Balance and walking problems often present before the diagnosis of mild cognitive impairment, Alzheimer's or dementia...By Bob DeMarco
Alzheimer's Reading Room
Showing posts with label patient. Show all posts
Showing posts with label patient. Show all posts
Problems with Balance, Walking and Falling Can Be an Early Sign of Alzheimer's
Alzheimer's Reading Room
Ten Symptoms of Alzheimer's
Doctors are not good at diagnosing Alzheimer's and neither are spouses or children.....By Bob DeMarco
The Caregiver
I would like to use the period from Mother's Day through Father's Day to try and spread the word about the symptoms of the early stages of Alzheimer's -- How to Spot Alzheimer's Early.
Most of the Alzheimer's caregivers I know can look back and identify symptoms and behaviors that they now know were early signs of dementia.
One of the things that caregivers learn is that the sooner that Alzheimer's is diagnosed the better the potential outcome. A failure to spot Alzheimer's early can be disastrous.
We have about ten people on this list that were fortunate and were put on the combination of Aricept and Namenda at the time of their diagnosis. All of these persons seem to be functioning quite well.
I am certain that there are exceptions to this experience. Nothing that is currently available as a treatment for Alzheimer's disease is perfect. Sometimes drugs like Aricept and Namenda don't work at all. This does not mean that they shouldn't be investigated and tried.
Ten Tips for Communicating with an Alzheimer’s Patient
Do not argue with them. It gets you nowhere......By Carole Larkin
Alzheimer's Reading Room
Ever feel like your loved one is ignoring you or that you just weren’t getting through to your loved one? Try some of these tips to see if they help.
Is your Elderly Parent Taking Their Medication as Prescribed? Doubt It
I learned the hard way that my mother was not taking her hypertension medicine as prescribed. I discovered this many months after she was diagnosed with dementia and probable Alzheimer's.
If I had paid attention sooner, would it have made a difference in her diagnosis? I'll never know for certain.
This I believe. If I had paid attention, I would have realized sooner that something was wrong. Very Wrong. This would have allowed me to get my mother taking her medication as prescibed and gotten her diagnosed sooner.
Here is how I discovered my mother was not taking her prescription medicines as prescribed.
If I had paid attention sooner, would it have made a difference in her diagnosis? I'll never know for certain.This I believe. If I had paid attention, I would have realized sooner that something was wrong. Very Wrong. This would have allowed me to get my mother taking her medication as prescibed and gotten her diagnosed sooner.
Here is how I discovered my mother was not taking her prescription medicines as prescribed.
I went to the pharmacy and asked for a print out of the previous 12 months. When I looked, I was aghast.
If you have an elderly parent here is my advice to you. Don't be lazy, get the printout from the pharmacy. After a quick review you will know if the medications were purchased and if they were taken on schedule.
You can put you head in the sand and wait for Alzheimer's or dementia to present in someone you love. Or, you can start paying attention to the little things. The little changes in behavior that come with dementia long before it is detected.
I guess you could say we were fortunate. Two of the worst things that can happen from not taking hypertension medication are a heart attack or a stroke.
If you have an elderly parent here is my advice to you. Don't be lazy, get the printout from the pharmacy. After a quick review you will know if the medications were purchased and if they were taken on schedule.
You can put you head in the sand and wait for Alzheimer's or dementia to present in someone you love. Or, you can start paying attention to the little things. The little changes in behavior that come with dementia long before it is detected.
I guess you could say we were fortunate. Two of the worst things that can happen from not taking hypertension medication are a heart attack or a stroke.
Early detection of Alzheimer's is important and critical to the quality of life your loved one is likely to experience. We got there early and my mother has benefited.
Enough said.
Patients Can't Recall Their Medication to Tell Doctors
Depending on patients' recall of their drugs, however, may be dangerous to their health.
New research from Northwestern University's Feinberg School of Medicine has found that nearly 50 percent of patients taking antihypertensive drugs in three community health centers were unable to accurately name a single one of their medications listed in their medical chart. That number climbed to 65 percent for patients with low health literacy.
