Post by norbert1 on Jun 19, 2006 9:03:23 GMT -5
Topics covered in this post:
Imaging Cat scan, MRI, and Pet scan
Alcohol induced dementia
There's nothing wrong, lack of insight
Safe return information
Namenda plus Aricept
Med adjustment at the Hospital Psych ward
Coping with caregiving and emotions of caregiving
Picking at skin
Dealing with Hallucinations
Miller trust used for medicaid Qualification
Range of motion exercises
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411 - Cat scan, MRI, and Pet scan 06/18/06 06:33 AM
MRI and Cat Scans are similar.
The Cat Scan is cheaper. It shows more of the surface of the brain, I believe.
The MRI is more expensive and shows more detail. It shows the brain in "slices" and shows internal structure. It cannot be done when the patient has certain implants.
The PET scan is about double the cost. First, they inject radioactive glucose into the bloodstream. The PET scan shows the levels of glucose metabolism and can be used to visualize levels of thinking is being done in different parts of the brain. Patterns of reduced activity in different parts of the brain are different in different types of dementia. They can look at the pattern and get a better idea of what type of dementia is present. This test is generally approved (by insurance) only when the patient is young, the doctor is having difficulty with the specific diagnosis, when there are complicating factors making diagnosis difficult, or there is suspicion of an atypical dementia such as frontotemporal dementia.
Note - earlier in Alzheimers, the MRI does not show anything that indicates Alzheimers. It can show brain shrinkage, but early on, it is difficult to determine if the shrinkage is greater than standard shrinkage do to aging. The greatest purpose of the MRI is to rule out other things - strokes, MID, tumors, hydrocephalus, atrophy that is not symetric, etc. White spots causing vascular dementia will also be detected with the MRI (or Cat scan).
There is no one specific test that says "Alzheimers." It is a matter of whether the progression of problems (reported by the family) and all the tests are consistent with Alzheimers.
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Alcohol induced dementia 03/28/05 11:21 AM
I recently found a fact sheet on Alcohol-induced dementia.
www.alzbrain.org/quicklinks/factsheets/alcoholicDementia.htm
At Alzheimers Outreach, there is a collection of articles regarding alcohol induced dementia
www.zarcrom.com/users/alzheimers/odem/al-d.html
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411 - There's nothing wrong, lack of insight 12/27/05
An unique aspect of Alzheimers and it's effect on the brain is "lack of insight" about their cognitive losses. (medical term - Anosognosia) Very few alzheimers patients will go to their doctor and complain of difficulties with memory. When it does happen, it is in the very mild stages, and often when the memory problems are causing problems with their job(employment).
Later in the disease there is a total denial that there is anything wrong with them. All difficulties in their life are blamed on others. And it is common that when the doctor informs them of an Alzheimers diagnosis, the person will refuse to go back to that doctor. (My aunt said the doctor was the one who was crazy.)
A related aspect is that people with alzheimers lose their ability to reason, so their opinions and viewpoints become very rigid and there is nothing you can do to change their mind.
Norbert
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Anosognosia can occur in the earliest stages of Alzheimer’s disease and can affect more than 40% of patients, complicating their management. According to Mateja de Leonni-Stanonik, MD, PhD, anosognosia is “usually manifested in patients with Alzheimer’s disease as an unawareness of cognitive deficits.” The mechanism of anosognosia remains unknown, “but several studies show that patients with Alzheimer’s disease and anosognosia have significantly more severe deficits on frontal lobe–related neuropsychological tests,” (The brain's frontal lobe is where executive function and thinking occurs.)
“For these patients, it’s not denial; it truly seems to be their unawareness and subsequent inability to recognize that something might be wrong with them—that is, anosognosia. Therefore, anosognosia may represent a specific defect in selective attention in Alzheimer’s disease,” she concluded.
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411 - Safe return information 10/19/05 06:06 AM
From the Alzheimers Association------
About Safe Return
The Alzheimers Association's Safe Return®is a nationwide identification, support and enrollment program that provides assistance when a person with Alzheimer's or a related dementia wanders and becomes lost locally or far from home.
Assistance is available 24 hours a day, seven days a week. If an enrollee is missing, one call immediately activates a community support network to help reunite the lost person with his or her caregiver.
Safe Return faxes the enrolled person's information and photo to local law enforcement. When the person is found, a citizen or law official calls the 800-number on the identification products and Safe Return notifies listed contacts. The nearest Alzheimer's Association office provides information and support during the search and rescue efforts.
- Identification products -
With a $40 enrollment in Alzheimer's Association Safe Return, you receive the following products:
Engraved identification bracelet or necklace and iron-on clothing labels.
Caregiver checklist, key chain, lapel pin, refrigerator magnet, stickers and wallet cards.
For an additional $5, you'll receive caregiver jewelry. In an emergency, it alerts others that you provide care for a person enrolled in Safe Return.
- Enrollment -
To enroll, a person with dementia or the caregiver fills out a simple form, supplies a photograph, chooses the type of identification product that the enrollee will wear and/or carry, and makes a enrollment payment of $40. Check with your local Alzheimer's Association chapter to find out if scholarships are available in your area to cover the cost of enrollment.
There are three ways you can enroll in Safe Return:
1) Online. Enroll with our secure form. It's fast and easy.
