Case Management in Patients With Early-Onset Alzheimer’s Disease

Patients with early-onset AD and their families face great obstacles—medically, socially, and psychologically. Depending on the age at onset, they may also face financial hardships. Helping patients and families cope with this disorder requires special skills in evaluating, counseling, applying for disability benefits, helping to shore up social networks, and more. Read how you can help develop a full care plan for these patients.

Read the full article here.

Substance Abuse and The Elderly

How do I know if my loved one is having a problem with abusing prescription drugs and or alcohol?

Alcohol and substance abuse rank third among the leading mental disorders in older adults, and the rates of alcohol abuse range from 2 to 10% . These percentages are considered to be underestimated due to the large amount of substance abusers who deny they have a drinking problem, and family members who are unable to recognize when it really is a problem.

If not dealt with in treatment, severe alcoholism can lead to severe depression and suicide in older adults. The alcoholic elderly are particularly vulnerable because their risk of suicide is five times higher than that of the nonalcoholic elderly (this is because alcohol acts as a depressant on the central nervous system). This means that heavy drinking produces feelings of sadness, anxiety, guilt, and remorse (1).
Long term alcohol abuse can do damage to the brain, and may cause behavioral and memory changes that resemble Alzheimer’s disease. Bottom line, if the underlying reason as to why the individual is drinking is not addressed, drinking puts a bandage on the problem and it becomes difficult for families as well as physicians to understand and address a treatment plan.

When a person has both chronic alcoholism and Alzheimer’s, it is difficult to tell which condition is the cause of which symptom (2).

The Reasons that Older Adults Resort to Alcoholism:
• Depression
• Low self-esteem
• Attempting to manage pain from medical conditions
• Genetic predisposition
• Loneliness
• Isolation
• Retirement roles
• Loss of friends/spouse

Medication overuse

The correct medication and dosage can increase quality of life with by managing medical conditions, However, sometimes there is a price to be paid. Part of that price is experiencing how some drugs can interfere with memory skills, mood, alertness, and ability to take in new information.
Thousands of older adults suffer from severe mental impairment, including memory loss, which is either caused by drugs, or worsened by them. Recent studies indicate that drugs greatly diminish or inhibit chemicals in the brain (e.g., neurotransmitters, such as and hormones) which can produce significant memory loss (3). This is especially dangerous if your loved one still drives or lives on his or her own and will not accept help.


Drugs Associated With Alcohol Interactions

(adapted from WebMD)

Hundreds of commonly used prescription and over-the-counter drugs may adversely interact with alcohol. These include medications used for:

• Allergies, colds, and flu
• Angina and coronary heart disease
• Anxiety and epilepsy
• Arthritis
• Blood clots
• Cough
• Depression
• Diabetes
• Enlarged prostrate
• Heartburn and indigestion
• High blood pressure
• High cholesterol
• Infections
• Muscle pain
• Nausea and motion sickness
• Pain, fever, and inflammation
• Seizures
• Severe pain from injury, post-surgical care, oral surgery, and migraine
• Sleep problems


Geriatric Care Managers can help!

A skilled professional such as a geriatric care manager can quickly assess the situation and work with the family to put an action plan in place, addressing the medical, psychological and social issues that may be interfering with the older adult getting the help they need. Geriatric Care Consultants LLC has a breadth of knowledge of trusted professionals and we can be an invaluable resource to help take the burden off the adult child and get the senior the help they need.

1. Osgood, N.J., Wood, H.E., & Parham, I.A. (1995) Overview. Alcoholism and Aging (pp. 14-19).
2. Rosenfeld, I.R. (1999) Live Now Age Later: Proven Ways to Slow Down the Clock.
3. Schaie,K.W., Willis, S.L. (1996). Alcoholism and Drug Misuse. Adult Development and Aging (pp.487-490).