“It was worse than we expected,” said lead author Stephen Persell, M.D., an assistant professor of medicine, and of the Institute for Healthcare Studies at the Feinberg School, and a physician at Northwestern Memorial Hospital. “It means doctors can't ask patients to tell them the medications they are taking for their chronic conditions like hypertension. It's very hard to get at the truth of what medications the patient is actually taking.”
The study will be published in the November issue of the Journal of General Internal Medicine.
The Northwestern study looked at 119 patients, average age 55, from community health centers in Grand Rapids, Mich. Researchers asked them to name their antihypertensive drugs and then compared their answers to the drugs listed in their medical charts.
While the study focused on low-income patients, Persell said other patients likely have similar trouble recalling the names and dosages of all their medications, particularly those who take a lot of different drugs and the elderly, who may have cognitive limitations.
The gap between what medications a doctor thinks a patient is taking - and what a patient actually takes - is a new focus for improving the safety and quality of health care. One third of the nation's 1.5 million adverse drug events occur in out-patient settings, resulting in a cost of $1 billion annually. Persell thinks this "knowledge of medication gap" may be one of the causes.
The goal is "medication reconciliation," a term in the healthcare field that means patients and their healthcare providers understand and agree on the medications the patients are using and should be using.
Persell's study also showed patients with low health literacy were prescribed more antihypertensive medications than other patients and had higher blood pressure by about five points.
“We think doctors may be prescribing more medications because the patients aren't giving them the right information about what they are taking,” he said.
Even examining patients' medical records won't necessarily tell a doctor what pills a patient is swallowing. Persell said some patients continue to fill old prescriptions even if a doctor has changed the dosages or the medication.
“I've seen patients who continued on drugs that I told them to discontinue and stop taking drugs I never told them to stop using," Persell said.
The solution is to ask patients to bring all their current medicine bottles to doctor appointments, so the physician can compare them to what has actually been prescribed in the medical charts, Persell noted. That's how he learned a patient he had switched to a cheaper version of a drug continued to take the older expensive one along with the new one, so he was double dosing himself.
"This could have caused a dangerous drop in his heart rate and blood pressure," Persell said.
The Northwestern study indicates a need for future research to address how patients' inability to name their medications -- particularly those with limited health literacy -- impacts hypertension control and drug safety, Persell said.
The study was funded by a career development award from the Agency for Healthcare Research and Quality, a Centers for Disease Control and Prevention Career Development Award and the Michigan Department of Community Health.
More from the Alzheimer's Reading Room
Original Content the Alzheimer's Reading Room
Enough said.
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Patients Can't Recall Their Medication to Tell Doctors
“We think doctors may be prescribing more medications because the patients aren't giving them the right information about what they are taking ..... I've seen patients who continued on drugs that I told them to discontinue and stop taking drugs I never told them to stop using."Doctors rely on patients to accurately tell them what prescription medications - and what dosages -- they are taking in out-patient visits. (A patient's chart may not always be available or complete.) That information is essential for physicians to monitor whether a drug is working, and whether it may have adverse interactions with any new medications prescribed.
Depending on patients' recall of their drugs, however, may be dangerous to their health.
New research from Northwestern University's Feinberg School of Medicine has found that nearly 50 percent of patients taking antihypertensive drugs in three community health centers were unable to accurately name a single one of their medications listed in their medical chart. That number climbed to 65 percent for patients with low health literacy.
“It was worse than we expected,” said lead author Stephen Persell, M.D., an assistant professor of medicine, and of the Institute for Healthcare Studies at the Feinberg School, and a physician at Northwestern Memorial Hospital. “It means doctors can't ask patients to tell them the medications they are taking for their chronic conditions like hypertension. It's very hard to get at the truth of what medications the patient is actually taking.”
The study will be published in the November issue of the Journal of General Internal Medicine.
The Northwestern study looked at 119 patients, average age 55, from community health centers in Grand Rapids, Mich. Researchers asked them to name their antihypertensive drugs and then compared their answers to the drugs listed in their medical charts.
While the study focused on low-income patients, Persell said other patients likely have similar trouble recalling the names and dosages of all their medications, particularly those who take a lot of different drugs and the elderly, who may have cognitive limitations.
The gap between what medications a doctor thinks a patient is taking - and what a patient actually takes - is a new focus for improving the safety and quality of health care. One third of the nation's 1.5 million adverse drug events occur in out-patient settings, resulting in a cost of $1 billion annually. Persell thinks this "knowledge of medication gap" may be one of the causes.