Enroll online now.
2) Phone: Enroll by phone using a credit card. Call 1.888.572.8566. We are available 24 hours a day.
3) Mail: To enroll by mail, simply print out and complete the enrollment form and send payment and enrollee photo to the address listed on the form. You may also phone 1.888.572.8566 to have an enrollment form mailed to you.
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411 - Namenda plus Aricept 01/27/06 11:45 AM
For studies done for FDA approval, Namenda was taken along with Aricept - but it doesn't mean that it has to be taken that way. If they had not been tested together, then there would have been a big question of whether they can be taken together.
The mechanism of action for the two drugs is totally different and not dependent on the other med to work.
For patients not able to take the aricept, use of the namenda still has benefit.
If it was my LO, I would ask the doctor to put back on the exelon which he can tolerate, and perhaps do a test and taper off for a short period of time to see if there are any consequences. I think that is what a dementia doctor would do. The only way to see if it is working is to see what happens when it is reduced.
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411 - Med adjustment at the Hospital Psych ward 03/10/06
AT WHITS END 03/10/06 07:37 AM by SHEBERTA
I AM GETTING SO CONFUSED ABOUT THE MEDS. MY MOTHER WAS PLACED IN ALF 8 MONTHS AGO. MOM HAD SEVERAL ALTERCATIONS WITH RESIDENTS AFTER ONE WOULD TELL HER TO SHUT UP. ALF PROTOCOL IS TO PLACE HER IN PSYCH WARD TO RE-EVALUATE HER MEDS.
FIRST ONE WAS A HELL HOLE, IT TOOK ME FIVE DAYS TO MOVE HER SOMEWHERE ELSE. FOUR WEEKS AGO THEY STARTED HER ON ABILIFY, NOT SURE HOW TO SPELL IT. ONE DOCTOR SAID TO TAKE HER OFF IT , ONE SAYS LEAVE HER ON IT. WE JUST WANT TO BE ABLE TO FIND SOMETHING THAT WILL KEEP HER FROM BEING COMBATIVE. IF SHE DOESN'T CHILL OUT THE ALF WON'T TAKE HER BACK. WE DON'T WANT TO PUT HER IN A NH. IT SEEMS YOU CAN'T GET A STRAIGHT ANSWER FROM ANYONE IN THE MEDICAL FIELD. SHE CAN'T TAKE SEROQUIL IT MAKES HER WORSE. JUST DON'T KNOW WHERE TO TURN. WE NEED ADVISE FROM SOMEONE WHO HAS HAD TO DEAL WITH KIND OF SITUATION. PLEASE HELP!
Sheberta,
I am sorry to read of your problems. It seems that the source of the problem might be the provoking resident, not your mother. This is a problem of facilities where many people with dementia must live together in one area. I would ask the facility what they plan to do to reduce the provocations. You wrote “AFTER ONE WOULD TELL HER TO SHUT UP” What’s up with this? Was she saying something to this lady or creating some kind of disturbing noise or vocalization?
I have an idea of what you are going through. My Aunt was kicked out of two different AL facilities via hospital med adjustments in Gero Psych units.
First, is your mother on Aricept? Often, it can provide enough of a boost that it can reduce some of the behavior problems that come with dementia.
The proper and appropriate way to treat harmful agitation and aggression is with an “atypical” antipsychotic. Seroquel is a mild one and the best to use if possible. Abilify is a rather new antipsychotic that is more expensive. It is a very acceptable alternative to Seroquel. If a stronger med is needed, then the doctors may need to switch to Risperdal or Zyprexa.
If an antipsychotic is not effective enough for aggression, they will likely add in a mood stabilizer - usually Depakote. Mood stabilizers help slow the persons reaction to stressors. (technically, Depakote is an antiseizure med.)
Any course of treatment other than this is questionable. (this is information learned the hard way)
Also from my experience, any dementia patient who has had a hospital med adjustment must be under the care of a doctor who is a dementia specialist - to monitor and adjust the medications after discharge. The hospital stay is too short to fine tune the meds for best results (benefit vs. side effects) and the levels need to be adjusted up or down over time. Call your local Alzheimers Association to find out who the dementia experts are in your area.
Please let us know how it goes.
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411 - Coping with caregiving and emotions of caregiving 01/12/06
A constant theme on this board is stress and emotions. It is something I experienced in caregiving. It is also something that is hard to provide answers about how to deal with it.
Why is it that some caregivers do it so well, and seem to have very little stress; while others suffer stress and emotions that affect their blood pressure and endangers their health?
For five plus years I have wondered about this with no answer to give. Lately, I have discovered some answers from various presentations given at my local alzheimers association’s monthly education series.
The first and major key is Acceptance. To accept the role of caregiver. One thing that you will notice on this board, is that the spouse caregivers do not write as much about stress as daughter/son caregivers. They often accept this as a new direction in their marriage and stand by their spouse in this new fight. The daughter/son do not accept this role easily, resent what it has done to their life, use the word “hate” to describe aspects of their life, and hate the things that they are missing because of caregiving.
Acceptance is difficult when we slide into caregiving, without knowing what lies ahead. Without making a conscious decision that we are caregivers, we become “reluctant caregivers” who hate what this has done to our life.