Making Tough Decisions

Spotlight on the family caregiver:
Many family members become “caregivers” to an elderly loved one in their family.  While your parent may not be living with you, you may be providing the ongoing emotional support, grocery shopping, scheduling doctors appointments and driving your parent if they can no longer do so.  Finding appropriate resources and health care professionals may be time consuming.  Work or family obligations may make it increasingly difficult to be there for your parent in the way you want to, adding additional stress that you may not anticipate.
If you live in the same town as your elderly parent, you may have notice subtle or sudden changes in them, but what if you live long distance? Seeing  a family member may during a holiday or planned visit may reveal shocking changes that are impossible to detect by a long distance phone call.
Troubling signs of slipping independence:
  • Unpaid bills
  • Noticeable decline in grooming habits and personal care
  • Signs of hoarding
  • Signs of depression
  • Noticeable Bruises which may indicate falls
  • Weight loss
  • Mood changes
  • Missed doctor appointments
  • Confusion/ Forgetfulness
  • Limited mobility
Should I allow my parent to live with me?
While many well meaning sons and daughters try to reciprocate the care the received as a young child by being a family caregiver, this  arrangement often puts additional strain on a marital relationship and may interfere with child care responsibilities.
  • Is my home appropriate in terms of safety for my loved one?
     A home that can accommodate younger family members may not be a safe environment for an elderly person especially with medical issues and or dementia.
  • Are my family members who live with me in agreement about my decision to have a loved one live with us? Ironing out specific roles/boundaries are important to minimize family conflict
  • Who do I hire to care for my loved one if I cannot? Knowing what level of care your parent needs and what type of caregiver would be appropriate is an important decision that needs to be made carefully.

Driving and Seniors: When is it time to have the talk?

There is no easy answer to this question, and telling mom or dad to stop driving is an emotional topic which must be tread lightly.  If you can imagine back to when you were a teenager and you got your first car, driving symbolized independence, freedom, competency.

As we get older our bodies start to change and we may start to experience changes in reaction time, concentration and overall abilities. There may be underlying health or cognitive difficulties that may impair judgement on the road.  Assessing the right time to have a conversation with your loved one is never easy, but planning ahead is essential  This is the perfect time to rally a team together of professionals and resources to think through your approach. The following are factors to consider that may impact your loved one’s performance on the road:

  • Alzheimer’s disease (or related neurological disorder)
  • Medication side effects
  • Hearing Loss
  • Macular degeneration (or glaucoma)
  • Diabetes
  • Stroke
  • Arthritis
  • Heart disease
  • Mental illness (depression)
  • Substance abuse (alcoholism)
  • Sleep deprivation

 Poly-pharmacy:  Older people with multiple medical conditions often take multiple medications which are necessary but may impair skills needed for driving. It is important to communicate with your loved one’s doctor as to how the benefits outweigh the risks.

 Prescription drugs are chemicals designed to produce specific and desired changes or functions within the body. But, as in the law of physics, for every action there is a reaction. That reaction may be drowsiness and/or a slowing of the person’s reaction time. In the field of medicine these are identified as side effects and may effect, even seriously, a person’s ability to drive.

A patient taking several different prescription drugs, particularly if they are prescribed by different doctors who don’t have updated knowledge of other drugs being taken, may have even more serious side effects as each of the drugs creates its own side effects plus conflict with other drugs to cause even worse reactions.  

Your parent’s physician(s) can advise you of the side effects of each drug plus the added conflicts through polypharmacy. You may also take all the prescription containers to a friendly pharmacist who can quickly do a computer-based analysis.

GERIATRIC CARE MANAGERS ARE KEY:
Many seniors want to “age in place” in the comfort of their own home, and this means at some point in time instrumental tasks of daily living such as managing money, driving, and completing tasks of daily living may become difficult. Often times an objective professional can help the family determine when the right time is to implement discussions and interventions- which may turn what appears to be an insurmountable obstacle, into an opportunity.

Geriatric Care Managers (GCMs) conduct an initial assessment to determine independence level, taking into account a multifaceted approach to individual functioning and care. Creative ideas can be explored to not only facilitate effective approaches for your loved one, but considering safety issues as well.

Resources:  

Garnering resources for you as a family caregiver can give you insight into what things you should be looking for, which can assist in facilitating difficult but necessary conversations for the safety of your loved one.  Arming yourself with knowledge can make you feel more empowered if there are options to put in place, when your loved one’s independence is threatened.

http://www.caring.com/articles/napgcm-kaaren-boothroyd

www.thehartford.com/mature-market-excellence/dementia-driving 

http://www.aarp.org/home-garden/transportation/driver_safety/

http://www.thecarconnection.com/news/1091982_oldest-drivers-are-driving-more–and-driving-medicated-more–than-ever

http://seniordriving.aaa.com

http://www.npr.org/blogs/health/2012/10/08/162392507/when-should-seniors-hang-up-the-car-keys