The goal is "medication reconciliation," a term in the healthcare field that means patients and their healthcare providers understand and agree on the medications the patients are using and should be using.
Persell's study also showed patients with low health literacy were prescribed more antihypertensive medications than other patients and had higher blood pressure by about five points.
“We think doctors may be prescribing more medications because the patients aren't giving them the right information about what they are taking,” he said.
Even examining patients' medical records won't necessarily tell a doctor what pills a patient is swallowing. Persell said some patients continue to fill old prescriptions even if a doctor has changed the dosages or the medication.
“I've seen patients who continued on drugs that I told them to discontinue and stop taking drugs I never told them to stop using," Persell said.
The solution is to ask patients to bring all their current medicine bottles to doctor appointments, so the physician can compare them to what has actually been prescribed in the medical charts, Persell noted. That's how he learned a patient he had switched to a cheaper version of a drug continued to take the older expensive one along with the new one, so he was double dosing himself.
"This could have caused a dangerous drop in his heart rate and blood pressure," Persell said.
The Northwestern study indicates a need for future research to address how patients' inability to name their medications -- particularly those with limited health literacy -- impacts hypertension control and drug safety, Persell said.
The study was funded by a career development award from the Agency for Healthcare Research and Quality, a Centers for Disease Control and Prevention Career Development Award and the Michigan Department of Community Health.
Bob DeMarco is an Alzheimer's caregiver and editor of the Alzheimer's Reading Room. The Alzheimer's Reading Room is the number one website on the Internet for advice and insight into Alzheimer's disease. Bob taught at the University of Georgia, was an executive at Bear Stearns, the CEO of IP Group, and is a mentor. He has written more than 700 articles with more than 18,000 links on the Internet. Bob resides in Delray Beach, FL.
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Original Content the Alzheimer's Reading Room
Big Insurers Pay for Online Doctor Visits
Doctors are finally starting to get compensated for online consultations with patients, but whether the practice will catch on is another story. Aetna recently took a three-state pilot project nationwide, and Cigna plans to start paying for Web visits next year, the Philadelphia Inquirer reports. Both companies contract with RelayHealth Patients typically pay the same co-pay whether they go to the doctor or have a Web consult. Insurers pay doctors less for the Web consult — typically $25 to $35, according to the Inquirer.
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With Alzheimer's, the Caregiver Is a Patient, Too
This is an interesting and thought provoking article that highlights the problems often effecting Alzheimer's care giver's.
With Alzheimer's, the Caregiver Is a Patient, Too
Alzheimer's Disease and other forms of dementia do not affect just the patient. These diseases gradually rob patients of memory and other intellectual abilities, leaving them unable to perform routine tasks. As the disease continues to destroy brain cells, patients increasingly depend on family members or others to carry out simple tasks like shopping and getting dressed. Ultimately, most patients will need complete care, adding to the caregiver's burden.
Alzheimer's disease is the most common form of dementia, affecting up to 4 million Americans - and untold millions of family members and others who care for them. Physicians now recognize that Alzheimer's caregivers themselves often require care and attention, says Diana R. Kerwin, MD, Medical College of Wisconsin Assistant Professor of Medicine in the Division of Geriatrics and Gerontology.
"What we're seeing is that Alzheimer's is not a typical disease model," she says, "precisely because the health and well-being of the caretaker is affected as well as the patient. I know when I assume the care of an Alzheimer's patient, I am also caring for the caregiver."
Caregivers who accompany patients to the Froedtert Senior Health Program's Geriatric Evaluation Clinic, where Dr. Kerwin practices, are screened for "caregiver stress" and see a gerontologic nurse and social worker who will answer their questions, provide information and help create a plan for care of the patient. Caregivers are given a kit with information about support groups and community services, including adult day care, home care agencies, assisted living, skilled nursing facilities and respite care.
Stress, Depression Are Common
According to the Alzheimer's Association, more than 80% of Alzheimer caregivers report that they frequently experience high levels of stress, and nearly half say they suffer from depression. It's not difficult to see why.
