Aging Parents, Pets And Long-Term Care

May 30, 2018

Most of us understand how pets bring joy to people and why they are important. This is particularly true for older folks who may have lost loved ones and who have also lost regular human companionship. A dog or cat can provide that unconditional love we all need.

More assisted living facilities and homes where elders live independently now allow pets, with certain restrictions, such as size and weight of the pet. When visiting my 95 year old mother in law, Alice, we often see people walking their dogs around the place. It's a senior's community which offers independent living apartments as well as assisted living. Like many of that type, it's pet friendly. In other locations, such as nursing homes, pet programs include bringing in dogs, birds or other small creatures for the residents to hold and play with on scheduled visits. The residents love it. Elders with dementia often relate very well to the creatures who visit.

It's not all fun though. When an older person lives alone in declining health, he or she may not be able to adequately care for the pooch or kitty. Someone has to take their animal to the vet for their shots or for treatment with the various ailments older pets suffer from just as their human counterparts do: arthritis, pneumonia, flu, etc. And a frail elder with balance issues may not be entirely safe with a rambunctious dog that likes to jump up, run around them and increase the risk of tripping or falling on Rover. Canes and walkers don't always mix well with beloved pets.

Families have to consider the pros and cons of keeping the pet on hand as a parent ages, perhaps has vision problems or is unsteady on his feet. Some families take in the parent's cherished animal and bring the pet to visit Mom or Dad at the seniors' residence. Some elders are forced to part with their favorite four legged friend when a move to a new residence and loss of ability to drive makes it impossible to care for the pet properly.

As a dog lover myself, I can only say that all solutions should be considered before the heartbreak of separating anyone from an animal they love. There are dog walkers who can be paid to exercise a loved one's pooch every day, run them to the vet, ensure that pet medication is given and that the dog or cat gets all needed care. Caregivers helping an aging parent may be recruited to care for a pet right along with caring for its owner. When recruiting a caregiver, that additional responsibility could be included in the job description, perhaps with a pay bonus for certain additional chores. Finally, if it is impossible to keep the pet where the parent lives, it is an act of caring to find a way for someone in the family, a neighbor or friend to adopt the animal and bring it for regular visits to see its owner. That's good for the human and good for the pet too.

It's not fair to any pet to allow it to be neglected as an aging parent becomes cognitively impaired. Memory loss might mean forgetting to feed the animal or keep it safe. We don't want to see any pet with less care than it needs because the elder's family forgot about the risks of aging and how the aging parent might do unintentional harm to the animal. Cognitive decline, "early dementia", Alzheimer's disease and many other problems can pose a danger to the pet. Considering long term care plans for your elders, be sure to consider a matching long term care plan for the elder's animals. Their pets are indeed family too and do a lot to comfort and support an aging person with communication difficulty or even with the loneliness that so many elders face. That furry cuddle from the cat or that doggie smile with wagging tail can give your aging parent a lift that goes beyond what words can say.

Carolyn Rosenblatt, RN, Elder Law Attorney, Healthy aging and protecting our elders, AgingParents.com, AgingInvestor.com

SOURCE: Forbes

Trump health secretary pushes back against Medicare drug negotiation

May 14, 2018

Trump health secretary pushes back against Medicare drug negotiation President Trump’s health secretary pushed back Monday at critics who said Trump’s drug pricing plan moved away from his campaign pledge of having Medicare negotiate drug prices.

Health and Human Services (HHS) Secretary Alex Azar dismissed the idea — backed by many Democrats — that Medicare can save money by negotiating directly with drug companies.

“The only way that direct negotiation saves money is by doing something this administration does not believe in: denying access to certain medicines for all Medicare beneficiaries, or setting prices for drugs by government fiat,” Azar said in a speech at HHS headquarters.

Still, Azar hinted that Trump has not completely abandoned the idea.

“The idea of direct negotiation in Medicare has come up” during his meetings with the president, Azar said, but they determined the approach first announced by President Trump on Friday was the “smart, effective way.”

In remarks to reporters following the speech, Azar said Trump wants Medicare to negotiate more effectively, “rather than trite, gimmicky, political proposals.”

Instead of allowing direct negotiation, Azar said Trump’s plan would “bring negotiation where it doesn’t exist” by merging drugs in Part B, Medicare’s program for doctor-prescribed drugs, with the Part D prescription drug benefit.

