A diagnosis of Alzheimer's raises many questions. The Alzheimer's Association has several free, online tools to help you find answers, local resources and support.
Alzheimer's Navigator®
ALZConnected® (Message Boards)
Caregiver Stress Check
Care Team Calendar
Comfort Zone®
Community Resource Finder
E-Learning Workshops
essentiALZ Individual Certification
TrialMatch®
Virtual Library
Read more: http://www.alz.org/care/alzheimers-dementia-online-tools.asp#ixzz3ST9Bt8Q1
Sunday, February 22, 2015
Tuesday, February 17, 2015
AMERICA’S EMERGENCY CARE ENVIRONMENT ... American College of Emergency Physicians
ACEP 2014 EM Report Card: AMERICA’S EMERGENCY
CARE ENVIRONMENT
About ACEP
The American College of Emergency Physicians (ACEP), founded in 1968, is the oldest and largest national medical specialty organization representing physicians who practice emergency medicine. With more than 32,000 members, ACEP continually monitors trends in the health care environment and analyzes issues affecting emergency physicians and their patients
CARE ENVIRONMENT
About ACEP
The American College of Emergency Physicians (ACEP), founded in 1968, is the oldest and largest national medical specialty organization representing physicians who practice emergency medicine. With more than 32,000 members, ACEP continually monitors trends in the health care environment and analyzes issues affecting emergency physicians and their patients
Saturday, February 14, 2015
Wednesday, February 11, 2015
4 Key Things to Know about Trusts and Medicaid Planning - AgingCare.com
4 Key Things to Know about Trusts and Medicaid Planning - AgingCare.com
There are many types of trusts that can be helpful in protecting your assets while allowing you to qualify for Medicaid. This article is a brief overview of the things you need to know when setting up a trust.
It must be irrevocable: An irrevocable trust cannot be altered or amended, and are thus the only type of trust that offers any benefit for Medicaid planning.
There are many types of trusts that can be helpful in protecting your assets while allowing you to qualify for Medicaid. This article is a brief overview of the things you need to know when setting up a trust.
It must be irrevocable: An irrevocable trust cannot be altered or amended, and are thus the only type of trust that offers any benefit for Medicaid planning.
Home Health Aide Certification and Certificate Programs
Home Health Aide Certification and Certificate Programs
Each state has its own requirements for home health aide certification. Some states only require that the employing agency be certified, while others require home health aides to pass a certification exam following completion of an educational program. Besides a skills assessment examination, certification may also require a state administered criminal background check. Some states maintain a registry database of certified home health aides that can be accessed by the public
===============
Home Health Aide Training Requirements in MA
Massachusetts does not require a State issued certification, nor is
there a State exam required to be eligible to work as a Home Health
Aide. Instead the State recommends national certification through the
National Association for Home Care and Hospice. The NAHC requires a 75 hour training course and a competency test before you are eligible to apply for their certification.
Each state has its own requirements for home health aide certification. Some states only require that the employing agency be certified, while others require home health aides to pass a certification exam following completion of an educational program. Besides a skills assessment examination, certification may also require a state administered criminal background check. Some states maintain a registry database of certified home health aides that can be accessed by the public
===============
Home Health Aide Training Requirements in MA
Massachusetts does not require a State issued certification, nor is
there a State exam required to be eligible to work as a Home Health
Aide. Instead the State recommends national certification through the
National Association for Home Care and Hospice. The NAHC requires a 75 hour training course and a competency test before you are eligible to apply for their certification.
Tuesday, February 10, 2015
Who would come to take your place in a crisis | emergency
What would you do if you had a crisis and had to leave in an ambulance in the middle of the night?
Who take your place to help your/our loved ones?
I have have a plan "b" in a closed plastic file folder with compartments in my car. It has our POA's, medical stuff, and health care proxy. I have also sent copies of POA and med proxies to the local hospitals' medical records.
Here is a early copy of the plan-B document {medial information for responders} which is in a "File of Life" folder.
Medic Information for responders
Our phone number:
Our home address:
--
Emergency call 911
Preferred Hospital:
Local hospital:
--
MedicAlert Services (med information) 800 432 5378
caregiver ID xxxxxxxxxxxxx ALZ Safe Return ID SRxxxxxxxx
--
In-Home Health Services Provider:
--
Insurance: Medicare & Medx (BXBS) Medex phone 800 678 2265
---
Housebound 's name
DOB MO/Day/Year
PCP; Dr name/phone/location
Alzheimer’s; Dr name/phone/location
Current medications: {list of meds and instructions}
--
My name:
DOB MO/Day/YEAR
PCP: Dr name/phone/location
Current medications: {list of meds and instructions}
--
Individuals to call to come in response to emergency
{FIRST CALL} name,phone, location
{Immediately call} Home Instead 508 393 8838
--
(if you can’t get first person others: possible calls)
list of trusted people.
--
other contacts:
Dentist :
--
Individual holding Durable Power of Attorneys: {holders names and their contact information}
--
Records (directives etc) on file at Family Attorney Contact information:
Who take your place to help your/our loved ones?
I have have a plan "b" in a closed plastic file folder with compartments in my car. It has our POA's, medical stuff, and health care proxy. I have also sent copies of POA and med proxies to the local hospitals' medical records.
Here is a early copy of the plan-B document {medial information for responders} which is in a "File of Life" folder.
Medic Information for responders
Our phone number:
Our home address:
--
Emergency call 911
Preferred Hospital:
Local hospital:
--
MedicAlert Services (med information) 800 432 5378
caregiver ID xxxxxxxxxxxxx ALZ Safe Return ID SRxxxxxxxx
--
In-Home Health Services Provider:
--
Insurance: Medicare & Medx (BXBS) Medex phone 800 678 2265
---
Housebound 's name
DOB MO/Day/Year
PCP; Dr name/phone/location
Alzheimer’s; Dr name/phone/location
Current medications: {list of meds and instructions}
--
My name:
DOB MO/Day/YEAR
PCP: Dr name/phone/location
Current medications: {list of meds and instructions}
--
Individuals to call to come in response to emergency
{FIRST CALL} name,phone, location
{Immediately call} Home Instead 508 393 8838
--
(if you can’t get first person others: possible calls)
list of trusted people.
--
other contacts:
Dentist :
--
Individual holding Durable Power of Attorneys: {holders names and their contact information}
--
Records (directives etc) on file at Family Attorney Contact information:
Thursday, February 5, 2015
How to help if someone you care for has a fall | Stroke4Carers
How to help if someone you care for has a fall | Stroke4Carers: How to help if someone you care for has a fall
Video running time: 07.13 minutes. The film may take time to download depending on your broadband speed.
To enlarge to full screen click on the arrows at the bottom right of the frame.
If you are having problems playing the video, download the clip here [.mp4, 28.6 MB] (Right click this link, and “Save As”). http://www.stroke4carers.org/wp-content/uploads/GETTING_UP_AFTER_A_FALL.mp4
Video running time: 07.13 minutes. The film may take time to download depending on your broadband speed.
To enlarge to full screen click on the arrows at the bottom right of the frame.
If you are having problems playing the video, download the clip here [.mp4, 28.6 MB] (Right click this link, and “Save As”). http://www.stroke4carers.org/wp-content/uploads/GETTING_UP_AFTER_A_FALL.mp4
Book list, this information and all links were active 8/20/2013
"A
Common Sense Guide to Alzheimer's Care Kisses for Elizabeth is
written for both family and professional caregivers of people with
Alzheimer's disease and other dementia’s. It is a practical
resource for anyone experiencing difficulty with significant
behavioral issues but is also helpful to caregivers who simply want
to provide the best possible care.
The author has developed 15 common sense guidelines which address a wide
variety of concerns by helping caregivers to solve problems or even
prevent them. The guidelines also address negative behaviors such as
wandering, combativeness, paranoia and sundowning. The book explains
what dementia is, how it affects people who suffer from it and why
these behaviors occur.
variety of concerns by helping caregivers to solve problems or even
prevent them. The guidelines also address negative behaviors such as
wandering, combativeness, paranoia and sundowning. The book explains
what dementia is, how it affects people who suffer from it and why
these behaviors occur.
Stephanie D Zeman MSN RN has included over 40 true heartwarming stories about her patients with dementia and ways in which the guidelines were
applied to help resolve their problems and enhance the individuals
quality of life
applied to help resolve their problems and enhance the individuals
quality of life
Since one of the best ways to learn is by example, Stephanie D Zeman MSN RN
has included over 40 true heartwarming stories about her patients
with dementia and ways in which the guidelines were applied to help
resolve their problems and enhance the individuals quality of life."
FYI ,,,,,,,,,,,,,,,,,,,,,,
Stephanie
is one of my on-line friends.
We are both active on
http://www.alzconnected.org/discussion.aspx
Stephanie
on abuse: READ TODAY
http://www.alzconnected.org/discussion.aspx?tid=2147495522&g=posts&t=2147495517
Another
excellent book I quote from often:
Jolene
Brackey "Creating Moments of Joy" Perdue University Press.
Stephanie
offerred this list, his information and all links are active
8/20/2013
This
is a list of links about information you will need. Most helpful for
you right now will be "Understanding the dementia experience"
which will give you an idea of what your LO is going through; and
"Communication skills" Which will help you to
communicate in ways which will avoid or decrease your LO
negative behaviors.
Understandingthe dementia experience:
https://www.smashwords.com/books/view/210580
Anosognosiaexplains why dementia patients are unaware of their problem
http://alzonline.phhp.ufl.edu/en/reading/Anosognosia.pdf
Communicationtechniques for dementia caregivers:
http://www.alzconnected.org/discussion.aspx?g=posts&t=2147497924
Guideto diagnosing and treating dementia: What your doctor should do:http://dementia.americangeriatrics.org/
Bathingand Showering
http://www.alzconnected.org/discussion.aspx?g=posts&t=2147491802
http://www.alzheimers.org.uk/site/scripts/documents_info.php?documentID=138
http://www.disabled-world.com/health/aging/uti.php
Pickingat skin/scabs: http://www.alzcompend.info/?p=233
http://prc.coh.org/PainNOA/Abbey_Tool.pdf
http://www.alzconnected.org/discussion.aspx?g=posts&t=2147489263
Caregiverkitchen http://caregiver.com/kitchen/index.htm
“Uncompensated Pending Medicaid Beneficiary Payment Relief Act,”
A3928
An Act providing compensation relief to long term care facilities when Medicaid eligibility determinations are delayed, designated the “Uncompensated Pending Medicaid Beneficiary Payment
1. The Commissioner of Human Services shall make an advance payment to a nursing facility, an assisted living residence, or a comprehensive personal care home licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.), at the facility’s request, whenever the facility is providing uncompensated services to one or more residents whose eligibility for Medicaid has not been determined more than ninety days after an application has been filed. Any such advance payment shall not exceed fifty percent of the estimated amount due for the uncompensated services. No later than 30 days after any such application is granted and payment has been made to the facility, or after any such application has been denied, the commissioner shall: provide reimbursement for any balance due to the facility; or recover any advance payments made on behalf of an applicant deemed ineligible for Medicaid by reducing any payments due to the facility.
2. The Commissioner of Human Services shall apply for such State plan amendments or waivers as may be necessary to implement the provisions of this act and to secure federal financial participation for State Medicaid expenditures under the federal Medicaid program.
3. The Commissioner of Human Services shall, in accordance with the “Administrative Procedure Act,” P.L.1968, c.410 (C.52:14B-1 et seq.), adopt any rules and regulations as the commissioner deems necessary to carry out the provisions of this act.
4. This act shall take effect on the first day of the fiscal year next following the date of enactment, except that the Commissioner of Human Services may take such anticipatory administrative action in advance thereof as shall be necessary for >the implementation of the act.
/>
STATEMENT
This bill, designated the “Uncompensated Pending Medicaid Beneficiary Payment Relief Act,” would provide payments to certain long term care facilities for residents who have applied for Medicaid but whose eligibility has not been determined more than 90 days after the initial application. The bill requires the Commissioner of Human Services to make advance payments to a nursing facility, an assisted living residence, or a comprehensive personal care home, at the facility’s request, whenever the facility is providing uncompensated services to one or more residents whose eligibility for Medicaid has not been determined more than ninety days after an application has been filed. Any such advance payment would not exceed fifty percent of the estimated amount due for the uncompensated services. No later than 30 days after any such application is granted and payment has been made to the facility, or after any such application has been denied, the commissioner would be required to: provide reimbursement for any balance due to the facility; or recover any advance payments made on behalf of an applicant deemed ineligible for Medicaid by reducing any payments due to the facility.
Tuesday, February 3, 2015
Dementia Behavior Can Seem Like Manipulation - AgingCare.com
Dementia Behavior Can Seem Like Manipulation - AgingCare.com:
"Sometimes caregivers assume that (their loved ones) are being manipulative because they just can't believe their behavior," she explains. But in reality, people with dementia aren't able to think through the process of manipulation.
"Sometimes caregivers assume that (their loved ones) are being manipulative because they just can't believe their behavior," she explains. But in reality, people with dementia aren't able to think through the process of manipulation.
