“The Four M’s” of Caring for an Older Adult with Dementia

Cleveland, MaryJo 4x6Maryjo L. Cleveland, MD
Medical Director, Post Acute & Senior Services
Chief, Division of Geriatric Medicine
Summa Health System
Akron, Ohio

Your older relative has just been diagnosed with dementia. Your head is spinning with questions, concerns, fears, and yes, disbelief.  Still, you want to know all you can. If you are going to be a caregiver, you want to be a good one. So, where to start?

Start with the things that, if not managed well, have the greatest chance of getting your relative into trouble! Start with “The Four M’s.”

 

Meals
From planning to shopping to preparing, meal preparation is a very complicated task—for someone with a memory problem. You may notice that the older person is losing weight, that they eat little at home but eat well when they go out to eat, or that there is spoiled food in the refrigerator.

Try: Have simple foods – especially your relative’s favorite ones – around the house, such as sandwiches, soup, and cereal. Bring in ready meals that just need to be microwaved. Consider arranging for home delivered meals. Try to make meal time a social time when possible. Ask friends, church and family members to stop in and stay during meals.

Medicine
Medication management can also be overwhelming and older adults are often taking 10 or more medications, including over-the-counter ones.

Try: Discuss simplifying the regimen with the primary healthcare provider. Are all medications still necessary, and how many can be given just daily? Set up the medicine in a “days of the week” pill box and monitor if they are being taken. Call daily to remind. Consider hiring help for in-person reminders. Take over the refill tasks. Continue reading

Finally summer! Time to get some sunshine!

Syed picQuratulain Syed, MD
Assistant Professor of Medicine,
Division of General Medicine and Geriatrics,
Emory University School of Medicine

Now that the long, harsh winter is over and the Sun has finally decided to shine on people living beyond Florida, it’s time to take advantage of the warm weather while it lasts. So ladies and gentlemen, let’s head out to lose the pounds you put on eating your favorite pies the last holiday season.

Outdoor activities have many health benefits, including helping your body make vitamin D, losing unwanted pounds, helping lower your blood pressure, and keeping your heart healthy. While outside, it’s important to take some precautions to avoid getting sick from excessive heat exposure. Here are some tips to help you enjoy the sun:

  • Walk in the early morning (before 10am) or late evening hours (2-3 hours prior to sunset) to avoid excessive heat exposure.
  • Keep a bottle of water with you and sip from it while you are out to avoid getting dehydrated.
  • Wear light colored, loose fitting, and lightweight clothing (such as cotton).
  • Get your hats out and wear them. You get to show them off and avoid the direct heat of the sun.
  • To prevent sunburns and skin cancer, buy sunblock lotion or spray from your local pharmacy and apply it liberally on all exposed parts of your body.
  • Choose pavement or a shaded trail in a park to walk on. Make sure to select a trail which is clean and even, to avoid stumbling on slippery stones and rocks. If you have been under trees and walked through grass, check for ticks on your skin and in skinfolds. Ticks prefer to be in hot moist areas. Also check your scalp after you get home. Have a healthcare provider remove the tick if you find one attached to your skin.
  • Try going to an indoor shopping mall to walk. However, if you love to shop, you might want to leave your credit card at home!
  • Be mindful of your surroundings and be sure to walk in well-lit, clean, and safe walking spaces. Let someone know where you are going and when you expect to return. Take your cell phone with you!
  • Water exercises are a great way to stay in shape for everyone, including people with joint aches and arthritis who can’t walk or run long distances. If there is a swimming pool available at the community center near you, ask about their water exercise schedule. If there are no water exercise classes, put your swimsuit on and walk from one shallow end to the other.
  • Pack some light snacks as low-salt crackers, vegetables (e.g., carrots, cucumbers etc.), and peanut butter to enjoy while you sit on a bench to rest during and after a long walk.
  • Make sure to wear comfortable walking shoes with good support and cushioning. No high heels!
  • If you have one, remember to bring your cane or walker with you. You might need it if you get exhausted from the exercise.
  • Keep your medicine list and emergency contact information in your wallet or handbag at all times.
  • If you experience a severe headache, nausea, spinning of your head, too much sweating, or your heart racing very fast, it may be signs of a condition called heat exhaustion. If this happens, do not wait. Alert your companion or asking people passing by to help you to a shaded place and call for help.