Along with acceptance of the caregiving role, is acceptance that we will have to give up some things in our lives and that some tasks are not going to be done as well as we would like. Acceptance will mean that adjustments need to be made from our life before Alzheimers.
Caregivers who are more accepting of their role decide that they will do their best and that will have to be good enough. They don’t beat them selves up about past decisions. They take one day at a time.
These points were discussed by the Alzheimeimers Association's local social worker.
From my notes-
The how to’s
-1- Accept it. Acknowledge that you are a caregiver. You may think, not yet, they are still able to function on their own. As soon as the diagnosis is made, you are a caregiver. It is best to say, “I am a caregiver” so that it is very real to you
Once you accept that, It brings peace of mind. Then you can move forward.
It becomes your reality, your life. It is not giving up – letting go of the non-essentials.
-2- Next step - Understand that Loss comes with this disease.
Future plans, relationship, the person you loved. There are losses.
The best thing is to recognize and feel these emotions of grief.
Expect it , but get help if needed.
-3- Learn all you can about caregiving. Support groups, how day care gets results. And trust your intuition.
-4- Readjust to your new world. Simplify your environment, schedule, life, your day. Slow down.
-5- Alter your emotional attachment to expectations. Be open to the unexpected. Let go of expectations.
-6- Invest energy into the role. Let go of energy draining emotions, things, people in your life. Let go of resentment, worry, doubt and discouragement, and what others think.
-7- Don’t take things personally. Whatever your loved one says, don’t take it personally. What other people say, don’t take it personally.
-8- Do your best, no more, no less. If More - you will be drained and lost. If Less - you will feel frustrated and guilt. Find the middle road.
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All that is mental preparation for caregiving. Now for a related and more advanced concept.
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For those coping experiencing great stress in their caregiving, I recommend the book “Coping with Alzheimer’s: A caregivers Emotional Survival Guide”
Rose Oliver, PhD, Frances A Bock, PhD
This book is based on a branch of psychology,--- that the way we internalize our thoughts has a lot to do with the way we react to the problem.
Have you ever noticed that some people deal with all kinds of difficulties but it doesn’t seem to affect them. Other people are just knocked for a loop when a difficulty comes along. It has to do with the way a person internalizes about the situation. The person who takes the attitude that “this is awful”, “I hate this”, “I cannot stand this” - is going to have much more difficult time dealing with the difficulty. These people “awfulize” or “catastrophize” the situation mentally. They are going to have much more trouble dealing with adversities.
It is much more helpful to say, “this is bad, and I wish this didn’t happen but I will deal with it.”
This book talks about reducing the emotional level of self messages from various caregiving emotions including: Anger, Shame, Self pity, Guilt, Anxiety, Depression, and Stress.
I don’t know how well reading a book can help dealing with these issues. I know that this is the most insightful information about emotions that I have encountered. I hope it can help some of you.
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411 - Picking at skin 03/29/06 10:01 AM
<<<My SIL picks at herself, especially when upset. She has scaps and sores on both arms, neck, and into hairline. Any suggestions? >>>
<<<My uncle does this, he is bald and has a spot on his head he picks at when he is nervous. When he starts doing it to the point of causing a wound we up his antianxiety meds.>>>
My aunt would do this. She would scratch at her scalp until it bled. She would not leave the scabs alone. I did see one book (a caregivers account) where it was called senile dermatitus, but I never found any information that this really is an accepted term. anyway...
I was really hoping one of our professional caregivers would answer this. Certainly it is something that is seen regularly in special care units. Until a professional comes along, I will post these thoughts.
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What is the reason for the scratching? - The skin itches, boredom/idle hands + obsessive behavior, or psychosis (thinking there something crawling on the skin)
Most likely it is the boredom/idle hands + obsessive behavior. Once she notices it, she cannot leave it alone.
Keep nails cut as short as possible - and filed smooth. Perhaps put bandaids on the prominent scratching fingers. Some caregivers have used a little deception- putting hand cream on persons hands and then putting on thin gloves "to keep the skin moist" as part of the "skin treatment."
Keep her occupied, give her things to hold and fiddle with.
Get some cream that will decrease the itching from dry skin. One thing that works pretty well is Lanacaine, but put a dot on the skin to test for allergies before spreading it around. Then use a thin film of unscented heavy duty moistureizer -- like the Nutrogena about 4 times each day.
It the area is kept moist, there should be less temptation to pick at it.
Keep large areas covered with bandages, long sleeve blouses, etc
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What are benzocaine skin cream, ointment, or aerosol?
BENZOCAINE (Americaine®, Lagol®, Hurricane®) causes loss of feeling in the skin and mucous membranes, relieving pain from insect bites, minor burns, small wounds, or dermatitis. Generic benzocaine skin products are available.
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411 - Dealing with Hallucinations 04/29/05 09:28 PM
In some cases, a person is aware that they are having hallucinations; and reassurance - telling them that you will keep them safe is helpful. They may only need you to tell them that it is just on of their visions (when visual hallucinations). But - this is not the norm in hallucinations.
In most cases, the hallucinations are part of the person's reality, and being told that it is not real, will provoke anger. It is best to comfort, distract, or redirect the person. You can play along - telling the monster in the closet to leave. (sorry, more is written about visual hallucinations.)