Sunday, February 1, 2015
Denial: When it helps, when it hurts - Mayo Clinic
Denial: When it helps, when it hurts - Mayo Clinic
Refuse to acknowledge a stressful problem or situation
Avoid facing the facts of the situation
Minimize the consequences of the situation
In its strictest sense, denial is an unconscious process. You don't generally decide to be in denial about something. But some research suggests that denial might have a conscious component — on some level, you might choose to be in denial.
You can be in denial about anything that makes you feel vulnerable or threatens your sense of control, such as:
Refuse to acknowledge a stressful problem or situation
In its strictest sense, denial is an unconscious process. You don't generally decide to be in denial about something. But some research suggests that denial might have a conscious component — on some level, you might choose to be in denial.
Common reasons for denial
- A chronic or terminal illness
- Depression or other mental health conditions
- Addiction
- Financial problems
- Job difficulties
- Relationship conflicts
- Traumatic events
Wednesday, January 28, 2015
Free Information Download on Stroke
Free Information Download on Stroke: How Do I Know It's a Stroke?
bigstock-Asthma-Disabled-Senior-6268943.jpg
Top 5 Signs of a Stroke
Preview of Your Free Download on Stroke
Approximately 795,000 people in the United States have a new or recurrent stroke each year (American Stroke Association [ASA], 2012a).
Here are some signs and symptoms:
SUDDEN numbness or weakness of face, arm or leg – especially on one side of the body.
SUDDEN confusion, trouble speaking or understanding.
SUDDEN trouble seeing in one or both eyes.
SUDDEN trouble walking, dizziness, loss of balance or coordination.
SUDDEN severe headache with no known cause (National Stroke Association, 2013)
Risk Factors, Diagnosis, Treatment and Post Stroke Rehabilitation available with FREE download.
bigstock-Asthma-Disabled-Senior-6268943.jpg
Top 5 Signs of a Stroke
Preview of Your Free Download on Stroke
Approximately 795,000 people in the United States have a new or recurrent stroke each year (American Stroke Association [ASA], 2012a).
Here are some signs and symptoms:
SUDDEN numbness or weakness of face, arm or leg – especially on one side of the body.
SUDDEN confusion, trouble speaking or understanding.
SUDDEN trouble seeing in one or both eyes.
SUDDEN trouble walking, dizziness, loss of balance or coordination.
SUDDEN severe headache with no known cause (National Stroke Association, 2013)
Risk Factors, Diagnosis, Treatment and Post Stroke Rehabilitation available with FREE download.
Tuesday, January 27, 2015
How do Alzheimer’s and dementia cue cards help communication? Video content included. « Caregiver Cards Caregiver Cards
How do Alzheimer’s and dementia cue cards help communication? Video content included. « Caregiver Cards Caregiver Cards: Caregiver Cards Communication Cues for Alzheimer's & Dementia Care
"Let's Continue the Communication"
"Let's Continue the Communication"
Saturday, January 24, 2015
A Sense of Calm DVD
"A Sense of Calm" is being used in over 600 care homes and schools, as well as by family carers at home, to help relax adults and children with a range of conditions, including dementia, Alzheimer’s, strokes, autism, Down’s syndrome and other learning difficulties, where the nature of their condition can lead to frustration, agitation, anxiety and sometimes rage.
DVD is 60 minutes long and features 6 video tracks of specially-created, flowing images, set to specially-composed music, designed to promote relaxation through sensory stimulation. We also include a booklet on how to get the best from your DVD. A Sense of Calm DVD:
DVD is 60 minutes long and features 6 video tracks of specially-created, flowing images, set to specially-composed music, designed to promote relaxation through sensory stimulation. We also include a booklet on how to get the best from your DVD. A Sense of Calm DVD:
Comfort Care Order (CCO-DNR) program Plus MOLST
EMS Comfort Care Order Do Not Resuscitate Program | doh
The
Emergency Medical Services (EMS) Comfort Care Order-Do Not Resuscitate
(CCO-DNR) program allows patients diagnosed with a specific medical or
terminal condition to express their wishes regarding end of life
resuscitation in the pre or post-hospital setting.
The program requires that a patient’s attending physician certify and sign a Comfort Care Order
(CCO) that states the patient (adult or child) has a specific medical
or terminal condition. The patient, or his or her authorized decision
maker or surrogate, must also consent and sign the CCO (verbal orders
are not valid). The physician then places a Comfort Care bracelet on the
patien
Emergency Medical Services (EMS) Comfort Care Order-Do Not Resuscitate
(CCO-DNR) program allows patients diagnosed with a specific medical or
terminal condition to express their wishes regarding end of life
resuscitation in the pre or post-hospital setting.
The program requires that a patient’s attending physician certify and sign a Comfort Care Order
(CCO) that states the patient (adult or child) has a specific medical
or terminal condition. The patient, or his or her authorized decision
maker or surrogate, must also consent and sign the CCO (verbal orders
are not valid). The physician then places a Comfort Care bracelet on the
patien
Friday, January 23, 2015
Caregiver Cards Cue Cards & Prompts for Alzheimers & Dementia Caregiver Cards
Caregiver Cards Cue Cards & Prompts for Alzheimers & Dementia Caregiver Cards:
<QUOTE>
Caregiver Cards provide essential visual picture cues that improve communication, promote independence and reduce anxiety for adults with memory, cognitive, or speech challenges due to dementia, Alzheimer’s disease, autism, deaf or hard of hearing, and other disabilities. An essential aid for helping adults understand and engage in activities at home or in residential care or memory care settings.
This easy-to-use, compact set of 76 cards includes simple, clear illustrations that prompt your loved one to understand and participate more independently in self-care and social activities.
The deck includes 146 picture cues covering 6 subject categories:
tivities of Daily Living
Instrumental
Activities of Daily Living
Activities
Command and Prompts
Emotions and Feelings
Events, People and Places
Packaged as a deck of 76 cue cards, double sided, ring bound so it opens
easily to the desired color-coded section. Cards are glossy, heavy card
stock so they can be wiped clean. Blank cards are provided so you can >
add other specific center or activity cues. Binder rings allow for
versatility of Caregiver Cards, allowing you to add or subtract
illustrations that are important for your caregiving needs
http://tinyurl.com/prbgcnq
Caregiver Cards - Communication Cue Cards | Visual Picture Cues That
Improve Communication, Promote Independence... by Caregiver Cards <END QUOTE>
<QUOTE>
Caregiver Cards provide essential visual picture cues that improve communication, promote independence and reduce anxiety for adults with memory, cognitive, or speech challenges due to dementia, Alzheimer’s disease, autism, deaf or hard of hearing, and other disabilities. An essential aid for helping adults understand and engage in activities at home or in residential care or memory care settings.
This easy-to-use, compact set of 76 cards includes simple, clear illustrations that prompt your loved one to understand and participate more independently in self-care and social activities.
The deck includes 146 picture cues covering 6 subject categories:
tivities of Daily Living
Instrumental
Activities of Daily Living
Activities
Command and Prompts
Emotions and Feelings
Events, People and Places
Packaged as a deck of 76 cue cards, double sided, ring bound so it opens
easily to the desired color-coded section. Cards are glossy, heavy card
stock so they can be wiped clean. Blank cards are provided so you can >
add other specific center or activity cues. Binder rings allow for
versatility of Caregiver Cards, allowing you to add or subtract
illustrations that are important for your caregiving needs
http://tinyurl.com/prbgcnq
Caregiver Cards - Communication Cue Cards | Visual Picture Cues That
Improve Communication, Promote Independence... by Caregiver Cards <END QUOTE>
Saturday, January 17, 2015
BayPath Elder Services | Caregiving MetroWest
Caregiving MetroWest –is a program of BayPath Elder Services, Inc. information, resources, and support for MetroWest caregivers.
The site offers Information on all aspects of caregiving; "Caregiving is a complex and demanding undertaking. There are many elements involved in the caregiving role, and we’ve assembled some helpful information on a variety of areas of importance to caregivers.}
BayPath Elder Services, Inc
BayPath Elder Services, Inc. administers programs offering home care and related services enabling people to live independently and comfortably in their homes while promoting their well-being and dignity.
Many BayPath services are free, others are based on one's ability to pay, and some are offered on a fee-for-service basis.
“This non-profitcorporation is organized to plan, develop and implement the coordination and delivery of services and supportive programs for persons sixty years of age and over unless otherwise restricted by conditions of grants or contracts, in the City of Marlborough, and the townships of Ashland, Holliston, Hopkinton, Dover, Sherborn, Natick, Framingham, Wayland, Sudbury, Hudson, Northborough , Southboro ugh and Westboro ugh , Massachusetts. The corporation shall endeavor to assist older persons to obtain services including but not limited to information and referral, homemaker and chore assistance, housing services, health maintenance and rehabilitation, nutritional services, legal and advocacy assistance , transportation, emergency assistance, and whatever medical or supportive services may be needed to prolong the life and well - being of older persons in the community and to prevent premature institutionalization.
The site offers Information on all aspects of caregiving; "Caregiving is a complex and demanding undertaking. There are many elements involved in the caregiving role, and we’ve assembled some helpful information on a variety of areas of importance to caregivers.}
BayPath Elder Services, Inc
BayPath Elder Services, Inc. administers programs offering home care and related services enabling people to live independently and comfortably in their homes while promoting their well-being and dignity.
Many BayPath services are free, others are based on one's ability to pay, and some are offered on a fee-for-service basis.
“This non-profitcorporation is organized to plan, develop and implement the coordination and delivery of services and supportive programs for persons sixty years of age and over unless otherwise restricted by conditions of grants or contracts, in the City of Marlborough, and the townships of Ashland, Holliston, Hopkinton, Dover, Sherborn, Natick, Framingham, Wayland, Sudbury, Hudson, Northborough , Southboro ugh and Westboro ugh , Massachusetts. The corporation shall endeavor to assist older persons to obtain services including but not limited to information and referral, homemaker and chore assistance, housing services, health maintenance and rehabilitation, nutritional services, legal and advocacy assistance , transportation, emergency assistance, and whatever medical or supportive services may be needed to prolong the life and well - being of older persons in the community and to prevent premature institutionalization.
Friday, January 16, 2015
Thursday, January 15, 2015
50 Best Senior Caregiving Tools Online | Minute Women Inc Home Care | Non-Medical Senior Care – Minute Women Inc
50 Best Senior Caregiving Tools Online
It can be very frustrating when trying to find caregiving tools on the internet. You know what you need is out there but can spend hours finding the right tool.
list of the best caregiving tools that we could find on the internet.
Wednesday, January 14, 2015
6 Questions To Ask Before Hiring An In-Home Caregiver
What is the cost, and how will the bills be paid? “Be certain to understand the whole payment package,” McVicker advises.
For example, does the agency tack on extra charges for billing, taxes and
worker’s compensation or include them in a single fee for services? Some
agencies will send you a bill that includes the hourly rate for
services plus additional itemized charges for taxes and administrative
costs.
Other agencies will simply charge you an hourly amount that
encompasses all costs.
For example, does the agency tack on extra charges for billing, taxes and
worker’s compensation or include them in a single fee for services? Some
agencies will send you a bill that includes the hourly rate for
services plus additional itemized charges for taxes and administrative
costs.
Other agencies will simply charge you an hourly amount that
encompasses all costs.
Thursday, January 8, 2015
Normal aging vs dementia | Tips for coping with normal age-related memory difficulties
Normal aging vs dementia
Tips for coping with normal age-related memory difficulties:
- Keep a routine
- Organize information (keep details in a calendar or day planner)
- Put items in the same spot (always put your keys in the same place by the door)
- Repeat information (repeat names when you meet people)
- Run through the alphabet in your head to help you remember a word
- Make associations (relate new information to things you already know)
- Involve your senses (if you are a visual learner, visualize an item)
- Teach others or tell them stories
- Get a full night's sleep
Saturday, January 3, 2015
Hiring an In-Home Caregiver
Hiring an In-Home Caregiver
For older adults, in-home non-medical care might be the key to independence. However, the quality of care depends on the quality of the caregiver. When looking for in-home care, finding the best service can be a challenge. This article offers suggestions on what to look for when hiring a caregiver.
What is In-Home Care?
In-home caregivers provide assistance with activities of daily living (ADL) such as meal preparation, dressing, grooming, medication monitoring, transportation and light housekeeping. These services should not be mistaken for home health services, which offer skilled, medical services by licensed professionals such as nurses and therapists. While in-home caregivers may be trained and/ or certified, they focus mostly on activities of daily living and are not required to perform complex health care related tasks. Programs such as Medicare, or Medicaid (Medi-cal) cover Home Health Services, but do not usually cover non-medical services. There are some long-term care insurance policies that cover non-medical in-home care services. Review your policy to determine whether in-home care is covered by your insurance.
What is In-Home Care?
In-home caregivers provide assistance with activities of daily living (ADL) such as meal preparation, dressing, grooming, medication monitoring, transportation and light housekeeping. These services should not be mistaken for home health services, which offer skilled, medical services by licensed professionals such as nurses and therapists. While in-home caregivers may be trained and/ or certified, they focus mostly on activities of daily living and are not required to perform complex health care related tasks. Programs such as Medicare, or Medicaid (Medi-cal) cover Home Health Services, but do not usually cover non-medical services. There are some long-term care insurance policies that cover non-medical in-home care services. Review your policy to determine whether in-home care is covered by your insurance.