The national Family Caregiver Alliance terms caregiver depression "one of today's all-too-silent health crises." The alliance estimates that caregiving spouses between the ages of 66 and 96 who are experiencing mental or emotional strain have a 63% higher risk of dying than people the same age who are not caregivers.
"Alzheimer's causes progressive memory loss, and in the later stages patients can develop behavior problems," Dr. Kerwin says. "It's distressing for the caregiver to suddenly have to cope with their loved one's anger, hallucinations, paranoia, aggression or inappropriate conduct in public. It's upsetting when, as the disease progresses, the patient no longer recognizes the spouse or loved one."
Caregivers often experience feelings of guilt, believing they are not doing enough to help, she adds. Spouses and adult children feel grief and loss, not unlike a death in the family - except that instead of being sudden, it's spread out over years. Alzheimer's is a progressively worsening disease, but the rate of progression from mild to advanced can vary widely, from three to 20 years. As Alzheimer's progresses, the loss of brain function itself will cause death unless the patient has one or more other serious illness.
When the Child Becomes the Parent
For an adult child who cares for a parent with dementia, taking on the role of caregiver is a role reversal and takes some adjustment. "It can be a difficult transition for a child to take on the role of 'parent' and decision-maker," Dr. Kerwin says. "The child often needs to be empowered to step in and begin caring for their ailing parent - making sure their parent takes his or her medication, for instance, or telling their parent they should not drive, and making difficult decisions about when the parent is no longer able to safely live alone."
Those caregivers are often already juggling multiple responsibilities with their own spouses, children and careers. In some cases, adult-child caregivers with siblings feel resentful if they must bear the brunt of their parent's care, Dr. Kerwin says. If the adult-child caregiver is the only sibling living in the same city as the parent he or she often feels isolated, overwhelmed and underappreciated.
And sometimes, whether the caregiver is a spouse or an adult sibling, out-of-town siblings or other family members who see the parent infrequently may think the caregiver is exaggerating the extent of the Alzheimer's patient's decline. The out-of-town family members may feel guilty about not being able to help from a distance, and when they do visit, they may criticize or ask to change the care their parent is receiving.
Caregivers are often fatigued from carrying out their new responsibilities, Dr. Kerwin says. "I see them neglecting their own health. It's not unusual for caregivers to suffer not only depression but also higher levels of hypertension. We recommend they have annual physicals, during which they should be sure to tell their primary care physician that they are caregivers. We also recommend they participate in support groups and learn about the community resources available."
Other concerns caregivers regularly express are loss of concentration due to their caregiving responsibilities and fear that they themselves might eventually get the disease.
Warning Signs for Caregivers What are some warning signs of caregiver stress? According to the Alzheimer's Association, they include:
Anger
Anxiety
Denial
Depression
Exhaustion
Health problems
Irritability
Lack of concentration
Sleeplessness
Social withdrawal
Caregivers who regularly experience these conditions should seek help from their physician, says the Alzheimer's Association.
Financial Strain Heightens Burden
In some families, the presence of Alzheimer's disease also brings financial problems that can add to stress and depression. Caregivers sometimes give up paying jobs for the unpaid one of caring for a loved one. They often find additional responsibilities are thrust on them, such as overseeing medications for their patient, knowing if or when the patient's care should be transferred to a nursing home, and taking on power of attorney duties along with living wills and advanced directives that specify whether terminal patients should undergo extreme measures to keep them alive.
The national Family Caregiver Alliance estimates that approximately 80% of the long-term care in the United States is provided without compensation, sometimes around the clock.
"The responsibilities are vast," Dr. Kerwin notes. "It's important for caregivers to regularly take some time for themselves, away from their caring responsibilities."
Barbara Abel
HealthLink Contributing Writer
The Medical College's Center for Healthy Communities, along with the local non-profit organization Community Care for the Elderly Partnership, has developed a Caring for Caregivers Program to support Medicaid- and Medicare-eligible residents in the community who care for frail relatives, often those with dementia. For more information, contact Tovah H. Bates, PhD, Assistant Professor, Family & Community Medicine, at 414-456-4305, or Community Care for the Elderly at 414-385-6600.
For more information on this topic, see the HealthLink articles End-Stage Alzheimer's - the Long Goodbye and Current Research on Alzheimer's, Memory Loss, and Aging.
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