One other thing, if the hallucinations do not cause problems or distress to the person, there may be no reason to treat them. Or it may be appropriate to treat so that they are reduced but not completely eliminated (to minimize sided effects from agressive treatment)
You can read a short discussion of Hallucinations in the following article - "Behavioral Problems in Dementia".
www.postgradmed.com/issues/2004/06_04/smith.htm
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411 - Miller trust used for medicaid Qualification 03/02/06
<<< Has anyone heard of Miller Trust, and if so, what is your opinion? Daddy and I are meeting with a financial counselor this afternoon to discuss it. >>>
The miller trust is a method used to qualify for Medicaid in states that have rediculous "income cap" regulations. It is a way to allow "excess" income to be used to pay for nursing home care but not disqualify the person from Medicaid benefits. There is nothing dishonest about using a miller trust. It is something you may have to do if the recipients income is too high, but still not enough to pay for the Nursing home.
The miller trust would need to be set up around the time you need to apply for the Medicaid. It would not need to be done in advance - as part of financial planning.
Norbert
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From elderlawanswers ---
In some states, known as "income cap" states, eligibility for Medicaid benefits is barred if the nursing home resident's income exceeds $1,809 a month (for 2006), unless the excess above this amount is paid into a "(d)(4)(B)" or "Miller" trust. If you live in an income cap state and require more information on such trusts, consult an elder law specialist in your state.
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From alzsupport-
(Note - this explaination uses old Medicaid limits- but the explaination is good.)
Income Test
In addition to looking at the amount of assets you have, some states, including Florida, impose an additional factor to consider when determining eligibility, the income of the applicant. In Florida, for example, the income amount is capped at $1,656 per month. In "income cap" states if the applicant is over the cap, even by a dollar, he is not eligible for benefits, despite the fact that he passes every other test.
This often imposes the harsh and arbitrary result of ineligibility for the applicant over the income cap even though he has no other assets and no other means to generate additional cash flow. Furthermore, while he may have a relatively high income he may not even be close to the amount required for care averaging $4,500.00 per month. The applicant has fallen into what we call the Medicaid Gap. Too much income to qualify for benefits, too little to pay for care. What do you do in this situation?
Prior to 1993 there were few if any options for the person in this situation. Sometimes the nursing home would provide services at a reduced rate; sometimes they would not. The person is considered INELIGIBLE for Medicaid benefits if he make greater than $1,656 per month. In 1993 Congress again modified the laws regarding the Medicaid program, and while they took away with one hand; again further restricting the criteria for determining eligibility, they gave with the other; giving people who were over the cap a work-around to avoid the Medicaid Gap. This work-around is called the income trust See the section on strategies for obtaining eligibility for a complete discussion of the income trust.
Income Trusts
While an income trust is not specifically related to protecting assets, it is an absolute necessity if your income is greater than the $1,656 per month income cap. If you are in an income cap state, are over the income cap and want to have benefits paid in an income cap state you must have an Income Trust drafted, executed and properly funded, prior to application for benefits.
Income Trusts are fairly simple in their concept. A trust is set up in order to divert income of the applicant to the trust in an amount great enough to reduce the income of the applicant below the cap. So, for example, if you have $1,666 in monthly income, you will need to put $10.00 into the trust each month to bring the income at or below the cap amount.
Now for the peculiar part; the total income of the applicant, with a few deductions for personal needs, is used to calculate what is known as the patient’s responsibility. This patient’s responsibility requires the applicant who has been granted benefits to pay his total income; $1,666.00, to the nursing home as his contribution to the cost of his care. There is an obvious shortfall of $10.00 that was sent to the income trust. The solution is that the trust then pays the $10.00 to the nursing home, making up the balance.
When the applicant is over the income cap, eligibility can not be established without the use of an income trust; therefore, the income trust must be set up before the application process is begun. Additionally, it must be properly funded with the applicant's excess (over the cap) income. For example: $10.00 would go into the trust as diagramed below. If you do not transfer the excess income to the trust prior to, and during the application process, eligibility will probably be denied for those months that the trust did not receive the excess income.
BTW, the new Medicaid rules are also explained on this site in an article titled “Is Medicaid Dead?” These new rules are more likely to cause major problems for someone who needs medicaid for the nursing home.
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411 - Range of motion exercises
this was posted by Ridzene on 6/26/06
I hope that this information will be helpful.
Zene
www.healthtouch.com/bin/EContent_HT/cnoteShowLfts.asp?fname=02524&title=PASSIVE+RANGE+OF+MOTION+EXERCISES+&cid =HTHLTH
www.healthtouch.com/bin/EContent_HT/cnoteShowLfts.asp?fname=02523&title=ACTIVE+RANGE+OF+MOTION+EXERCISES+&cid= HTHLTH
Note - the website would not let me click directly to these articles. Go to www.healthtouch.com
click on "health information" www.healthtouch.com/bin/Econtent_HT/cnoteinfo.asp?cid=HTHLTH
and search for "active range of motion" (when the patient can do the movement themselves) or "passive range of motion"
Note - some literature suggests that passive range of motion exercises involving the head and neck should only be done by a physical therapist. Please consult with the doctor first. - Norbert
__________________
Imaging Cat scan, MRI, and Pet scan
Alcohol induced dementia
There's nothing wrong, lack of insight
Safe return information
Namenda plus Aricept
Med adjustment at the Hospital Psych ward
Coping with caregiving and emotions of caregiving
Picking at skin
Dealing with Hallucinations
Miller trust used for medicaid Qualification
Range of motion exercises
----------------------------------------------
411 - Cat scan, MRI, and Pet scan 06/18/06 06:33 AM
MRI and Cat Scans are similar.