Thursday, January 1, 2015
Hiring Home Care Workers: Why Work through an Agency? By Rona S. Bartelstone,
Hiring Private Duty Home Care Workers: Why Work through an Agency
Quoted:
One of the greatest long-term needs of older adults and those with
chronic illnesses is for in-home, custodial care services. These
workers are often referred to as home health aides, certified nursing
assistants and custodial care workers. These in-home workers make it
possible for people with functional limitations to remain at home in a
comfortable, familiar environment. Home health aides (as we will refer
to this class of workers) provide a wide range of assistance with
activities of daily living (ADLs), such as bathing, dressing, grooming,
assisting with ambulation or transferring, toileting, feeding and
providing medication reminders. In addition, home health aides help
with what professionals call, instrumental activities of daily living
(IADLs), such as shopping, meal preparation, making medical
appointments, transportation, laundry and companionship.
While it is true that most people would prefer to remain in their
own homes, there are circumstances in which care in a residential or
nursing facility is more appropriate and more cost-effective. For
example, the individual who needs round the clock care because of
treatments or behavioral issues will find a nursing facility or
residential setting likely to be more affordable.
The biggest proportion of people who utilize home health aide services are those
who need several hours per day of assistance, as opposed to those who need full-time care.
Due to the cost and the increasing shortage of home health
aides, many families seeking to hire in-home staff turn to private
individuals rather than working through an agency. While at first
glance this seems reasonable, it can also cause numerous problems and create unexpected liabilities for the family, who becomes the employer.
Quoted:
One of the greatest long-term needs of older adults and those with
chronic illnesses is for in-home, custodial care services. These
workers are often referred to as home health aides, certified nursing
assistants and custodial care workers. These in-home workers make it
possible for people with functional limitations to remain at home in a
comfortable, familiar environment. Home health aides (as we will refer
to this class of workers) provide a wide range of assistance with
activities of daily living (ADLs), such as bathing, dressing, grooming,
assisting with ambulation or transferring, toileting, feeding and
providing medication reminders. In addition, home health aides help
with what professionals call, instrumental activities of daily living
(IADLs), such as shopping, meal preparation, making medical
appointments, transportation, laundry and companionship.
While it is true that most people would prefer to remain in their
own homes, there are circumstances in which care in a residential or
nursing facility is more appropriate and more cost-effective. For
example, the individual who needs round the clock care because of
treatments or behavioral issues will find a nursing facility or
residential setting likely to be more affordable.
The biggest proportion of people who utilize home health aide services are those
who need several hours per day of assistance, as opposed to those who need full-time care.
Due to the cost and the increasing shortage of home health
aides, many families seeking to hire in-home staff turn to private
individuals rather than working through an agency. While at first
glance this seems reasonable, it can also cause numerous problems and create unexpected liabilities for the family, who becomes the employer.
Great Big List of Caregiver Blogs | Caregiver's Corner July 14, 2010
Great Big List of Caregiver Blogs
One of the best ways for a caregiver to find answers, reassurance,
and understanding is to connect with other caregivers. To help with
that, here is a list of blogs run by caregivers. If you know of any
blogs that should be added to this list, let us know!
One of the best ways for a caregiver to find answers, reassurance,
and understanding is to connect with other caregivers. To help with
that, here is a list of blogs run by caregivers. If you know of any
blogs that should be added to this list, let us know!
Tuesday, December 23, 2014
How private payers detect EHR-enabled fraud - FierceEMR
How private payers detect EHR-enabled fraud - FierceEMR
http://www.fierceemr.com/special-reports/much-improper-billing-well-concealed
http://www.fierceemr.com/special-reports/much-improper-billing-well-concealed
Tuesday, December 9, 2014
Wednesday, December 3, 2014
Dementia: How to Protect Your Family Member in a Nursing Home | Alzheimer's Speaks Blog
Dementia: How to Protect Your Family Member in a Nursing Home | Alzheimer's Speaks Blog: Key Points When Choosing a Home
When you’re looking at different nursing homes, there are different things to look at and consider. By taking a look at these points, you’ll know exactly what kind of a home that your loved one is living at.
· You should start by checking out the Nursing Home Compare program provided by the Medicare website. This online programs allow you to view if they have any recent penalties, what they scored on their last inspection, and how they rate in comparison to other nursing homes in the area.
· Look at the staffing. Especially if your loved one is diagnosed with dementia—they are going to be in need of constant care. Look at the ratio of aid to patients on the nursing home compare website. Ask the employees how often they switch patients. You can also find this information on the Nursing Home Compare website. You’re paying the money—make sure you are getting what you ask for.
When you’re looking at different nursing homes, there are different things to look at and consider. By taking a look at these points, you’ll know exactly what kind of a home that your loved one is living at.
· You should start by checking out the Nursing Home Compare program provided by the Medicare website. This online programs allow you to view if they have any recent penalties, what they scored on their last inspection, and how they rate in comparison to other nursing homes in the area.
· Look at the staffing. Especially if your loved one is diagnosed with dementia—they are going to be in need of constant care. Look at the ratio of aid to patients on the nursing home compare website. Ask the employees how often they switch patients. You can also find this information on the Nursing Home Compare website. You’re paying the money—make sure you are getting what you ask for.
Sunday, November 30, 2014
Memory Lapses That Are Normal - Mary A. Fischer is an award-winning journalist and contributing editor to AARP The Magazine.
{Paraphrased Quotes, snips from article}
Brain freezes happen to most of us, to different degrees, as we age.?..... If your lapses aren't disrupting your life, there's no need to be actively worried, experts say.
Your lapses may well have very treatable causes. Severe stress, depression, a vitamin B12 deficiency, insufficient sleep, some prescription drugs and infections can all play a role.
Types of normal memory lapses that are not signs of dementia.
1. Absentmindedness
Focus on what you're doing or thinking in any given moment, and you'll head off a lot of these lapses. If you find yourself in the middle of one, retracing your steps, mentally or actually, can help.
2. Blocking
You know the word you're trying to say, but you can't quite retrieve it from memory. It usually happens when several similar memories interfere with each other.
If you find yourself stuck in the moment, try to remember other details about the event, name or place, which often will trigger the memory you are searching for.
4. Fade Out
The brain is always sweeping out older memories to make room for new ones. The more time that passes between an experience and when you want to recall it, the more likely you are to have forgotten much of it.
Events we discuss, ponder over, record or rehearse are recalled in the most detail and for longest periods of time. So one of the best ways to remember events and experiences — whether everyday or life changing — is to talk or think about them.
{END QUOTE}
Brain freezes happen to most of us, to different degrees, as we age.?..... If your lapses aren't disrupting your life, there's no need to be actively worried, experts say.
Your lapses may well have very treatable causes. Severe stress, depression, a vitamin B12 deficiency, insufficient sleep, some prescription drugs and infections can all play a role.
Types of normal memory lapses that are not signs of dementia.
1. Absentmindedness
Focus on what you're doing or thinking in any given moment, and you'll head off a lot of these lapses. If you find yourself in the middle of one, retracing your steps, mentally or actually, can help.
2. Blocking
You know the word you're trying to say, but you can't quite retrieve it from memory. It usually happens when several similar memories interfere with each other.
If you find yourself stuck in the moment, try to remember other details about the event, name or place, which often will trigger the memory you are searching for.
4. Fade Out
The brain is always sweeping out older memories to make room for new ones. The more time that passes between an experience and when you want to recall it, the more likely you are to have forgotten much of it.
Events we discuss, ponder over, record or rehearse are recalled in the most detail and for longest periods of time. So one of the best ways to remember events and experiences — whether everyday or life changing — is to talk or think about them.
{END QUOTE}
Wednesday, November 19, 2014
Protect YOURSELF From Frigid Winter Weather - AgingCare.com
How to Protect YOURSELF From Frigid Winter Weather
Chilling temperatures and treacherous snow and ice can terrorize the elderly and their caregivers during the winter months.Here are a few things to keep in mind to help keep seniors safe during the frigid season approaches:
Protect Senior From Frigid Weather - AgingCare.com
Monday, October 20, 2014
public health requirements for long term care facilities. Nursing Homes
Quoted from:http://tinyurl.com/pmmrher December 14, 2013 Long Term Care Facilities: Are You Being Treated Right? By CzepigaDalyPope LLC
The Code of Federal Regulations (herein either “the Code” or “CFR”) is a codification of rules published in the Federal Register by the departments and agencies of the Federal Government. Title 42 of the Code, Part 483, addresses public health requirements for long term care facilities.
Part 483 specifically addresses, among many other issues, the following:
Resident rights (§483.10) Admission, transfer, and discharge rights (§483.12) Resident behavior and facility practices (§483.13) Quality of life (§483.15) Quality of care (§483.25)
Most of the fundamental questions you have will be addressed, at least in part, in the sections cited above. Section 483.10, as one example, addresses resident rights and specifically provides for what a facility must do regarding issues that range from providing, for inspection, a resident with his or her medical records within twenty four hours of request, to prominently displaying information about how to apply for and use Medicare and Medicaid benefits.
Section 483.12, as one other example, lists the six permissible reasons to discharge a resident from a long term care facility. It is important to note, there are no other reasons for discharge beyond these six, any other purported reason for discharge that is not listed in §483.12 (a)(2) is a violation of Federal law.
6 Reasons for Discharge
The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility
the transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility
The safety of individuals in the facility is endangered
The health of individuals in the facility would otherwise be endangered
The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility.
The facility ceases to operate
For those who live in long term care facilities, it is your home and you are entitled to certain rights within it. For those of you who visit a loved one in a long term care facility, if you begin to question whether your loved one is being treated appropriately, simply go online, type into Google “42 CFR 483,” and start getting your questions answered.
A trial attorney who handles these types of matters, can give you lots of help,
however,
you would be surprised how effective Federal law is when properly cited during discussions with facility administrators and staff.
Posted in: Elder Law and Nursing Home Litigation
The Code of Federal Regulations (herein either “the Code” or “CFR”) is a codification of rules published in the Federal Register by the departments and agencies of the Federal Government. Title 42 of the Code, Part 483, addresses public health requirements for long term care facilities.
Part 483 specifically addresses, among many other issues, the following:
Resident rights (§483.10) Admission, transfer, and discharge rights (§483.12) Resident behavior and facility practices (§483.13) Quality of life (§483.15) Quality of care (§483.25)
Most of the fundamental questions you have will be addressed, at least in part, in the sections cited above. Section 483.10, as one example, addresses resident rights and specifically provides for what a facility must do regarding issues that range from providing, for inspection, a resident with his or her medical records within twenty four hours of request, to prominently displaying information about how to apply for and use Medicare and Medicaid benefits.
Section 483.12, as one other example, lists the six permissible reasons to discharge a resident from a long term care facility. It is important to note, there are no other reasons for discharge beyond these six, any other purported reason for discharge that is not listed in §483.12 (a)(2) is a violation of Federal law.
6 Reasons for Discharge
The transfer or discharge is necessary for the resident’s welfare and the resident’s needs cannot be met in the facility
the transfer or discharge is appropriate because the resident’s health has improved sufficiently so the resident no longer needs the services provided by the facility
The safety of individuals in the facility is endangered
The health of individuals in the facility would otherwise be endangered
The resident has failed, after reasonable and appropriate notice, to pay for (or to have paid under Medicare or Medicaid) a stay at the facility.
The facility ceases to operate
For those who live in long term care facilities, it is your home and you are entitled to certain rights within it. For those of you who visit a loved one in a long term care facility, if you begin to question whether your loved one is being treated appropriately, simply go online, type into Google “42 CFR 483,” and start getting your questions answered.
A trial attorney who handles these types of matters, can give you lots of help,
however,
you would be surprised how effective Federal law is when properly cited during discussions with facility administrators and staff.
Posted in: Elder Law and Nursing Home Litigation
Saturday, October 11, 2014
Decrease Identity Theft Risk with MySSA Account - AgingCare.com
Decrease Identity Theft Risk with MySSA Account - AgingCare.com What can you do to prevent an identity thief from tampering with your MySSA account? Create a MySSA account. By creating your MySSA account you are preventing an identity thief from doing so using your information. Opt-out of MySSA. If you are not very computer savvy (or you prefer not to have online access), then you can contact the SSA and opt-out of the MySSA program. Doing so prevents you (or an identity thief) from being able to set up an online account in your name. This is a great option for those taking care of their aging parents. Living in an ever-more-connected digital world means that there are always going to be certain security risks surrounding our personal information. However, you can reduce some of that risk for you and your family simply by setting up a MySSA account or opting out of the MySSA program. Carrie Kerskie, Expert Author, speaker and identity theft expert
Friday, September 26, 2014
Cyber Seniors Documentary } expanding the use of technology by seniors
Cyber Seniors Documentary
Upload CyberSeniors_Participants_Handbook_nc.pdf
A humorous and heart-warming documentary directed by Saffron Cassady Video
Help Spread the Word
Upload CyberSeniors_Participants_Handbook_nc.pdf
A humorous and heart-warming documentary directed by Saffron Cassady Video
Help Spread the Word
Tuesday, September 23, 2014
Monday, September 22, 2014
Monday, September 15, 2014
Senior Care Tips for Sundowners Syndrome
Senior Care Tips for Sundowners Syndrome: EasyLiving Blog
Have you noticed your loved one with dementia experiencing changed sleeping patterns and more difficulty late in the day?