Enjoy the summer and stay safe!

About the Author
Dr. Syed is a member of the American Geriatrics Society’s Public Education Committee.

A Good Day at the White House—#AGSProud

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Heading into the East Room of the White House.

The White House Conference on Aging (WHCOA) was this week. It’s a once-in-a-decade gathering of people who are passionate about older Americans. The next time this conference occurs, I’ll be 66 and my siblings will be in their 60s with one turning the corner to 70. With a little luck and some healthy choices, we’ll be active and engaged with our communities well into our golden years.

One thing that is clear from the 2015 conference is that, as a country, we still have a lot of hard work to do if our communities are going to be ready for me and my siblings. That said, I was proud to represent geriatrics health professionals at the WHCOA and it gave me hope that the type of future we envision for older adults could be a reality (especially on the cusp of some momentous news today from the U.S. Senate—you’ll just have to keep reading to find out more!).

WHCOAPresObama

President Obama giving his remarks.

First, the things that made me proud…

Falls Prevention Takes Center Stage at the Centers for Disease Control & Prevention: In 2001, the American Geriatrics Society (together with the British Geriatrics Society and the American Academy of Orthopedic Surgeons) released our first Guideline for the Prevention of Falls in Older Persons, with an updated guideline issued in 2010. This was seminal work, and not just for the AGS. In fact, our most recent guideline informed the U.S. Centers for Disease Control and Prevention (CDC) work on creating the Stopping Elderly Accidents, Deaths, & Injuries (STEADI) initiative that was announced at the WHCOA. STEADI provides educational tools to healthcare professionals that can help them identify individuals at risk for falls, understand how to modify certain risks that they are likely to find, and learn how to implement effective options for preventing falls altogether. The CDC has been working with Epic Systems Corporation (an electronic health record technology provider) and EPIC will be rolling out a clinical support tool for falls assessment. This resource will make it easier for ALL healthcare providers to screen for falls, intervene to reduce risk, and provide follow-up care. AGS members are leading the STRIDE study that is testing a multifactorial fall injury prevention strategy that is being co-funded by the Patient-Centered Outcomes Institute (PCORI) and the National Institute on Aging (NIA). I’m proud of AGS and our members—we built the foundation for STEADI and, looking towards the WHCOA in 2025, I expect that we will have progressed even further in our understanding of how to prevent older adult falls.

Medicare & Geriatrics Health Professions Funding: President Obama had some good news for geriatrics health professionals, as well—noting that we are working to implement Medicare payment models that support the quality rather than the quantity of care. AGS has been at the forefront of efforts that will benefit beneficiaries by ensuring that clinicians are supported to provide care coordination, care transitions, and advance care planning. We continue to advocate for payment models that support geriatrics health professionals in doing what they love to do: maximize the function and quality of life of the older adults they serve. Look for more news from us on the recently released 2016 proposed physician fee schedule rule in the coming weeks.

Continue reading

Alzheimer’s & Brain Awareness Month

Brangman,Sharon27resized

Sharon A. Brangman, MD
Professor of Medicine
Division Chief, Geriatrics
Director, Central New York Alzheimer’s Disease Assistance Center

SUNY Upstate Medical University

Summer is definitely in full swing: the temperatures are rising, the days are getting longer, and the world is looking a bit more…purple. That may sound strange, but it’s part of a new initiative championed by the Alzheimer’s Association to commemorate the first Alzheimer’s and Brain Awareness Month this June.

In the spirit of Alzheimer’s and Brain Awareness Month, it’s important to understand what Alzheimer’s disease really is (and what it isn’t) and what you can do if you’re concerned about the condition, already living with it, or supporting someone who has been diagnosed.