The Cat Scan is cheaper. It shows more of the surface of the brain, I believe.
The MRI is more expensive and shows more detail. It shows the brain in "slices" and shows internal structure. It cannot be done when the patient has certain implants.
The PET scan is about double the cost. First, they inject radioactive glucose into the bloodstream. The PET scan shows the levels of glucose metabolism and can be used to visualize levels of thinking is being done in different parts of the brain. Patterns of reduced activity in different parts of the brain are different in different types of dementia. They can look at the pattern and get a better idea of what type of dementia is present. This test is generally approved (by insurance) only when the patient is young, the doctor is having difficulty with the specific diagnosis, when there are complicating factors making diagnosis difficult, or there is suspicion of an atypical dementia such as frontotemporal dementia.
Note - earlier in Alzheimers, the MRI does not show anything that indicates Alzheimers. It can show brain shrinkage, but early on, it is difficult to determine if the shrinkage is greater than standard shrinkage do to aging. The greatest purpose of the MRI is to rule out other things - strokes, MID, tumors, hydrocephalus, atrophy that is not symetric, etc. White spots causing vascular dementia will also be detected with the MRI (or Cat scan).
There is no one specific test that says "Alzheimers." It is a matter of whether the progression of problems (reported by the family) and all the tests are consistent with Alzheimers.
--------------------------------------------
Alcohol induced dementia 03/28/05 11:21 AM
I recently found a fact sheet on Alcohol-induced dementia.
www.alzbrain.org/quicklinks/factsheets/alcoholicDementia.htm
At Alzheimers Outreach, there is a collection of articles regarding alcohol induced dementia
www.zarcrom.com/users/alzheimers/odem/al-d.html
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411 - There's nothing wrong, lack of insight 12/27/05
An unique aspect of Alzheimers and it's effect on the brain is "lack of insight" about their cognitive losses. (medical term - Anosognosia) Very few alzheimers patients will go to their doctor and complain of difficulties with memory. When it does happen, it is in the very mild stages, and often when the memory problems are causing problems with their job(employment).
Later in the disease there is a total denial that there is anything wrong with them. All difficulties in their life are blamed on others. And it is common that when the doctor informs them of an Alzheimers diagnosis, the person will refuse to go back to that doctor. (My aunt said the doctor was the one who was crazy.)
A related aspect is that people with alzheimers lose their ability to reason, so their opinions and viewpoints become very rigid and there is nothing you can do to change their mind.
Norbert
----------
Anosognosia can occur in the earliest stages of Alzheimer’s disease and can affect more than 40% of patients, complicating their management. According to Mateja de Leonni-Stanonik, MD, PhD, anosognosia is “usually manifested in patients with Alzheimer’s disease as an unawareness of cognitive deficits.” The mechanism of anosognosia remains unknown, “but several studies show that patients with Alzheimer’s disease and anosognosia have significantly more severe deficits on frontal lobe–related neuropsychological tests,” (The brain's frontal lobe is where executive function and thinking occurs.)
“For these patients, it’s not denial; it truly seems to be their unawareness and subsequent inability to recognize that something might be wrong with them—that is, anosognosia. Therefore, anosognosia may represent a specific defect in selective attention in Alzheimer’s disease,” she concluded.
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411 - Safe return information 10/19/05 06:06 AM
From the Alzheimers Association------
About Safe Return
The Alzheimers Association's Safe Return®is a nationwide identification, support and enrollment program that provides assistance when a person with Alzheimer's or a related dementia wanders and becomes lost locally or far from home.
Assistance is available 24 hours a day, seven days a week. If an enrollee is missing, one call immediately activates a community support network to help reunite the lost person with his or her caregiver.
Safe Return faxes the enrolled person's information and photo to local law enforcement. When the person is found, a citizen or law official calls the 800-number on the identification products and Safe Return notifies listed contacts. The nearest Alzheimer's Association office provides information and support during the search and rescue efforts.
- Identification products -
With a $40 enrollment in Alzheimer's Association Safe Return, you receive the following products:
Engraved identification bracelet or necklace and iron-on clothing labels.
Caregiver checklist, key chain, lapel pin, refrigerator magnet, stickers and wallet cards.
For an additional $5, you'll receive caregiver jewelry. In an emergency, it alerts others that you provide care for a person enrolled in Safe Return.
- Enrollment -
To enroll, a person with dementia or the caregiver fills out a simple form, supplies a photograph, chooses the type of identification product that the enrollee will wear and/or carry, and makes a enrollment payment of $40. Check with your local Alzheimer's Association chapter to find out if scholarships are available in your area to cover the cost of enrollment.
There are three ways you can enroll in Safe Return:
1) Online. Enroll with our secure form. It's fast and easy.