Most likely you are experiencing the set of symptoms termed Sundowners Syndrome or sundowning behavior in dementia. For a variety of reasons (from our bodies' natural rhythms and light signals to learned patterns), persons with dementia may have particular difficulty in the late afternoon and evening hours. The person often feels a sense of restlesness and agitation--a need to go somewhere or do something, the sense of being unsettled. This may manifest itself as a need "to go home" and lead to wandering or may show up in a variety of behaviors.
Senior care providers should be aware of this set of symptoms and watch for such patterns. A care facility may want to staff this time of day differently or plan for specific activities and try to manage the environment. Some examples include changes to lighting, providing distracting and/or calming activities during this time, ensuring residents have a snack and are well-rested and reducing irritating stimuli. More one-on-one attention may be needed for safety and reassurance during late afternoons and evenings.
Senior caregivers caring for a loved one or client at home should also monitor for different behaviors and patterns. What are some things you can do to better manage sundowners syndrome and provide safe, dignified dementia care?
Have you noticed your loved one with dementia experiencing changed sleeping patterns and more difficulty late in the day?
Most likely you are experiencing the set of symptoms termed Sundowners Syndrome or sundowning behavior in dementia. For a variety of reasons (from our bodies' natural rhythms and light signals to learned patterns), persons with dementia may have particular difficulty in the late afternoon and evening hours. The person often feels a sense of restlesness and agitation--a need to go somewhere or do something, the sense of being unsettled. This may manifest itself as a need "to go home" and lead to wandering or may show up in a variety of behaviors.
Senior care providers should be aware of this set of symptoms and watch for such patterns. A care facility may want to staff this time of day differently or plan for specific activities and try to manage the environment. Some examples include changes to lighting, providing distracting and/or calming activities during this time, ensuring residents have a snack and are well-rested and reducing irritating stimuli. More one-on-one attention may be needed for safety and reassurance during late afternoons and evenings.
Senior caregivers caring for a loved one or client at home should also monitor for different behaviors and patterns. What are some things you can do to better manage sundowners syndrome and provide safe, dignified dementia care?
Wednesday, September 10, 2014
Saturday, September 6, 2014
California, Arizona, Florida - Senior Care Authority ORG
Assisted Living in California, Arizona, Florida - Senior Care Authority
Senior Care Authority™ is a free assisted living, dementia and residential care placement service providing hands on quality assistance throughout the selection process.
Senior Care Authority™ is a free assisted living, dementia and residential care placement service providing hands on quality assistance throughout the selection process.
Friday, September 5, 2014
Jumping for Joy in the ER: When patients have clear advance directives by Monica Williams-Murphy, MD | It's OK to Die
Jumping for Joy in the ER: When patients have clear advance directives by Monica Williams-Murphy, MD | It's OK to Die:
<Q>“What’s going on out there?” the “leaving” doctor asked me in a curious manner.
Before I answered him, I called out, “You guys come listen to this. This is a success story!”
As you might imagine, a small group of curious Emergency Department staff had crowded around me in attempts to understand the commotion.
Speaking in low but excited tones to maintain HIPPA compliance, I gushed the following story:
“So, I just walked into room 48 to see Mr. Bronson. He’s an 85 year old man with COPD who had arrived in respiratory distress and the respiratory therapists had already started BIPAP because the patient arrived on his own machine and it wasn’t doing any good. So, here’s the kicker… he was too short of breath to even speak a word and when I listened to his lungs, I heard no air movement. There was no one in the room family-wise whom I could turn to for a discussion of next steps (meaning no surrogate decision maker). Just as I started to feel a twist developing in the pit of my stomach, assuming that I might have to intubate him without understanding his own personal wishes, the nurse whips out a piece of paper from behind his home med list and starts waving it at me.”
“Voila!” She said smiling, “I know that you would want to see this.”
With two steps in her direction, I was across the room and pulled it from her hand like a young child getting her first mail. <EQ>
<Q>“What’s going on out there?” the “leaving” doctor asked me in a curious manner.
Before I answered him, I called out, “You guys come listen to this. This is a success story!”
As you might imagine, a small group of curious Emergency Department staff had crowded around me in attempts to understand the commotion.
Speaking in low but excited tones to maintain HIPPA compliance, I gushed the following story:
“So, I just walked into room 48 to see Mr. Bronson. He’s an 85 year old man with COPD who had arrived in respiratory distress and the respiratory therapists had already started BIPAP because the patient arrived on his own machine and it wasn’t doing any good. So, here’s the kicker… he was too short of breath to even speak a word and when I listened to his lungs, I heard no air movement. There was no one in the room family-wise whom I could turn to for a discussion of next steps (meaning no surrogate decision maker). Just as I started to feel a twist developing in the pit of my stomach, assuming that I might have to intubate him without understanding his own personal wishes, the nurse whips out a piece of paper from behind his home med list and starts waving it at me.”
“Voila!” She said smiling, “I know that you would want to see this.”
With two steps in her direction, I was across the room and pulled it from her hand like a young child getting her first mail. <EQ>
Tuesday, August 12, 2014
Sunday, July 20, 2014
Elder Community Care | Marlborough, MA 01752
Elder Community Care | Marlborough, MA 01752
Elder Community Care a team of trained social workers & mental health clinicians
Elder Community Care is a network of agencies working together to serve elders in their own homes. We provide comprehensive assessment and counseling
services to elders and their families in Metrowest. We provide comprehensive assessment, counseling and referral services.
services to elders and their families in Metrowest. We provide comprehensive assessment, counseling and referral services.
Friday, July 18, 2014
Need In Home Care for a Senior? 10 Tips to Find the Right Caregiver - OpenPlacement Community | OpenPlacement
Need In Home Care for a Senior? 10 Tips to Find the Right Caregiver - OpenPlacement Community | OpenPlacement
7) The Interview – Here are a few items you should discuss:
Where did you get trained? What past experiences have you had? Do you have any specialized training?
What did you like or dislike about previous caregiver jobs?
Why did you choose to be a caregiver?
Are you willing to perform the following duties: ____? (See #5)
My loved one has this specific issue (arthritis, dementia, diabetes, etc.). How would you help him/her with this condition on a daily basis?
Here are the wages and benefits I am offering. You will/will not get holidays off and holiday pay. Do you have any questions or concerns?
Most importantly, trust your inner voice. You need to have peace of mind and if you don’t, then you will always be uncomfortable and worried.
- See more at: https://www.openplacement.com/community/blog/need-in-home-care-for-a-senior-10-tips-to-find-the-right-caregiver/#sthash.x3FqFOTp.dpuf
7) The Interview – Here are a few items you should discuss:
Where did you get trained? What past experiences have you had? Do you have any specialized training?
What did you like or dislike about previous caregiver jobs?
Why did you choose to be a caregiver?
Are you willing to perform the following duties: ____? (See #5)
My loved one has this specific issue (arthritis, dementia, diabetes, etc.). How would you help him/her with this condition on a daily basis?
Here are the wages and benefits I am offering. You will/will not get holidays off and holiday pay. Do you have any questions or concerns?
Most importantly, trust your inner voice. You need to have peace of mind and if you don’t, then you will always be uncomfortable and worried.
- See more at: https://www.openplacement.com/community/blog/need-in-home-care-for-a-senior-10-tips-to-find-the-right-caregiver/#sthash.x3FqFOTp.dpuf
Saturday, July 12, 2014
What are person's forgotten active online accounts.
I discovered WebCease, Inc. 917 SW Oak Street, Suite 403 Portland, OR 97205 888.399.2768.
Here is what founder and CEO Glenn Williamson says:
WebCease identifies active online accounts instructs on the different options for retrieval, closure or memorialization in accordance with the policies of each site.
Digital assets include a person’s electronically stored content and online accounts, such as emails, photos, music, social networking profiles, career information, and blogs. They can have an emotional, sentimental, or monetary value. Digital assets usually fall into four main categories: Financial, Personal, Social, and Loyalty Rewards.
According to Pew Research, a recent survey conducted in January 2014 found that 87% of American adults now use the internet. Everything from emails to shopping to travel planning to social networking to photo sharing and more consume our online lives. Dozens of digital accounts can be created during a person’s lifetime. What happens once we are gone?
“If everyone planned you wouldn’t need our stuff. But, only 50 percent of people have a will and 90 percent don’t think about digital assets,” said founder and CEO Glenn Williamson.
WebCease, Inc. helps heirs, executors, trustees and administrators find online accounts that are digital assets for the estate of the deceased
--
http://www.webcease.com/about/about-webcease
Here is what founder and CEO Glenn Williamson says:
WebCease identifies active online accounts instructs on the different options for retrieval, closure or memorialization in accordance with the policies of each site.
Digital assets include a person’s electronically stored content and online accounts, such as emails, photos, music, social networking profiles, career information, and blogs. They can have an emotional, sentimental, or monetary value. Digital assets usually fall into four main categories: Financial, Personal, Social, and Loyalty Rewards.
According to Pew Research, a recent survey conducted in January 2014 found that 87% of American adults now use the internet. Everything from emails to shopping to travel planning to social networking to photo sharing and more consume our online lives. Dozens of digital accounts can be created during a person’s lifetime. What happens once we are gone?
“If everyone planned you wouldn’t need our stuff. But, only 50 percent of people have a will and 90 percent don’t think about digital assets,” said founder and CEO Glenn Williamson.
WebCease, Inc. helps heirs, executors, trustees and administrators find online accounts that are digital assets for the estate of the deceased
--
http://www.webcease.com/about/about-webcease
WebCease, Inc. helps heirs, executors, trustees and administrators find online accounts that are digital assets for the estate of the deceased. WebCease's service identifies the active online accounts and instructs on the different options for retrieval, closure or memorialization in accordance with the policies of each site According to Pew Research, a recent survey conducted in January 2014 found that 87% of American adults now use the internet. Everything from emails to shopping to travel planning to social networking to photo sharing and more consume our online lives. Dozens of digital accounts can be created during a person’s lifetime. What happens once we are gone? “We focus on the fact that if everyone planned you wouldn’t need our stuff. But, only 50 percent of people have a will and 90 percent don’t think about digital assets,” said founder and CEO Glenn Williamson. WebCease, Inc. helps heirs, executors, trustees and administrators find online accounts that are digital assets for the estate of the deceased
Saturday, July 5, 2014
Thursday, July 3, 2014
Medication Management in Disaster Planning | caregiver.com
Medication Management in Disaster Planning
A family disaster plan
can be of valuable assistance to every member of the family.
In order for it to be effective, however, it needs to
encompass all aspects of your current living situation. When
considering a home or family disaster plan, it is easy to
overlook medications and the special needs of family
members. Instead of waiting for an event to occur, think
ahead to these important areas:
A family disaster plan
can be of valuable assistance to every member of the family.
In order for it to be effective, however, it needs to
encompass all aspects of your current living situation. When
considering a home or family disaster plan, it is easy to
overlook medications and the special needs of family
members. Instead of waiting for an event to occur, think
ahead to these important areas:
Wednesday, June 25, 2014
Monday, June 23, 2014
Sunday, June 8, 2014
Medicare Available For Chronic Conditions, But Word Slow To Get Out | Lawyer For Seniors
The Law Offices of Osofsky & Osofsky
The Osofsky Law Firm is a boutique Medi-Cal planning, Elder Law and Estate Planning firm in the East Bay Area.
{Q} Unfortunately, even though the Jimmo settlement is more than a year old, we find that many healthcare providers are unaware of the end of the old “improvement standard”. As a result, many seniors still experience premature Medicare coverage terminations because they are not improving. This is especially problematic for person suffering with Parkinson’s disease, ALS, heart disease and stroke. The good news, however, is that advocacy on your part can play a big role in correcting premature coverage terminations.If you receive a notice that Medicare coverage is about to terminate, consider an immediate appeal. Talk to your husband’s doctor and ask for a written chart note that continued therapy is necessary for your husband to “maintain” function and/or to “slow further deterioration”. To further aid you in your appeal, download the excellent Self-help Packets available for free on the website of the Center for Medicare Advocacy at www.MedicareAdvocacy.org, or by calling 860-456-7790. Individualized Self-Help Packets are available for denials of outpatient therapy, home healthcare, nursing home, and the misuse of hospital “observation status”. {EQ}
Thursday, June 5, 2014
Room-by-Room Home Safety Checklist
 | Most people want to remain in their homes as they age, but that means making sure home is a place safe from hazards that could jeopardize well-being and independence. Use this checklist to do a thorough home safety audit. Get Home Safety Checklist » |
| Brought to you by: | |||
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Tuesday, June 3, 2014
Sunday, May 18, 2014
Tools Every Caregiver Should Add to Emergency Plan - AgingCare.com
Tools Every Caregiver Should Add to Emergency Plan - AgingCare.com
Gloria Huang, social engagement specialist for the American Red Cross
Huang suggests that people taking care of elderly loved ones consider adding a social media component to their emergency preparedness plan.