According to the Center for Disease Control, seniors can take several steps to try and stay safe on the road:

  • Exercising regularly to increase strength and flexibility.
  • Asking your doctor or pharmacist to review medicines-both prescription and over-the counter-to reduce side effects and interactions.
  • Having eyes checked by an eye doctor at least once a year. Wear glasses and corrective lenses as required.
  • Driving during daylight and in good weather.
  • Finding the safest route with well-lit streets, intersections with left turn arrows, and easy parking.
  • Planning your route before you drive.
  • Leaving a large following distance behind the car in front of you.
  • Avoiding distractions in your car, such as listening to a loud radio, talking on your cell phone, texting, and eating.
  • Considering potential alternatives to driving, such as riding with a friend or using public transit, that you can use to get around.

Fall Prevention

The Problem

Many seniors and their families do not realize that there are many components which come into play to contributing to the high risk of falling for seniors.  Often it takes a crisis to occur-which can result in hospitalization and or placement in a long term care facility for the family and the senior to realize a change must be made.  A geriatric care manager/gerontologist is often hired on a case after a fall as the family becomes concerned that their loved one can no longer live without support at home or question whether the current living environment supports their loved ones changing health status.

Dementia, multiple medical issues, poor eyesight, depression, and medication side effects are just a few factors that come to mind.  Families and or a professional,  often have to point out to mom or dad, that as their physical and or mental condition changes, environmental adjustments as well as the incorporation of assistive devices must be incorporated in the home.

The National Safety Council estimates that persons over the age of 65 have the highest mortality rate (death rate) from injuries. Among older adults, injuries cause more deaths than either pneumonia or diabetes. Falls account for about one-half of the deaths due to injury in the elderly. Several epidemiological studies have looked at the rate of falls in the elderly at home, in outpatient settings and institutions.

  • Among 65 year-old women nearly one in three (30 percent) will fall; after age 85, over half of women will suffer a fall.
  • For men, the proportion who fall increases from 13 percent in the 65 to 69 age group to a peak of 31 percent in the 80- to 84-year age group. For those over the age of 85 there is a slight decrease.
  • It appears that for the elderly living at home one-third to one-half tend to fall or do fall.Those who are more aged, female, single, divorced or widowed have an increased rate of falling.
  • In the younger, healthier elderly, environmental factors are more important, with stairs and floor obstacles being common causes of falls.
  • For the older, sick elderly, falls are often associated with dizziness and syncope (brief loss of consciousness; “passing out”), cardiac and neurologic disease, poor health status and functional disability.

Functional Ability 

If a senior has poor balance, how can they function in the home properly?  Tasks of eating, bathing, dressing, toileting and even driving are impacted.   If the senior does not have a caregiver and or does not use assistive devices, the chances of falling multiple times trying to fulfill every day tasks of functioning increases. Safety issues of ambulation, transferring from bed to standing or chair to standing can become a risk each time. Instrumental tasks of daily living such as managing finances, driving to the bank, shopping, and cooking can all be impacted if the senior’s balance is in question and perhaps they do not do many tasks for fear of falling again.

 Home modification

When ever I enter into the seniors home I assess their medical and cognitive condition and then I look at all rooms they primarily function.  Do they now need a walker, cane or wheelchair for transferring? Does their bathroom have multiple scatter rugs which can contribute to falls. Could a grab bar or shower chair in the bathroom help the senior steady themselves while bathing? Do they have an emergency response system if they live alone?  These are important factors to consider.   If a fall has become severe enough sometimes the senior will need 24 hour monitoring to ensure that they can function in their home.

Solutions

Falls are usually multi-factorial in nature,  involving many different factors. Exercise/balance training, physical therapy, incorporating adequate social supports, proper diet/hydration, and checking with medical doctors about side effects of medication are just a few.   A geriatric care manager can often attend medical appointments with the senior to discuss with the MD how new medications/doses may impact balance. They are also good detectives in assessing whether or not neurological and or emotional issues may be contributing to falls. A professional assessment is often needed to ascertain which factors are at play and what professional/interventions are needed for the senior.

Hiring a professional such as a geriatric care manager to do an assessment can be worth its weight in gold and save the family and senior unwanted pain and suffering that may otherwise be costly to the seniors health, quality of life and overall independence.