Enroll online now.
2) Phone: Enroll by phone using a credit card. Call 1.888.572.8566. We are available 24 hours a day.
3) Mail: To enroll by mail, simply print out and complete the enrollment form and send payment and enrollee photo to the address listed on the form. You may also phone 1.888.572.8566 to have an enrollment form mailed to you.
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411 - Namenda plus Aricept 01/27/06 11:45 AM
For studies done for FDA approval, Namenda was taken along with Aricept - but it doesn't mean that it has to be taken that way. If they had not been tested together, then there would have been a big question of whether they can be taken together.
The mechanism of action for the two drugs is totally different and not dependent on the other med to work.
For patients not able to take the aricept, use of the namenda still has benefit.
If it was my LO, I would ask the doctor to put back on the exelon which he can tolerate, and perhaps do a test and taper off for a short period of time to see if there are any consequences. I think that is what a dementia doctor would do. The only way to see if it is working is to see what happens when it is reduced.
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411 - Med adjustment at the Hospital Psych ward 03/10/06
AT WHITS END 03/10/06 07:37 AM by SHEBERTA
I AM GETTING SO CONFUSED ABOUT THE MEDS. MY MOTHER WAS PLACED IN ALF 8 MONTHS AGO. MOM HAD SEVERAL ALTERCATIONS WITH RESIDENTS AFTER ONE WOULD TELL HER TO SHUT UP. ALF PROTOCOL IS TO PLACE HER IN PSYCH WARD TO RE-EVALUATE HER MEDS.
FIRST ONE WAS A HELL HOLE, IT TOOK ME FIVE DAYS TO MOVE HER SOMEWHERE ELSE. FOUR WEEKS AGO THEY STARTED HER ON ABILIFY, NOT SURE HOW TO SPELL IT. ONE DOCTOR SAID TO TAKE HER OFF IT , ONE SAYS LEAVE HER ON IT. WE JUST WANT TO BE ABLE TO FIND SOMETHING THAT WILL KEEP HER FROM BEING COMBATIVE. IF SHE DOESN'T CHILL OUT THE ALF WON'T TAKE HER BACK. WE DON'T WANT TO PUT HER IN A NH. IT SEEMS YOU CAN'T GET A STRAIGHT ANSWER FROM ANYONE IN THE MEDICAL FIELD. SHE CAN'T TAKE SEROQUIL IT MAKES HER WORSE. JUST DON'T KNOW WHERE TO TURN. WE NEED ADVISE FROM SOMEONE WHO HAS HAD TO DEAL WITH KIND OF SITUATION. PLEASE HELP!
Sheberta,
I am sorry to read of your problems. It seems that the source of the problem might be the provoking resident, not your mother. This is a problem of facilities where many people with dementia must live together in one area. I would ask the facility what they plan to do to reduce the provocations. You wrote “AFTER ONE WOULD TELL HER TO SHUT UP” What’s up with this? Was she saying something to this lady or creating some kind of disturbing noise or vocalization?
I have an idea of what you are going through. My Aunt was kicked out of two different AL facilities via hospital med adjustments in Gero Psych units.
First, is your mother on Aricept? Often, it can provide enough of a boost that it can reduce some of the behavior problems that come with dementia.
The proper and appropriate way to treat harmful agitation and aggression is with an “atypical” antipsychotic. Seroquel is a mild one and the best to use if possible. Abilify is a rather new antipsychotic that is more expensive. It is a very acceptable alternative to Seroquel. If a stronger med is needed, then the doctors may need to switch to Risperdal or Zyprexa.
If an antipsychotic is not effective enough for aggression, they will likely add in a mood stabilizer - usually Depakote. Mood stabilizers help slow the persons reaction to stressors. (technically, Depakote is an antiseizure med.)
Any course of treatment other than this is questionable. (this is information learned the hard way)
Also from my experience, any dementia patient who has had a hospital med adjustment must be under the care of a doctor who is a dementia specialist - to monitor and adjust the medications after discharge. The hospital stay is too short to fine tune the meds for best results (benefit vs. side effects) and the levels need to be adjusted up or down over time. Call your local Alzheimers Association to find out who the dementia experts are in your area.
Please let us know how it goes.
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411 - Coping with caregiving and emotions of caregiving 01/12/06
A constant theme on this board is stress and emotions. It is something I experienced in caregiving. It is also something that is hard to provide answers about how to deal with it.
Why is it that some caregivers do it so well, and seem to have very little stress; while others suffer stress and emotions that affect their blood pressure and endangers their health?
For five plus years I have wondered about this with no answer to give. Lately, I have discovered some answers from various presentations given at my local alzheimers association’s monthly education series.
The first and major key is Acceptance. To accept the role of caregiver. One thing that you will notice on this board, is that the spouse caregivers do not write as much about stress as daughter/son caregivers. They often accept this as a new direction in their marriage and stand by their spouse in this new fight. The daughter/son do not accept this role easily, resent what it has done to their life, use the word “hate” to describe aspects of their life, and hate the things that they are missing because of caregiving.
Acceptance is difficult when we slide into caregiving, without knowing what lies ahead. Without making a conscious decision that we are caregivers, we become “reluctant caregivers” who hate what this has done to our life.