"So many people are using social media as a way to communicate,
including emergency agencies, the Red Cross, etc.," she says. "If we're
putting all the information out there, it can be a good way to get
official reports on what's going on in your area."
The key, says Huang, is picking the social media resources that work best for you and your loved one.
Twitter probably isn't a go-to resource for seniors and their
caregivers, and a Facebook post is by no means a substitute for dialing
9-1-1. But, there are some simple (and free) downloadable tools that can
make useful additions to an existing response plan:
Gloria Huang, social engagement specialist for the American Red Cross
Huang suggests that people taking care of elderly loved ones consider adding a social media component to their emergency preparedness plan.
"So many people are using social media as a way to communicate,
including emergency agencies, the Red Cross, etc.," she says. "If we're
putting all the information out there, it can be a good way to get
official reports on what's going on in your area."
The key, says Huang, is picking the social media resources that work best for you and your loved one.
Twitter probably isn't a go-to resource for seniors and their
caregivers, and a Facebook post is by no means a substitute for dialing
9-1-1. But, there are some simple (and free) downloadable tools that can
make useful additions to an existing response plan:
- Emergency (free): directly dials the numbers for 4
primary emergency services, including: police, firemen, medical and
general. Also allows you to send an SMS text to request help that
includes your current location. - First Aid by American Red Cross (free): offers treatment instructions for burns, bleeding, broken bones, etc.
- Hurricane by American Red Cross (free): allows
you to keep an eye on the weather conditions in your area and offers
instructions on how to stay safe during a storm. Additional features
include: a feature that turns your phone into a flashlight or emergency
beacon, a directory of Red Cross shelters in your area, and a program
that allows you to update your Facebook status, notifying others that
you and your loved one are safe.
Wednesday, May 7, 2014
▶ Meet Teepa Snow - YouTube: must watch for caregivers
▶ Meet Teepa Snow - YouTube
Maggie Pheasant said: I
Maggie Pheasant said: I
completed three of Teepa's trainings - she is simply not to be missed if
she comes to your area - make every effort to clear your calendar and
attend, whether you are directly a care giver or know someone who is,
you will learn a lot.
Thursday, May 1, 2014
Tuesday, April 29, 2014
Community Transportation Programs- Helping with Dignity and Caring
Community Transportation Programs- Helping with Dignity and Caring : Community Transportation Programs -
Helping with Dignity and Caring
By Sandra Ray, Staff Writer
(Page 1 of 2)
There are a multitude of programs available to help the elderly and disabled reach appointments, go shopping, and perform other tasks associated with daily living. Not all of these are easily accessible or easy to find. The requirements often range from proof of age or disability, to income, as well as stating that no other transportation means are available. It is easy to become discouraged with the process and give up interacting with the community at large.
developed a viable model program that can be readily
duplicated across the United States, helping to solve
some of the transportation woes that communities are
facing today. Started in 1999 as a result of research
sponsored by the Federal Transit Administration, AARP,
and the Transportation Research Board, the Maine-based
non-profit offers the program to seniors and individuals
with vision impairments.
Helping with Dignity and Caring
By Sandra Ray, Staff Writer
(Page 1 of 2)
There are a multitude of programs available to help the elderly and disabled reach appointments, go shopping, and perform other tasks associated with daily living. Not all of these are easily accessible or easy to find. The requirements often range from proof of age or disability, to income, as well as stating that no other transportation means are available. It is easy to become discouraged with the process and give up interacting with the community at large.
Independent Transportation Network (ITN):
The Independent Transportation Network (ITN) has developed a viable model program that can be readily
duplicated across the United States, helping to solve
some of the transportation woes that communities are
facing today. Started in 1999 as a result of research
sponsored by the Federal Transit Administration, AARP,
and the Transportation Research Board, the Maine-based
non-profit offers the program to seniors and individuals
with vision impairments.
Monday, April 28, 2014
Nursing Home Costs Covered by Medicare and Medicaid - AgingCare.com
Nursing Home Costs Covered by Medicare and Medicaid - AgingCare.com:
Medicare coverage of nursing home costs
In order for Medicare to cover a person's nursing home stay, the person must:
Have been hospitalized for medically necessary inpatient hospital care for at least three, consecutive days, not counting the date of discharge,
Be admitted to the nursing home within 30 days after the date of discharge from the hospital,
Require skilled nursing or rehab care on a daily basis for a condition for which the patient was hospitalized, and
Receive a physician's order that such care is needed.
Medicare coverage of nursing home costs
In order for Medicare to cover a person's nursing home stay, the person must:
Have been hospitalized for medically necessary inpatient hospital care for at least three, consecutive days, not counting the date of discharge,
Be admitted to the nursing home within 30 days after the date of discharge from the hospital,
Require skilled nursing or rehab care on a daily basis for a condition for which the patient was hospitalized, and
Receive a physician's order that such care is needed.
Saturday, April 26, 2014
While the other person is talking
Do not formulate your answer while the other person is talking.
People who don't listen decide how they are going to respond before you even stop talking. Don't be afraid to pause for five or ten seconds to consider, validate, the what the person is saying.
Doing so demonstrates that you listened carefully and that you are giving them the courtesy of a thoughtful reply. If you actually give a thoughtful reply, no one will remember that it took you nine seconds to start talking.
Repeat what the person is saying before you answer.
Never make the mistake of taking five minutes of a{person's} time answering a something s/he did not say. First, validate the point by saying, "If I understand you correctly, you want to know (Repeat, validate, what the person is saying) Is that right?"
If necessary, allow the other person to clarify what they are saying. Only start your answer when you are 100% certain you understand what the person is saying.
It may seem like a waste of time to do this, but you will be demonstrating your ability to obtain and understand feedback.
People who don't listen decide how they are going to respond before you even stop talking. Don't be afraid to pause for five or ten seconds to consider, validate, the what the person is saying.
Doing so demonstrates that you listened carefully and that you are giving them the courtesy of a thoughtful reply. If you actually give a thoughtful reply, no one will remember that it took you nine seconds to start talking.
Repeat what the person is saying before you answer.
Never make the mistake of taking five minutes of a
If necessary, allow the other person to clarify what they are saying. Only start your answer when you are 100% certain you understand what the person is saying.
It may seem like a waste of time to do this, but you will be demonstrating your ability to obtain and understand feedback.
Respecting Different Approaches to Caregiving is Important - AgingCare.com
Respecting Different Approaches to Caregiving is Important - AgingCare.com: Respecting Diverse Approaches to Caregiving is Important
There is no one-size-fits-all approach to caregiving.
Short of neglect or abuse of the care receiver, nearly every family caregiver must be free to make choices that work best for their unique situation. Even then, the available choices aren't always ideal.
You simply have to try and acknowledge what it really means to just do your best.
There is no one-size-fits-all approach to caregiving.
Short of neglect or abuse of the care receiver, nearly every family caregiver must be free to make choices that work best for their unique situation. Even then, the available choices aren't always ideal.
You simply have to try and acknowledge what it really means to just do your best.
Monday, April 21, 2014
Tips for Coping with Symptoms/Alzheimer's and Sundowning | alzcompend.info
from alzcompend.info/?p=268
1. WHAT IS SUNDOWNING?
Surprisingly, that's not an easy question to answer. Sundowning is a descriptive term rather than a diagnosis. Different researchers have different definitions -- which has complicated attempts to study the symptom, determine what causes it, and find ways to treat it.
Broadly speaking, sundowning is a cyclical increase in agitation (which may include restlessness, confusion, disorientation, wandering, searching, escape behaviors, tapping or banging, vocalization, combativeness, and/or hallucinations) that takes place at roughly the same time every day. Despite its name, and the wide-spread belief that sundowning occurs in the late afternoon and early evening, studies have found that the peak of sundowning activity is more likely to occur in the early- to mid-afternoon (e.g., around 1:00pm), while in some patients, it may occur late at night. It may even peak in the early morning in a fairly high percentage of patients.
For those of you struggling to cope with sundowning -- whenever it peaks -- take heart: many researchers have reported that it tends to occur in the middle stages of dementia, and to disappear as the dementia progresses.
2. WHAT CAUSES SUNDOWNING?
Many researchers consider sundowning to be a type of agitation, called "spontaneous agitation", that is caused by two factors, i.e.:
(1) Confusion, over-stimulation, and fatigue during the day, which results in increased disorientation, restlessness, and insecurity at night. And
(2) Fear of the dark, perhaps because of the lack of familiar daytime noises and activity and the lack of visual cues. The loved one may not be able to see as well in the gathering dusk, and/or be disturbed by strange shadows or reflections in window glass.
Others consider it to be a type of sleep disturbance that is "characterized by nocturnal wandering and confusion". Sundowning and sleep disturbance may appear to be related to each other since a sleep disorder, such as sleep disordered breathing, can be associated with a daytime behavior disorder.
However, more recent studies have concluded that sundowning is a chronobiological phenomenon that is unrelated to sleep disturbances. It is thought to be caused by a disturbance in the normal circadian rhythms, i.e., the "internal clock". Human circadian rhythms are biological cycles of ~24 hours that include sleep/wake, body temperature, and melatonin secretion cycles. They are regulated, in large part, by the suprachiasmatic nucleus (SCN), a cluster of neurons in the anterior hypothalamus. The SCN deteriorates significantly in Alzheimer's disease, contributing to disruption of circadian rhythms.
Decreased exposure to bright light has been suggested as a factor that contributes to the disruption of the circadian clock in dementia patients. Bright light (≥2,000 lux) is one of the most powerful synchronizers of circadian rhythms and directly influences secretion of melatonin, sleep/wake patterns, and body temperature cycles. Young adults and healthy older people are, on average, exposed to one hour of bright light a day, whereas Alzheimer's patients living at home are exposed to only 30 minutes a day, and Alzheimer's patients living in nursing homes are typically exposed to little or no bright light above 2,000 lux and only 10-20 minutes a day to light above 1,000 lux. However, it should be noted that the circadian rhythm disturbances in frontotemporal dementia (FTD) patients differ significantly from those in Alzheimer's patients. For example, in one study, Alzheimer's patients showed increased nocturnal activity and a significant phase-delay in their rhythms of core-body temperature and activity compared with FTD patients (and controls); whereas the activity rhythm of FTD patients was highly fragmented and phase-advanced in comparison with controls and apparently uncoupled from the rhythm of core-body temperature. The implication is that environmental factors such as exposure to bright light could not have caused differences between the two groups of dementia patients, suggesting a neurobiological basis for the time-dependent changes in activity.
Some studies have found no clinical evidence for the existence of sundowning per se. Studies that monitored agitated behaviors throughout the 24-hour day have repeatedly found that roughly the same number of patients exhibited cyclical agitated behavior in the early morning as those exhibiting it in the late afternoon/early evening. One conclusion was that disruptive behaviors which occur in the evening simply are noticed and reported much more frequently because they have a greater impact on caregivers. By the end of the day, the caregivers (whether at home or in a nursing facility) are too tired and irritated to cope with the loved one's behaviors as easily and effectively as they could when they were fresh and rested, and are also likely to be distracted by shift changes, family returning home from work/school, and evening chores such as preparing/serving dinner. Although often noticed, the "sunrising" phenomenon has rarely been studied, in and of itself, since cyclical early morning agitation has been dismissed as a symptom of depression, which is often worse in the early morning. However, a study designed specifically to determine whether there is a correlation between "sunrising" and depression did not find one.
3. HOW COMMON IS SUNDOWNING?
Reports of sundowning in Alzheimer's patients are typically in the 10 - 25% range, but have been as low as 2.4% and as high as 66%. Not surprisingly, the prevalence that is reported depends on the definition of "sundowning" that is used, and the type of population involved in the study (e.g., the type and level of dementia and the environment in which the patients live).
4. WHAT CAN BE DONE TO MINIMIZE SUNDOWNING?
Conventional recommendations for treating sundowning behavior revolve around trying to establish "good sleep hygiene", a reflection of the widely-held belief that sundowning is a sleep disorder. However, there are a number of other approaches to consider, as well.
4.1. Is it really sundowning?
First, be sure that what you are observing actually is "sundowning". Is the behavior new and did it appear suddenly? Have the doctor check for infections (especially urinary tract infections, UTIs) and dehydration. Perhaps your loved one recently had a new stroke or was hurt in a fall. Flare-ups of chronic diseases such as diabetes or heart, liver, or kidney disease can also cause agitation or delirium.
Pain is undiagnosed or undertreated in a staggeringly high percentage of dementia patients, and is a major cause of agitation and sleeplessness. Could your loved one be suffering from arthritis, constipation, gastroesophageal reflux, or sitting all day in an uncomfortable position? Tools to help you evaluate whether your loved one is in pain can be found at the University of Alberta and AlzBrain websites:
http://www.painanddementia.ualberta.ca/
http://www.alzbrain.org/pdf/handouts/2049.%20MANAGEMENT%20OF%20PAIN%20IN%20PERSONS%20WITH%20DEMENTIA.pdf
Perhaps your loved one takes a medicine that would control some source of discomfort, and that is wearing off at the time when the "sundowning" behavior appears.