Dementia and Alzheimer’s: What’s the Difference?
Alzheimer’s disease and dementia are often lumped together, but they aren’t the same thing. Dementia is the umbrella term that covers a wide range of symptoms related to loss of memory and thinking skills severe enough to affect a person’s ability to perform everyday activities. Alzheimer’s disease accounts for 60 to 80 percent of all dementia cases. Vascular dementia, which can follow a stroke, is the second most common type. Additionally, many other, often-reversible conditions like thyroid problems or vitamin deficiencies can cause dementia-like symptoms.

Despite what many people think, dementia isn’t a normal part of aging. Many people have memory loss issues—but that doesn’t mean they have dementia or Alzheimer’s. Those two conditions mean something very different, which is why it’s so important to get a check-up from a healthcare professional if you’re concerned about your cognitive abilities and the potential for developing Alzheimer’s disease. Continue reading

Multiple Chronic Conditions and You

Nancy Lundebjerg casual

I have multiple chronic conditions (MCCs). There—I’ve said it: in my mid-50s, I already have MCCs. Fortunately, nothing is life-threatening, but I do need to keep track of my arthritic toe, my eyesight, and a bit of acid reflux. My friends and I also talk about our weak bladders—likely the precursor to being incontinent later in life, but for now we are managing with the philosophy (in my case, after speaking with my gynecologist): “If there’s a bathroom, we should use it because we never know when we’ll spot another one!”

You’re probably wondering why I’m sharing all of this on the Health in Aging blog. After all, at my age I don’t yet qualify as an older adult. But thinking about all of your conditions any time you get a new diagnosis, try a new vitamin, or are prescribed a new medicine is important at any age. It’s particularly important as you get older, and the American Geriatrics Society (AGS) and the Health in Aging Foundation have tools you can use to create care plans with your providers that take into account all of your conditions and your preferences.

So just what is a chronic condition? Simply put, it’s a physical or mental condition that lasts a year or more and requires ongoing medical attention and/or limits what you can do on a daily basis. At one point, my arthritic left toe was limiting how far I could walk, which, for a New Yorker, had a big impact on my quality of life. Even now, post-surgery, the toe requires an orthotic and monitoring by my doctor. Cute little shoes are basically not an option!

MCC Tools for You
According to Medicare data, more than two-thirds of beneficiaries have 3 or more chronic conditions. If you—or someone you care for—has MCCs, the AGS Health in Aging Foundation has tools that can guide you as you work with clinicians to plan a course of care that takes into account your goals and also helps to prevent having a bad outcome. I always start with our A-Z chapters, as these provide a general overview of a topic and serve as a road map to AGS Health in Aging Foundation resources and those from other organizations. Our chapter on Managing Multiple Health Problems is based on a piece that we created to assist health professionals who are caring for older adults. You can also find other tools, including advice from Drs. Cythia Boyd and Matt McNabney.

Tools for Your Clinicians
The tools and resources that we provide on HealthinAging.org are drawn from the health professional resources of the AGS. In 2012, AGS developed “Guiding Principles for the Care of Older Adults with Multimorbidity: A Stepwise Approach for Clinicians,” which provides a stepwise approach (or one based on a series of stages or steps) for any clinician who is caring for someone with MCCs. One of our primary goals in creating this document was to help clinicians who do not have training in geriatrics and who are treating patients for one or more of their chronic conditions. This is why, with funding from the Agency for Healthcare Research and Quality (AHRQ), we created and released our MCC Geriatrics Evaluation and Management Strategies (GEMS) app this past May and are currently disseminating it to our specialty physician partners. The MCC GEMS app provides a short overview of the guiding principles for busy clinicians as well as some suggested tools that can be helpful to them in managing their older patients.

I know I need to take an active role in managing my own healthcare. That’s why I look for information from trustworthy sources whenever I have a decision to make. Having worked with leaders in the field of geriatrics and gerontology on creating HealthinAging.org, I also know that the information we provide is based on the best evidence available and that it can help you (or someone you love) make healthcare decisions that are consistent with your goals and preferences.

About the Author
Nancy Lundebjerg is the Chief Executive Officer of the American Geriatrics Society and the AGS Health in Aging Foundation.