Along with acceptance of the caregiving role, is acceptance that we will have to give up some things in our lives and that some tasks are not going to be done as well as we would like. Acceptance will mean that adjustments need to be made from our life before Alzheimers.
Caregivers who are more accepting of their role decide that they will do their best and that will have to be good enough. They don’t beat them selves up about past decisions. They take one day at a time.
These points were discussed by the Alzheimeimers Association's local social worker.
From my notes-
The how to’s
-1- Accept it. Acknowledge that you are a caregiver. You may think, not yet, they are still able to function on their own. As soon as the diagnosis is made, you are a caregiver. It is best to say, “I am a caregiver” so that it is very real to you
Once you accept that, It brings peace of mind. Then you can move forward.
It becomes your reality, your life. It is not giving up – letting go of the non-essentials.
-2- Next step - Understand that Loss comes with this disease.
Future plans, relationship, the person you loved. There are losses.
The best thing is to recognize and feel these emotions of grief.
Expect it , but get help if needed.
-3- Learn all you can about caregiving. Support groups, how day care gets results. And trust your intuition.
-4- Readjust to your new world. Simplify your environment, schedule, life, your day. Slow down.
-5- Alter your emotional attachment to expectations. Be open to the unexpected. Let go of expectations.
-6- Invest energy into the role. Let go of energy draining emotions, things, people in your life. Let go of resentment, worry, doubt and discouragement, and what others think.
-7- Don’t take things personally. Whatever your loved one says, don’t take it personally. What other people say, don’t take it personally.
-8- Do your best, no more, no less. If More - you will be drained and lost. If Less - you will feel frustrated and guilt. Find the middle road.
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All that is mental preparation for caregiving. Now for a related and more advanced concept.
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For those coping experiencing great stress in their caregiving, I recommend the book “Coping with Alzheimer’s: A caregivers Emotional Survival Guide”
Rose Oliver, PhD, Frances A Bock, PhD
This book is based on a branch of psychology,--- that the way we internalize our thoughts has a lot to do with the way we react to the problem.
Have you ever noticed that some people deal with all kinds of difficulties but it doesn’t seem to affect them. Other people are just knocked for a loop when a difficulty comes along. It has to do with the way a person internalizes about the situation. The person who takes the attitude that “this is awful”, “I hate this”, “I cannot stand this” - is going to have much more difficult time dealing with the difficulty. These people “awfulize” or “catastrophize” the situation mentally. They are going to have much more trouble dealing with adversities.
It is much more helpful to say, “this is bad, and I wish this didn’t happen but I will deal with it.”
This book talks about reducing the emotional level of self messages from various caregiving emotions including: Anger, Shame, Self pity, Guilt, Anxiety, Depression, and Stress.
I don’t know how well reading a book can help dealing with these issues. I know that this is the most insightful information about emotions that I have encountered. I hope it can help some of you.
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411 - Picking at skin 03/29/06 10:01 AM
<<<My SIL picks at herself, especially when upset. She has scaps and sores on both arms, neck, and into hairline. Any suggestions? >>>
<<<My uncle does this, he is bald and has a spot on his head he picks at when he is nervous. When he starts doing it to the point of causing a wound we up his antianxiety meds.>>>
My aunt would do this. She would scratch at her scalp until it bled. She would not leave the scabs alone. I did see one book (a caregivers account) where it was called senile dermatitus, but I never found any information that this really is an accepted term. anyway...
I was really hoping one of our professional caregivers would answer this. Certainly it is something that is seen regularly in special care units. Until a professional comes along, I will post these thoughts.
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What is the reason for the scratching? - The skin itches, boredom/idle hands + obsessive behavior, or psychosis (thinking there something crawling on the skin)
Most likely it is the boredom/idle hands + obsessive behavior. Once she notices it, she cannot leave it alone.
Keep nails cut as short as possible - and filed smooth. Perhaps put bandaids on the prominent scratching fingers. Some caregivers have used a little deception- putting hand cream on persons hands and then putting on thin gloves "to keep the skin moist" as part of the "skin treatment."
Keep her occupied, give her things to hold and fiddle with.
Get some cream that will decrease the itching from dry skin. One thing that works pretty well is Lanacaine, but put a dot on the skin to test for allergies before spreading it around. Then use a thin film of unscented heavy duty moistureizer -- like the Nutrogena about 4 times each day.
It the area is kept moist, there should be less temptation to pick at it.
Keep large areas covered with bandages, long sleeve blouses, etc
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What are benzocaine skin cream, ointment, or aerosol?
BENZOCAINE (Americaine®, Lagol®, Hurricane®) causes loss of feeling in the skin and mucous membranes, relieving pain from insect bites, minor burns, small wounds, or dermatitis. Generic benzocaine skin products are available.
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411 - Dealing with Hallucinations 04/29/05 09:28 PM
In some cases, a person is aware that they are having hallucinations; and reassurance - telling them that you will keep them safe is helpful. They may only need you to tell them that it is just on of their visions (when visual hallucinations). But - this is not the norm in hallucinations.
In most cases, the hallucinations are part of the person's reality, and being told that it is not real, will provoke anger. It is best to comfort, distract, or redirect the person. You can play along - telling the monster in the closet to leave. (sorry, more is written about visual hallucinations.)