Conversely, a medicine might be causing the symptoms you're seeing. Medicines that are commonly prescribed for dementia patients often have side effects that negatively affect sleep and wakefulness, or cause agitation or discomfort. Aricept, for example, can cause dream disturbances and/or insomnia. Antidepressants (especially SSRIs) can induce or exacerbate periodic limb movements in sleep (PLMS). Atypical antipsychotics increase daytime fatigue and somnolence, and may induce restlessness or akathisia. Check any medicines that your loved one takes -- even those he has been taking for a long time -- for possible adverse effects. ( http://www.rxlist.com ) Also, consider the possibility of drug interactions that can exacerbate adverse effects or make one or both of the drugs less effective. ( http://www.drugs.com/drug_interactions.php ) Talk with the doctor or pharmacist about the possibility that your loved one is on the wrong dose, possibly due to kidney or liver problems, or weight loss or gain.
Your loved one may be getting tired and irritable due to a sleep disorder. There are many different sleep disorders that may develop in dementia patients, such as sleep-disordered breathing, PLMS, restless legs syndrome (RLS), obstructive sleep apnea, nocturnal myoclonus, and parasomnias (e.g., REM sleep behavior disorder, RBD.) The treatments that are most likely to be helpful depend on the specific type(s) of sleep disturbances involved. For example, patients suffering from sleep apnea have difficulty breathing; depending on the cause of the apnea, treatment may be, e.g., a change in diet, simple devices to encourage sleeping in a different position, an oral appliance which prevents airway blockage, or a CPAP (continuous positive airway pressure) machine. RLS is caused by a functional disturbance in the dopaminergic system, and so the treatment of choice consists of dopaminergic drugs or dopamine agonists such as pergolide or pramipexole.
Depression is very common in dementia patients. Diurnal mood variation, a pattern of mood variability in which a person’s worst and best moods vary in a predictable fashion, is a symptom of major depression. Mood is most commonly worse in the morning and better in the early evening, but the opposite pattern occurs as well. As noted elsewhere, variability in mood associated with depression is not sundowning (or "sunrising"), and may be responsive to an antidepressant.
Specific interactions with other people might be the culprit. For example, a dementia patient in a nursing home might become upset by visitors they don't recognize or don't like, or by strangers who are visiting other residents of the facility. Because visiting hours are time-regulated, this reactive agitation might appear to have a temporal association.
Your loved one's behavior might even be due to something as simple as hunger and/or thirst. Try serving dinner earlier, or offering a snack or something to drink until dinner is ready.
4.2. Good sleep hygiene
Conventional wisdom for treating sundowning has been to try to help re-establish a "normal" sleeping pattern, coupled with taking steps to minimize factors that might trigger fear or confusion:
• Increase your loved one's daytime activities, particularly physical exercise, and discourage inactivity and napping during the day. If fatigue is exacerbating the sundowning, try a brief (one hour) nap, early afternoon or just before the usual sundowning time. If the loved one won't nap, an hour of quiet time -- sitting quietly and talking together, for example, or listening to soothing music -- may help.
• Since an Alzheimer's patient is usually better able to tolerate outings, activities and increased stimulus during the earlier part of the day, plan trips to the grocery store, involvement with kids, visits to day care and so forth during the morning.
• Even during the earlier part of the day, an Alzheimer’s patient can tolerate only so much stimulation and commotion. Take steps to eliminate over-stimulation such as noisy television or radio, boisterous children, quick movements, and many things going on at one time.
• Sometimes excessive stimulation cannot be avoided. Make sure that there is a private "time out" place where your loved one can retreat for peace and quiet. Make it off-limits to children and general traffic; even the caregiver should try not to intrude unless absolutely necessary.
• Don’t physically restrain the loved one. Let him pace where he is safe. A supervised walk outdoors can help reduce restlessness. Indoors, clear all clutter and obstacles (e.g., low coffee tables and foot stools) from your loved one’s walking paths. Keep knickknacks to a minimum and the tops of tables, shelves, and other surfaces as clear as possible. Mirrors and pictures may be interpreted as unfriendly visitors; complicated, noisy appliances can be frustrating. Avoid making changes once you have things simplified.
• Give diuretics and laxatives early in day.
• Plan for the afternoon hours to be quiet and calm, to allow your loved one to unwind and relax. However, structured, quiet activity is important. Perhaps take a stroll outdoors, play a simple card game, or sing favorite songs together.
• Early evening activities that are familiar from an earlier time in the person’s life may be helpful, for example, walking the dog, a pre-dinner drink, or assisting with preparing dinner or setting the table.
• Physical discomfort -- hunger, being wet or soiled, or feeling cold/hot -- can play a part in sundowning. Light snacking during the day can be helpful. Apples and other fruits can help replace lost energy; even a loved one who is pacing back and forth does not have an endless supply of energy.
• Turning on lights well before sunset and closing the curtains at dusk will minimize shadows and may help diminish confusion.
• Discourage drinking stimulants (e.g., caffeine) or smoking near bedtime.
• Set a quiet, peaceful mood in the evening to help the loved one relax. Keep the lights low, and try to reduce the noise levels, e.g., from television and radios. Some loved ones are comforted by soft toy animals, pets, hearing familiar tunes, or an opportunity to engage in a favorite pastime.
• Have a bedtime routine. Try to have the loved one go to bed at the same time each night. Have a routine for getting ready for bed, such as taking a bath and having some warm milk, a back rub, or perhaps reading out loud.
• Make sure the loved one gets enough rest at night. Provide a comfortable bed. Create a calm atmosphere for sleeping. Reduce noise and light. Stuffed animals or a pet may soothe the loved one and allow them to sleep. Soothing music may help, or a recording of ocean waves or a mountain stream, or even "white noise" from, e.g., a fan.
• Have the loved one use the toilet right before bedtime, to minimize the need for nighttime toileting. Place a commode next to the bed for nighttime urination. Walking to the bathroom in the middle of the night may wake the loved one up too much, making it difficult to get back to sleep.
• Close the curtains and leave night lights on in the bedroom, hall, and bathroom if the darkness is frightening or disorienting.
Most of these recommendations appear (to me) to be based on common sense. A few, however, might be somewhat controversial, as will be discussed later.
Such recommendations have rarely been studied in clinical trials. I did find one, called "NITE-AD" (McCurry et al 2005), which was focused primarily on sleep disturbances. At the end of six months, loved ones whose caregivers were trained in a combination of sleep hygiene, daily walking, and light exposure interventions were found to have fewer nighttime awakenings, less total time awake at night, and less depression. The researchers noted that, given the design of the study, it was impossible to determine whether an individual intervention or some combination of interventions had the greatest effect on the outcomes.
I found it curious that the paper did not present any data on "secondary outcomes" other than depression, such as disruptive behaviors -- even though the data was collected -- and ignored the worrisome (to me) observation that NITE-AD patients exhibited a trend toward more-rapid cognitive decline over time. Granted, the trial was very small and the data might have been skewed ... but that is true of all the data, not just the rates of cognitive decline.
4.3. Support a "normal" circadian rhythm
As sundowning is being established more firmly as a chronobiological phenomenon, measures intended to help re-establish a "normal" circadian rhythm are being suggested more often for treating it. These include:
- Designing ChEI therapy to support, rather than disrupt, the circadian rhythm
Deterioration of the brain's cholinergic system is a hallmark of Alzheimer's, with degeneration of cholinergic neurons in the basal forebrain being one of the first biochemical changes that is seen. The cholinergic system comprises the neurotransmitter acetylcholine, the enzyme cholinesterase (whose function is to destroy excess acetylcholine), and cholinergic receptors. The Alzheimer's brain does not produce adequate acetylcholine for optimum neurotransmission. Drugs such as Aricept/donepezil, Razadyne/galantamine, and Exelon/rivastigmine are cholinesterase inhibitors (ChEIs), i.e., they prevent the enzyme from destroying as much of the acetylcholine as usual, thereby effectively increasing its levels in the brain and increasing cholinergic activity.
The cholinergic system has a pronounced circadian rhythm upon which sleep, waking, and fundamental aspects of learning depend. For example, in general, the healthy brain has low levels of acetylcholine during slow-wave sleep, and high levels during wakefulness. ChEIs have the potential to either mitigate disease-induced disturbances of the cholinergic rhythm by raising acetylcholine levels (increasing cholinergic activity) during the day, or to exacerbate sleeplessness and agitation by preventing the normal fall in acetylcholine levels (and thereby interfering with the normally reduced cholinergic transmission) at night.
The ChEI drug that is used and the time of day at which it is given can determine whether the normal cholinergic transmission and rest-activity cycles are supported or undermined. For example, Aricept/donepezil has a very long half-life (70 hours) in the body. Since its concentration in the blood doesn't vary much over the course of a 24-hour day (once the loved one has reached steady state, i.e., has been taking a given dose of the drug for a couple of weeks), it maintains high levels of acetylcholine in the brain at night, even if the drug is given in the morning. Aricept therefore has the potential to disrupt sleep and trigger insomnia. Razadyne/galantamine, on the other hand, has a much shorter half-life (7 hours). The extended-release formulation administered in the morning, in particular, helps support the normal circadian cholinergic rhythm, maintaining higher levels of the drug in the blood (and thereby higher levels of acetylcholine in the brain) during the day and lower levels at night.
- Bright light therapy
Since exposure to light plays a major role in regulating the phase relationships among core body temperature, melatonin rhythm, and the circadian rest-activity cycle, bright light therapy is frequently suggested as one simple way to help treat sundowning.
There is evidence that bright light can be used to change the timing of circadian rhythms (the circadian "phase") or, when administered at certain times of the day, may increase the amplitude of circadian rhythms without necessarily affecting the phase. Some -- but not all -- studies have found that circadian rhythms in older adults are phase-advanced, that is, the rhythms are shifted to an abnormally early time, resulting in the adults falling asleep and waking up earlier than usual. Conversely, some Alzheimer's patients have phase-delayed activity, that is, sleep onset and morning rising are shifted to abnormally late times. Evening bright light has been shown to delay circadian rhythms, whereas early morning light has been shown to advance circadian rhythms. As a result, advanced rhythms, such as those seen in healthy older adults, might be beneficially delayed with exposure to evening light, whereas a phase delay such as that seen in Alzheimer's may be beneficially advanced with exposure to morning light.
Results from clinical studies on dementia patients, however, have been inconsistent -- quite possibly due to differences in the type of light that was used, the length of exposure, and the time of day the therapy was implemented. Some researchers have suggested that more consistent results might be obtained if only one type of dementia were included in a study, or if the studies did not focus on severely impaired institutionalized patients who are likely to have incurred more marked SCN degeneration. Women show different patterns of sleep and circadian physiology during aging than men, so perhaps the genders should be studied separately. Some researchers suspect that other factors are likely to have been involved, that were not detected due to lack of appropriate controls. One wonders whether more consistent results might have been seen if subjects were screened to eliminate dementia patients who suffer from sleep disorders and other common causes of agitation (e.g., pain), for example.
In any event, some of the largest and best-designed studies found no improvement in nighttime sleep or daytime alertness from bright light therapy, and/or no improvement in agitated behavior, and one study actually reported an increase in behavioral problems. (Note: bright light can contribute to eyestrain and headaches, and can cause glare and reflection off polished surfaces which, in turn, can cause confusion, agitation, and anger.)
- Melatonin supplements, alone and in combination with bright light therapy
As noted above, circadian rhythm disturbances have been linked to abnormalities in the SCN. Rhythmic nocturnal melatonin secretion from the pineal gland is directly generated by the circadian clock located in the SCN. Because several studies suggest that melatonin levels are either low or dysregulated in Alzheimer's, oral melatonin supplements have been proposed as a treatment for sundowning.
However, clinical trials on the use of melatonin for treating sundowning or sleep disorders have failed to show that the approach will be broadly beneficial for dementia patients. A recent multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer's disease found, on average, no significant improvement in objective measures of sleep. Some patients showed improved sleep quality (less interrupted sleep and reduced daytime sleepiness and agitation), some showed no effects on sleep, and some patients became more aggressive. Three double-blind, placebo-controlled studies with objective assessment criteria for measuring sundowning behavior itself -- not sleep per se -- produced conflicting results. Two concluded that there was a small but statistically significant improvement in sundowning/agitated behavior, although one of these noted that melatonin was less effective than morning bright light therapy. The third controlled study concluded there was no improvement.
The stage of dementia may affect the potential benefit of melatonin. For melatonin to have an effect, it must be able to bind to melatonin receptors. Since the numbers of melatonin MT1 receptors in the SCN are extremely low in late-stage Alzheimer's patients (i.e., only 10% of those found in age-matched controls), supplementary melatonin in the late stages may not have a discernible effect on circadian rhythm disorders. Moreover, the sleep/circadian timing systems are the product of complex interactions among multiple brain regions, neurotransmitter systems and modulatory hormones. The rhythmic levels of many other hormones besides melatonin (e.g., cortisol, vasopressin, pulsatile luteinizing hormone, testosterone secretion, dehydroepiandrosterone, beta-endorphine) may be affected in Alzheimer's patients. Since abnormalities in any key neurotransmitter system will impinge on the sleep/circadian timing systems at multiple levels, oral supplements of a single hormone are unlikely to readjust the entire, complex sleep/circadian timing systems as the dementia progresses and more of these neurotransmitter systems are damaged.
