combination therapy using different classes of analgesics may be more effective with fewer side-effects, compared with higher doses of a single medicine
- Further research is needed on psychological treatments for pain in older people
You can see the entire two-page article by clicking on the link for the PDF file under “Related Files” in the middle of the page.
Liah Greenfeld, Ph.D., writes that medical advances in prolonging life may have unintended consequences. She offers as evidence the fate of her parents:
My mother, who will be 85 next month and whose mind is still sharper than a surgical scalpel, repeats now and then: one must die in time. She was a doctor, she watched many deaths. She believes that the ability of medical science in developed countries to prolong life into the 80s and beyond is nothing to celebrate and, in fact, actively contributes to unnecessary suffering. My mother is tired of life – and since my father’s death eleven years ago, in 2002, has often wished she were dead. They were married for 53 years, with his death meaningful life ended for her – there was nothing to live for anymore. His death – sudden, on the operation table, at 75 — was a terrible loss for all of us. For two years I, his eldest daughter, 48 when this happened, was overwhelmed by grief. Yet, before that, I had been consciously happy, that is, I realized that my life was a truly happy one, full to the brim of love and passionate interest in the surrounding world, which make life worth living. My father knew that he was going to die: we have discovered this in his diary. He was a doctor too, and a very good doctor, in contrast to the young and eager to cut surgeons who operated on him. He knew that, given the regimen of medications he was on, if operated, he would die of the loss of blood; his doctors, who suggested an exploratory surgery, missed this essential detail. Signing the consent form, my father was, therefore, consciously signing his death warrant. He was a man interested in so many things, always excited about something, always full of projects. In fact, at the time of his death he was learning a new language. And he was afraid of dying, as he wrote in the last entry of his diary, adding, though, but can life after 75 be considered life? I understand now that he died, as my mother says, “in time.”
After his death, my mother suddenly became very old. Her health drastically deteriorated. She started dying and has been dying for eleven years.
She ends by asking: “When is the time? Shouldn’t we at least think of this before further advancing our ability to prolong physical existence, without at the same time being able to fill the additional years with meaning?”
Aren’t they beautiful? I had never seen these before.
We bought them at Metropolitan Market, located in Tacoma’s Proctor District.
When it comes to providing health care for an aging nation, the bad news is no longer news. We already lack sufficient numbers of geriatricians and other professionals — nurses, social workers, pharmacists, aides — trained to care for the elderly, and the shortage is projected to increase.
The good news, confirmed by a study in the Journal of the American Geriatrics Society, is that nurse practitioners can markedly improve the quality of care for older patients.
This article in The New York Times‘s health section “The New Old Age” reports on a recent study revealing that nurse practitioners can, in many cases, dramatically improve the quality of patient care.
Researchers from UCLA examined medical visits involving four common conditions among older patients: urinary incontinence, falls, depression and dementia:
When it came to treating depression, patients seeing a doctor and a nurse practitioner received about the same care as those treated by doctors alone. In both groups, patients received 60 percent to 63 percent of recommended care.
But when patients showed up with one of the other three conditions, the addition of nurse practitioners meant much higher scores. Patients who saw a nurse practitioner along with a doctor received 80 percent of the recommended assessments and treatments for falls (compared with 34 percent for those who only saw a doctor), 59 percent for dementia (versus 38 percent) and 66 percent for incontinence (versus a particularly dismal 19 percent).
Dr. David Reuben, director of geriatrics at the University of California, Los Angeles and lead author of the study, explains the benefits of a team approach to medical management that uses both doctors and nurse practitioners:
“There are certain things doctors do well, certain things they don’t do well, certain things nurse practitioners do better,” he said. He added that he sympathized with primary care doctors working with elderly patients who have many chronic conditions: “The job is too big. It’s too complicated. There’s too much to do.”
Studies presented Wednesday at an Alzheimer’s Association conference in Boston showed that people with some types of cognitive concerns were more likely to have Alzheimer’s pathology in their brains, and to develop dementia later. Research presented by Dr. Amariglio, for example, found that people with more concerns about memory and organizing ability were more likely to have amyloid, a key Alzheimer’s-related protein, in their brains.
And, in a significant shift highlighted at the conference, leading Alzheimer’s researchers are identifying a new category called “subjective cognitive decline,” which is people’s own sense that their memory and thinking skills are slipping even before others have noticed.
This article reports on a new interest in Alzheimer’s research, the subjective reports of aging patients, known as “the worried well,” who sense their cognitive abilities changing before standard testing procedures reveal definite signs of dementia:
leading Alzheimer’s researchers are identifying a new category called “subjective cognitive decline,” which is people’s own sense that their memory and thinking skills are slipping even before others have noticed.
However, it’s important to note that:
Some memory decline reflects normal aging, they say, and some concerns reflect psychological angst. People who forget what they wanted in the kitchen or the names of relatively unfamiliar people are probably aging normally. People who forget important details of recent events, get lost in familiar places or lose track of book or television plots may not be, especially if they have more problems than others their age.
Finally, a bit of good news:
A new study has found dementia rates among people 65 and older in England and Wales have plummeted by 25 percent over the past two decades, to 6.2 percent from 8.3 percent, a trend researchers say is likely occurring across developed countries and that could have major social and economic implications for families and societies.Another recent study, in Denmark, found that people in their 90s who were given a standard test of mental ability in 2010 scored substantially better than people who reached their 90s a decade earlier.