One other thing, if the hallucinations do not cause problems or distress to the person, there may be no reason to treat them. Or it may be appropriate to treat so that they are reduced but not completely eliminated (to minimize sided effects from agressive treatment)
You can read a short discussion of Hallucinations in the following article - "Behavioral Problems in Dementia".
www.postgradmed.com/issues/2004/06_04/smith.htm
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411 - Miller trust used for medicaid Qualification 03/02/06
<<< Has anyone heard of Miller Trust, and if so, what is your opinion? Daddy and I are meeting with a financial counselor this afternoon to discuss it. >>>
The miller trust is a method used to qualify for Medicaid in states that have rediculous "income cap" regulations. It is a way to allow "excess" income to be used to pay for nursing home care but not disqualify the person from Medicaid benefits. There is nothing dishonest about using a miller trust. It is something you may have to do if the recipients income is too high, but still not enough to pay for the Nursing home.
The miller trust would need to be set up around the time you need to apply for the Medicaid. It would not need to be done in advance - as part of financial planning.
Norbert
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From elderlawanswers ---
In some states, known as "income cap" states, eligibility for Medicaid benefits is barred if the nursing home resident's income exceeds $1,809 a month (for 2006), unless the excess above this amount is paid into a "(d)(4)(B)" or "Miller" trust. If you live in an income cap state and require more information on such trusts, consult an elder law specialist in your state.
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From alzsupport-
(Note - this explaination uses old Medicaid limits- but the explaination is good.)
Income Test
In addition to looking at the amount of assets you have, some states, including Florida, impose an additional factor to consider when determining eligibility, the income of the applicant. In Florida, for example, the income amount is capped at $1,656 per month. In "income cap" states if the applicant is over the cap, even by a dollar, he is not eligible for benefits, despite the fact that he passes every other test.
This often imposes the harsh and arbitrary result of ineligibility for the applicant over the income cap even though he has no other assets and no other means to generate additional cash flow. Furthermore, while he may have a relatively high income he may not even be close to the amount required for care averaging $4,500.00 per month. The applicant has fallen into what we call the Medicaid Gap. Too much income to qualify for benefits, too little to pay for care. What do you do in this situation?
Prior to 1993 there were few if any options for the person in this situation. Sometimes the nursing home would provide services at a reduced rate; sometimes they would not. The person is considered INELIGIBLE for Medicaid benefits if he make greater than $1,656 per month. In 1993 Congress again modified the laws regarding the Medicaid program, and while they took away with one hand; again further restricting the criteria for determining eligibility, they gave with the other; giving people who were over the cap a work-around to avoid the Medicaid Gap. This work-around is called the income trust See the section on strategies for obtaining eligibility for a complete discussion of the income trust.
Income Trusts
While an income trust is not specifically related to protecting assets, it is an absolute necessity if your income is greater than the $1,656 per month income cap. If you are in an income cap state, are over the income cap and want to have benefits paid in an income cap state you must have an Income Trust drafted, executed and properly funded, prior to application for benefits.
Income Trusts are fairly simple in their concept. A trust is set up in order to divert income of the applicant to the trust in an amount great enough to reduce the income of the applicant below the cap. So, for example, if you have $1,666 in monthly income, you will need to put $10.00 into the trust each month to bring the income at or below the cap amount.
Now for the peculiar part; the total income of the applicant, with a few deductions for personal needs, is used to calculate what is known as the patient’s responsibility. This patient’s responsibility requires the applicant who has been granted benefits to pay his total income; $1,666.00, to the nursing home as his contribution to the cost of his care. There is an obvious shortfall of $10.00 that was sent to the income trust. The solution is that the trust then pays the $10.00 to the nursing home, making up the balance.
When the applicant is over the income cap, eligibility can not be established without the use of an income trust; therefore, the income trust must be set up before the application process is begun. Additionally, it must be properly funded with the applicant's excess (over the cap) income. For example: $10.00 would go into the trust as diagramed below. If you do not transfer the excess income to the trust prior to, and during the application process, eligibility will probably be denied for those months that the trust did not receive the excess income.
BTW, the new Medicaid rules are also explained on this site in an article titled “Is Medicaid Dead?” These new rules are more likely to cause major problems for someone who needs medicaid for the nursing home.
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411 - Range of motion exercises
this was posted by Ridzene on 6/26/06
I hope that this information will be helpful.
Zene
www.healthtouch.com/bin/EContent_HT/cnoteShowLfts.asp?fname=02524&title=PASSIVE+RANGE+OF+MOTION+EXERCISES+&cid =HTHLTH
www.healthtouch.com/bin/EContent_HT/cnoteShowLfts.asp?fname=02523&title=ACTIVE+RANGE+OF+MOTION+EXERCISES+&cid= HTHLTH
Note - the website would not let me click directly to these articles. Go to www.healthtouch.com
click on "health information" www.healthtouch.com/bin/Econtent_HT/cnoteinfo.asp?cid=HTHLTH
and search for "active range of motion" (when the patient can do the movement themselves) or "passive range of motion"
Note - some literature suggests that passive range of motion exercises involving the head and neck should only be done by a physical therapist. Please consult with the doctor first. - Norbert
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