Studies on bright light therapy in combination with melatonin supplements have also produced conflicting results. Haffmans et al (2001), for example, found that bright light therapy has a positive effect on sundowning, whereas bright light therapy plus melatonin does not. They hypothesized that the treatment, as designed, "overshot" the chronobiological synchronization of the melatonin supplement. (In healthy people, the density and the sensitivity of melatonin receptors are elevated during the daytime, when endogeneous melatonin levels are low. Hence, a melatonin dose given at a time when melatonin receptor density and sensitivity are lowest may show no effect compared with the same dose given when receptor density and sensitivity are highest.) Others found that the combination reduced agitation and improved several sleep parameters, although some adverse side effects were reported (dysphoric mood, irritability, dizziness, and headache.)
One recent study concluded that melatonin should only be used in combination with bright light therapy. Melatonin by itself shortened sleep onset latency and increased total sleep time; however, it also decreased affect ratings and increased withdrawn behavior, which were counteracted by light therapy. ("Affect" refers to the experience of feeling or emotion.)
All of these were relatively short-term studies. It should be noted that the safety of long-term use of melatonin supplements has never been established. Melatonin can cause a number of serious side effects -- including confusion and depression -- which become more likely as the patient continues to receive it. Supplemental melatonin may exacerbate seizure disorders, which is a concern for Alzheimer's patients since they can develop seizure disorders at any stage. Since melatonin shrinks arteries, it may be contraindicated in loved ones with cardiovascular disease (including vascular dementia). It may also aggravate autoimmune disorders (which can cause dementia symptoms) such as arthritis and severe allergies.
Daily administration of melatonin, even of a low dose (e.g., < 3 mg) can cause the loved one to build up a tolerance, and can eventually disrupt, rather than improve, sleep in some people. Also, melatonin can have serious interactions with a number of medicines, including the antidepressants that are often prescribed for Alzheimer's patients, blood thinners (e.g., warfarin, heparin), blood pressure medications (especially nifedipine), drugs that may affect the immune system (e.g., azathioprine, cyclosporine, prednisone), and fluvoxamine. Anyone considering starting a loved one on melatonin should first discuss it with the doctor and the pharmacist.
- Physical activity
Numerous studies have concluded that exercise can help minimize or eliminate agitated behavior in dementia patients. Exercise also has been linked to phase shifting of circadian rhythms as well as promotion of more restful sleep in older adults, and is considered to be likely to do the same for dementia patients, although no controlled trials that looked at the isolated effects of exercise on sleep in dementia have been done, to my knowledge. Regular exercise also builds muscle mass, improves strength, reduces falls, and improves mood. There do not appear to be any down sides to physical activity, as long as the exercise program is designed for the capabilities and interests of the loved one, whereas there are many potential benefits.
4.4. Let them eat chocolate
Over the past dozen or so years, Alzheimer's care has been undergoing a major paradigm shift, toward "person-centered care". Person-centered care is based on the premise that the personality of the loved one is increasingly concealed rather than lost, and therefore seeks to personalize the loved one's care and environment, to honor who he is and what brings him joy.
This has led to recognition of the fact that the loved ones' behaviors may often be understood as expressions of their individual desires and needs, rather than simply as symptoms of the disease process. As the loved ones' dementia advances, they experience increasing deficits in all aspects of their lives, but most especially and importantly, they lose the ability to verbally communicate their needs -- physiological, psychological, spiritual, social, and comfort needs -- to others. Their behaviors become the conduit for expressing their needs, pleasures, and frustrations. Stress, from fatigue, changes in routine, caregiver, or environment, demands that exceed the loved one's ability to function, multiple and competing stimuli, perceptions of loss, and physiologic factors such as illness, pain, discomfort, and adverse effects of medications, can result in anxiety and increasingly dysfunctional behaviors. In this context, behavioral "symptoms" -- both verbal manifestations such as repetitive questioning or vocalizations and non-verbal ones including withdrawal or physical violence -- can be interpreted as communications meant to convey specific messages and to achieve particular goals relating to unmet needs. Comfortable people do not hit, scream, pound on tables, or call out.
If the loved one's needs remain unmet while the caregivers' energies are directed toward curtailing the behaviors themselves, the likely outcome of this miscommunication is a vicious cycle of further withdrawal and isolation due to perceived inability of the loved one to interact effectively with others, leading to increased depression and anxiety, leading to more dysfunctional behaviors.
Here we get to the crux of it: If the loved one's circadian rhythm is out of whack, and we struggle mightily to force the loved one into wake-sleep patterns that fit our own circadian rhythms instead of his, won't we be in danger of increasing his agitation, as an expression of his stress, fears, and discomfort? And to my way of thinking, this concern is supported by the rash of studies, both recent and not so recent, which have shown that allowing dementia patients to be active when they choose to be active, and sleep when they choose to sleep, may decrease, or even eliminate, serious behavioral problems.
For example, in a study of more than 50 nursing homes (Sloane et al 1998), the proportion of residents who exhibited an agitated behavior varied from "none" in several homes to 38% in one home. Lower rates of agitation were seen in homes that had higher proportions of residents in bed during the day.
More recently, the Parker Jewish Institute in New Hyde Park, NY, implemented a "midnight snack" program, giving wanderers access to food and beverages at will in the middle of the night, instead of insisting that they go back to bed. They report that the program resulted not only in far less agitation among their residents, but also in a sharp decrease in falls and related injuries, and even a huge decrease in pressure sores.
The Hebrew Home at Riverdale in New York established "ElderServe at Night", an "Adult Night Care" program that offers activities and socialization, meals and showers, and even evening trips to the circus or nearby restaurants, for loved ones who are active at night and sleep during the day. Both the patients and their caregivers are enthusiastic about the program. The patients are more alert and happy, and exhibit far fewer behavioral problems, while their families can sleep soundly through the night.
Beatitudes nursing home in Phoenix has gone even further, setting up a person-centered care facility in which residents are allowed to sleep, be bathed, and dine whenever they choose, and eat and drink whatever appeals to them -- even a little alcoholic "nip" now and then. There is a 24-hour restaurant which functions as the primary dining room and snack area. There is an around-the-clock activity program, that offers a balance of sensory-calming and sensory-stimulating activities individualized to each resident. Instead of group activities such as bingo, in which few residents could actually participate, they conduct one-on-one activities -- block-building, coloring, simply conversing -- and use art, music, and exercise to "generate positive emotions", and the outdoors to create connections with the wind, bird song, and sunshine. They have eliminated anything that might be considered restraining, from deep-seated wheelchairs that hinder standing up to bedrails (although some beds are lowered and protected by mats). Bathing is a pleasurable experience and the towel bath method is an option for those who no longer enjoy a shower. Instead of using antipsychotics to treat serious behavioral issues, emphasis is on adequate pain medication and antidepressants. There is no sundowning -- even though the facility is specifically for patients with moderate to severe dementias (of all sorts, including frontotemporal dementia and dementia with Lewy bodies), and accepts those who previously exhibited serious behavioral problems; and even though residents are allowed to stay until they die.
In 2005, Beatitudes instituted a training program for qualified and interested nursing facilities to learn best practices in person-centered dementia care. Those facilities similarly report a reduction in the use of antipsychotic, antidepressant, and sedative medications, decreased use of physical restraints, decreased weight loss, and less hospitalization and emergency department use.
In short, it seems prudent to adjust "conventional wisdom" recommendations to take personal preferences of the loved one into account, including preferences for wake/sleep cycles and napping, to the greatest extent practicable. One caregiver on a discussion forum noted that her loved one was very resistant to staying in bed at night, and was developing behavioral problems. The situation was resolved simply by offering a midnight snack. Beatitudes emphasizes that it is much easier and more effective to anticipate needs rather than wait for a behavior to occur. Caregivers need to be sure to identify discomfort (such as pain, constipation, skin deterioration, malnutrition, physical exhaustion, and adverse drug effects) and manage it effectively. Offer food and drink frequently; anticipate bowel and bladder needs by regularly escorting the loved one to the bathroom (on the loved one’s schedule); and assure other comfort needs are met such as comfortable clothing, room temperatures, and lighting and noise levels. Activities need to be meaningful to the loved one, with the opportunity to make connections to the people and the environment around him; and should be offered to the loved one, not forced on him. Remember that too much stimulation can be just as harmful (if not more so) as too little.
It is one thing for a well-staffed facility to cater to its residents' unique needs, but it may not be practical for the at-home caregiver to adjust the entire household to the rhythms of the loved one. If your loved one simply must be active in the middle of the night, one thing that might be considered is setting up a "safe room" where your loved one can safely pace, which allows you to sleep more soundly. Beverly Bigtree Murphy (if you're not familiar with her website, you should be) describes the "safe room" she set up for her husband -- who paced at night for two years -- at: http://bigtreemurphy.com/Symptoms%20of%20Taking%20Charge%20Stage%20of%20Care.htm#Sundowing,%20Ritualistic%20Behaviors,%20Ccompulsions
5. When all else fails
Learning person-centered care techniques sounds like a lot of hard work and effort. Actually, the sooner the caregiver begins learning "how to speak Alzheimer's", the better off everyone will be, and the less likely that behavioral problems will crop up. Studies have repeatedly shown that caregivers trained in non-drug interventions can not only reduce the frequency and severity of behavioral symptoms and produce higher quality of care for their loved ones, but also reduce their own depression and burden.
Are there medicines that may help? There is some evidence that antipsychotics may help reduce agitation in select patients, but little evidence to support the use of other drugs that are sometimes suggested, such as benzodiazepines, antihistaminics, anticonvulsants, monoamine oxidase inhibitors, or SSRIs. To date, there is no published Class I evidence that any of these drugs are useful for treating sundowning per se. Moreover, there is an increasing reluctance on the part of educated doctors to prescribe medicines for "treating" sundowning because (a) evidence indicates that non-drug interventions are more likely to be beneficial, (b) antipsychotics and benzodiazepines further weaken the already unstable sleep-wake rhythms and further decrease neuronal metabolic activity, and (c) each class of drugs carries considerable risk, ranging from increased likelihood of falls and hip fractures, confusion, psychoses, weight loss, stroke, and/or heart attacks, to increased likelihood of sudden death. Concomitant use of cholinesterase inhibitors (Aricept/donepezil, Razadyne/galantamine, and Exelon/rivastigmine) and antipsychotics may increase the risk of extrapyramidal symptoms by disrupting the acetylcholine/dopamine balance in the striatum. In addition, some drugs are contraindicated for loved ones with some types of dementia, such as the antipsychotics to which Lewy body dementia patients are typically extremely sensitive.
However, each loved one is different. If all else fails, yours might be helped by a drug that is not generally beneficial. Given the risks associated with the candidate drugs, plus possible interactions with other medicines your loved one may be taking, it would be prudent to seek the help of a highly qualified and experienced neuro or geripsych to manage the treatment for your loved one. Be sure to discuss the risks with the doctor, and ask what adverse effects to watch for.
If you are willing to consider trying something outside-the-box, there have been two successful (albeit tiny) clinical trials on using prazosin to treat agitation and aggression in Alzheimer's patients. Two larger trials are now recruiting. Prazosin is a mild antihypertensive with a good safety profile, is inexpensive, and is becoming more and more widely used to treat sleep disruption and agitation associated with PTSD. Given an hour before bedtime, low doses of prazosin reduce light sleep, normalize REM sleep, and increase total sleep time. An additional daytime dose was found to reduce residual daytime agitation symptoms of civilian trauma victims.
Further reading and references
General overviews on sundowning, circadian rhythms, and sleep disturbances
- Volicer L, Harper DG, Manning BC, Goldstein R, Satlin A. Sundowning and circadian rhythms in Alzheimer's disease. Am J Psychiatry 2001;158 (5): 704–11.
http://ajp.psychiatryonline.org/cgi/content/full/158/5/704
- Bachman D, Rabins P. "Sundowning" and other temporally associated agitation states in dementia patients. Annu Rev Med. 2006;57:499-511.
http://cursa.ihmc.us/rid%3D1GM097FD0-1SFSKL8-1FVH/sundowning.pdf
- Kim P, Louis C, Muralee S, Tampi RR. Sundowning Syndrome in the Older Patient. Clinical Geriatrics 2005; 13(4):32-36.
http://www.clinicalgeriatrics.com/article/4013
- Klaffke S, Staedt J. Sundowning and circadian rhythm disorders in dementia. Acta Neurol Belg 2006; 106:168-175
http://www.actaneurologica.be/acta/download/2006-4/03-Klaffke%20et%20al.pdf
- Theison AK, Geisthoff UW, Förstl H, Schröder SG. Agitation in the morning: symptom of depression in dementia? Int J Geriatr Psychiatry 2009 Apr;24(4):335-40.
http://www.gnmhealthcare.com/pdf/09-2008/09/1638914_Agitationinthemorningsymp.pdf
- Wulff K, Gatti S, Wettstein JG, Foster RG. Sleep and circadian rhythm disruption in psychiatric and neurodegenerative disease. Nat Rev Neurosci. 2010 Aug;11(8):589-99.
http://www.ncbi.nlm.nih.gov/pubmed/20631712
- Ancoli-Israel S, Ayalon L. Diagnosis and Treatment of Sleep Disorders in Older Adults. American Journal of Geriatric Psychiatry 2006; 14:95–103
http://www.focus.psychiatryonline.org/cgi/content/full/7/1/98
- Harper DG, Stopa EG, McKee AC, Satlin A, Harlan PC, Goldstein R, Volicer L. Differential circadian rhythm disturbances in men with Alzheimer disease and frontotemporal degeneration. Arch Gen Psychiatry 2001;58:353-360
http://archpsyc.ama-assn.org/cgi/content/full/58/4/353
- Weldemichael DA, Grossberg GT. Circadian Rhythm Disturbances in Patients with Alzheimer's Disease: A Review. Int J Alz Disease 2010; Article ID 716453.
http://www.sage-hindawi.com/journals/ijad/2010/716453/
- Huybrechts KF, Rothman KJ, Silliman RA, Brookhart A, Schneeweiss S. Risk of death and hospital admission for major medical events after initiation of psychotropic medications in older adults admitted to nursing homes.CMAJ 10.1503/cmaj.101406
http://www.eurekalert.org/pub_releases/2011-03/cmaj-omh032311.php
http://www.cmaj.ca/cgi/rapidpdf/cmaj.101406v1.pdf
Nondrug interventions
- Kolanowski AM, Litaker M, Buettner L. Efficacy of theory-based activities for behavioral symptoms of dementia. Nurs Res 2005 Jul-Aug;54(4):219-28.
http://www.nursing-research-editor.com/authors/OMR/5/OMRManuscript.pdf
Note that the patients engaged in the activities for "up to 20 minutes per day", and the authors referenced Kovach and Wells (2002) who found that the daily activity schedule had to be balanced, since over-stimulation as well as under-stimulation can contribute to agitation.
- Teri L, Logsdon RG, McCurry SM. Exercise interventions for dementia and cognitive impairment: the Seattle Protocols. J Nutr Health Aging. 2008;12:391–394.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518041/
- Baehr EK, Eastman CI, Revelle W, Olson SH, Wolfe LF, Zee PC. Circadian phase-shifting effects of nocturnal exercise in older compared with young adults. Am J Physiol Regul Integr Comp Physiol. 2003;284:R1542–R1550.
http://ajpregu.physiology.org/content/284/6/R1542.long
- McCurry SM, Gibbons LE, Logsdon RG, Vitiello MV, Teri L. Nighttime Insomnia Treatment and Education for Alzheimer's Disease: A Randomized, Controlled Trial. J Am Geriatr Soc. 2005;53(5):793-802.
http://www.medscape.com/viewarticle/504709
Person-centered care
- Long CO, Alonzo TA. (2008). Palliative care for advanced dementia: A model teaching unit. Practical approaches and results. Arizona Geriatrics Society Journal, 13(2), 14-17.
http://www.nccdp.org/resources/PalliativeCare.pdf
- Long CO. Palliative care for advanced dementia. J Gerontol Nurs. 2009 Nov;35(11):19-24.
http://www.ncbi.nlm.nih.gov/pubmed/19904852
- Belluck P. Giving Alzheimer’s Patients Their Way, Even Chocolate. New York Times Dec 31, 2010.
http://www.nytimes.com/2011/01/01/health/01care.html
- Buckley C, Estrin J. All-Night Care for Dementia’s Restless Minds. New York Times June 12, 2009.
http://www.nytimes.com/2009/06/14/nyregion/14cover.html
- Girshman P. Midnight Munchies Keep Elderly Safer In NY Nursing Home. Kaiser Health News Mar 16, 2010.
http://www.kaiserhealthnews.org/stories/2010/march/16/midnight-munchies-keep-elderly-safer-in-ny-nursing-home.aspx
- Sloane PD, Mitchell CM, Preisser JS, Phillips C, Commander C, Burker E. Environmental correlates of resident agitation in Alzheimer's disease special care units. J Am Geriatr Soc 1998; 46:862-869.
http://www.ncbi.nlm.nih.gov/pubmed/9670873
http://psycnet.apa.org/?fa=main.doiLanding&uid=1998-04923-004
- Gauthier S, Cummings J, Ballard C, Brodaty H, Grossberg G, Robert P, Lyketsos C. Management of behavioral problems in Alzheimer’s disease. International Psychogeriatrics 2010
http://www.cmrr-nice.fr/doc/IP2010.pdf
- Smith M, Buckwalter K. Behaviors associated with dementia. AJN 2005; 105(7):40-52.
http://journals.lww.com/ajnonline/Fulltext/2005/07000/BEHAVIORS_ASSOCIATED_WITH_DEMENTIA__Whether.28.aspx
- Rader J, Barrick AL, Hoeffer B, Sloane PD, McKenzie D, Talerico KA, et al. (2006). The bathing of older adults with dementia. American Journal of Nursing 106(4), 40-48.
http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=637530
- Whall AL. Changing the care provided persons with dementia -- The role of experiential knowledge and philosophy of science.
http://www2.oakland.edu/oujournal/files/15_changing_the_care.pdf
- McGeorge, S. (2008) Acute Mental Health Issues, in Older People and Mental Health Nursing: A Handbook of Care (eds R. Neno, B. Aveyard and H. Heath), Blackwell Publishing Ltd, Oxford, UK.
http://faculty.ksu.edu.sa/73408/documents/older_people_and_mental_health_nursing.pdf#page=171
Person-centered care at home
- Brackey J. Creating Moments of Joy: A Journal for Caregivers, Fourth Edition. Purdue University Press; (September 1, 2008)
http://www.enhancedmoments.com/
- The Savvy Caregiver training program
http://www.caresprogram.com
(You may be able to get a 20% discount with code AADVD20 .)
- Feil N. The Validation Breakthrough: Simple Techniques for Communicating with People with 'Alzheimer's-Type Dementia, Second edition. Health Professions Press (January 15, 2002).
http://www.vfvalidation.org
Bright light therapy
- Forbes D, Culum I, Lischka AR, Morgan DG, Peacock S, Forbes J, Forbes S. Light therapy for managing cognitive, sleep, functional, behavioural, or psychiatric disturbances in dementia. Cochrane Database Syst Rev. 2009 Oct 7;(4):CD003946.
http://www2.cochrane.org/reviews/en/ab003946.html
- Skjerve A, Bjorvatn B, Holsten F. Light therapy for behavioural and psychological symptoms of dementia. Int J Geriatr Psychiatry. 2004 Jun;19(6):516-22.
http://ot.creighton.edu/community/EBLP/Question4/Skjerve%202004%20Light%20Therapy%20for%20behavioral.pdf
- Ancoli-Israel S, Martin JL, Gehrman P, et al: Effect of light on agitation in institutionalized patients with severe Alzheimer disease. Am J Geriatr Psychiatry 2003;11:194-203.
http://luminoterapia.blogdiario.com/img/Luminoterapia-Alzheimer.pdf
- Barrick AL, Sloane PD, Williams CS, Mitchell CM, Connell BR, Wood W, Hickman SE, Preisser JS, Zimmerman S. Impact of ambient bright light on agitation in dementia. Int J Geriatr Psychiatry. 2010 Oct;25(10):1013-21.
http://www.ncbi.nlm.nih.gov/pubmed/20104513
Melatonin
- Melatonin. Alzheimer Research Forum.
http://www.alzforum.org/dis/tre/drc/detail.asp?id=52
- Gehrman PR, Connor DJ, Martin JL, Shochat T, Corey-Bloom J, Ancoli-Israel S. Melatonin Fails To Improve Sleep Or Agitation In A Double-Blind Randomized Placebo-Controlled Trial Of Institutionalized Patients With Alzheimer’s Disease. Am J Geriatr Psychiatry. 2009 February; 17(2): 166–169.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2630117/
- Asayama K, Yamadera H, Ito T, Suzuki H, Kudo Y, Endo S. Double blind study of melatonin effects on the sleep-wake rhythm, cognitive and non-cognitive functions in Alzheimer type dementia. J Nippon Med Sch. 2003 Aug;70(4):334-41.
http://www.ncbi.nlm.nih.gov/pubmed/12928714
- Singer C, Tractenberg RE, Kaye J, Schafer K, Gamst A, Grundman M, Thomas R, Thal LJ. 2003. A multicenter, placebo-controlled trial of melatonin for sleep disturbance in Alzheimer’s disease. Sleep 26(7): 893–901.
http://www.chalmersresearch.com/bmg/docs/t2a3.pdf
- Serfaty M, Kennell-Webb S, Warner J, Blizard R, Raven P. 2002. Double blind randomised placebo controlled trial of low dose melatonin for sleep disorders in dementia. Int J Geriatr Psychiatry 17(12): 1120–1127.
http://www.chalmersresearch.com/bmg/docs/t2a2.pdf
Bright light and melatonin
- Haffmans PM, Sival RC, Lucius SA, Cats Q, Van Gelder L. Bright light therapy and melatonin in motor restless behaviour in dementia: A placebo-controlled study. Int J Geriatric Psych 2001; 16[1]:106-10
http://ot.creighton.edu/community/EBLP/Question4/Haffmanns%202001%20Bright%20light%20therapy%20and%20melatonin.pdf
- Dowling A, Burr Robert L, Van Someren Eus JW, Hubbard Erin M, Luxenberg JS, Mastick J, Cooper BA. Melatonin and bright-light treatment for rest-activity disruption in institutionalized patients with Alzheimer's disease. J Am Geriatr Soc 2008; 56(2): 239-246.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2642966/
- Riemersma-van der Lek RF, Swaab DF, Tiwsk J, Hol EM, Hoogendijk WJ, Van Someren EJ. Effect of bright light and melatonin on cognitive and noncognitive function in elderly residents of group care facilities: a randomized controlled trial. JAMA. 2008;299:2642–2655.
http://jama.ama-assn.org/content/299/22/2642.long
Cholinesterase inhibitors (ChEIs)
- Nieoullon A, Bentué-Ferrer D, Bordet R, Tsolaki M, Förstl H. Importance of circadian rhythmicity in the cholinergic treatment of Alzheimer’s disease: focus on galantamine*. Curr Med Res Opin. 2008 Dec;24(12):3357-67.
http://www.ncbi.nlm.nih.gov/pubmed/19032118
- Davis B, Sadik K. Circadian cholinergic rhythms: implications for cholinesterase inhibitor therapy. Dement Geriatr Cogn Disord. 2006;21(2):120-9.
http://www.ncbi.nlm.nih.gov/pubmed/16391473
- Robert P. Understanding and Managing Behavioral Symptoms in Alzheimer’s Disease and Related Dementias: Focus on Rivastigmine. Curr Med Res Opin. 2002;18(3).
http://www.medscape.com/viewarticle/439728
Prazosin
- Wang LY, Shofer JB, Rohde K, Hart KL, Hoff DJ, McFall YH, Raskind MA, Peskind ER. Prazosin for the treatment of behavioral symptoms in patients with Alzheimer disease with agitation and aggression. Am J Geriatr Psychiatry. 2009 Sep;17(9):744-51.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842091
- Wang LY, Petrie EC, Rohde K, Hart KL, Hoff DJ, Shofer JB, Rasking MA, Peskind ER. P2-277: Prazosin for treatment of disruptive agitation in Alzheimer's disease. Alz & Dementia 2008;4(4):T453
http://www.alzheimersanddementia.com/article/PIIS1552526008015136/fulltext
- Two larger trials are now recruiting.
http://clinicaltrial.gov/ct2/show/NCT01126099
http://clinicaltrial.gov/ct2/show/NCT00161473
- Taylor FB, Martin P, Thompson C, et al. (2008) Prazosin effects on objective sleep measures and clinical symptoms in civilian trauma posttraumatic stress disorder: a placebo-controlled study. Biol Psychiatry 63:629–632.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2350188
- Raskind MA, Peskind ER, Hoff DJ, et al. (2007) A parallel group placebo controlled study of prazosin for trauma nightmares and sleep disturbance in combat veterans with post-traumatic stress disorder. Biol Psychiatry 61:928–934.
http://axon.psyc.memphis.edu/~charlesblaha/7705/Papers_10/Aycock%20Rebecca%20-%20Prazosin%20and%20PTSD.pdf
- Raskind MA, Peskind ER, Kanter ED, Petrie EC, Radant A, Thompson C, et al. Reduction of Nightmares and Other PTSD Symptoms in Combat Veterans by Prazosin: A Placebo-Controlled Study. Am J Psychiatry. 2003;160:371–373.
http://ajp.psychiatryonline.org/cgi/content/full/160/2/371
- Taylor F, Raskind MA. The alpha1-adrenergic antagonist prazosin improves sleep and nightmares in civilian trauma posttraumatic stress disorder. J Clin Psychopharmacol. 2002;22:82–85.
http://www.ncbi.nlm.nih.gov/pubmed/11799347
- Taylor F, Lowe K, Thompson C, McFall MM, Peskind ER, Kanter ED, et al. Daytime prazosin reduces psychological distress to trauma specific cues in civilian trauma posttraumatic stress disorder. Biol Psychiatry. 2006;59:577–581
http://www.ncbi.nlm.nih.gov/pubmed/16460691
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