In an interview with "The Hugh Hewitt Show" on Monday morning, Azar suggested that moving Part B drugs into the Part D program could require legislation. But Azar told reporters later he won’t need congressional approval for such a sweeping change to the system, so long as it’s conducted as a demonstration project first.

Former President Obama proposed reforms to Medicare Part B drug payments in 2016, but eventually scrapped the plan in the face of fierce resistance from doctors and drug companies.

SOURCE: The Hill

Nursing homes confronting elderly bullies

May 12, 2018

SAN FRANCISCO — The unwanted were turned away from cafeteria tables.

Fistfights broke out at karaoke.

Dances became breeding grounds for gossip and cruelty.

It became clear this place had a bullying problem on its hands. What many found surprising was that the perpetrators and victims alike were all senior citizens.

Nursing homes, senior centers and housing complexes for the elderly have introduced programs, training and policies aimed at curbing spates of bullying, an issue once thought the exclusive domain of the young.

“There’s the clique system just like everywhere else,” said Betsy Gran, who until recently was assistant director at San Francisco’s On Lok 30th Street Senior Center. “It’s like ‘Mean Girls,’ but everyone is 80.”

After the cafeteria exiles and karaoke brouhahas, the On Lok 30th Street Senior Center teamed up with a local nonprofit, the Institute on Aging, to develop an anti-bullying program.

All staff members received 18 hours of training that included lessons on what constitutes bullying, causes of the problem and how to manage such conflicts.

Seniors were then invited to similar classes, held in English and Spanish, teaching them to alert staff or intervene themselves if they witness bullying. Signs and even placemats around the center now declare it a “Bully Free Zone.”

“I think in the past I would have just stayed out of it,” said Mary Murphy, 86, a retired real estate agent who took the classes. “Now I might be inclined to help.”

Robin Bonifas, a social work professor at Arizona State University and author of the book “Bullying Among Older Adults: How to Recognize and Address an Unseen Epidemic,” said existing studies suggest about 1 in 5 seniors encounters bullying.

She sees it as an outgrowth of frustrations characteristic in communal settings, as well as a reflection of issues unique to getting older. Many elderly see their independence and sense of control disappear and, for some, becoming a bully can feel like regaining some of that lost power.

“It makes them feel very out of control,” Bonifas said, “and the way they sort of get on top of things and make their name in this new world is intimidating, picking on people, gossiping.”

There is far less recognition of bullying as a problem among seniors compared with young people. Even among those who have been called bullies, many are unaware how problematic their behavior is until it’s labeled. Campaigns around the country have sought to spread the word, including a booklet circulated last year by the National Center for Assisted Living.

“In the life cycle, it doesn’t go away,” said Katherine Arnold, a member of the city Human Rights Commission in St. Louis Park, Minnesota, which created a public service announcement on its community-access station that included a portrayal of a man who was excluded from a card game and became the subject of gossip by other seniors. “There’s really not a lot of escape.”

Most senior bullying isn’t physical but rather involves name-calling, rumors and exclusion, said Pamela Countouris, a longtime schoolteacher who now runs a Pittsburgh-based consultancy that offers training on bullying. Women constitute the bulk of the bullies Countouris encounters among seniors, a reflection of lifespan disparities and the gender makeup of those who live at or participate in programs at senior facilities.

Countouris’ business began with a focus on school bullying but now centers exclusively on seniors. In the next month alone, she has more than a dozen training sessions planned.

After four years immersed in the wrath of older bullies, Countouris has heard all manner of stories.

At a senior high-rise, a woman who saw herself as the queen of the parking garage would key the cars of those who crossed her.

Elsewhere, laundry rooms became vicious places where the bullied had their detergent stolen and their clothes thrown on the floor.

Bingo rooms so often devolved into battlefields – with lucky newcomers badgered and accused of cheating by veteran players – she came to call it “the devil’s game.”

“I didn’t realize it was an underground society where people could be mean to each other,” Countouris said.

SOURCE: Press Herald

Anxiety in middle age linked to dementia later

Apr 30, 2018

(Reuters Health) - People with moderate to severe anxiety in middle age may be more likely to develop dementia as they get older, a recent study suggests.

Researchers examined data from four previously published studies that tracked a total of almost 30,000 people for at least a decade. In each of the smaller studies, there was a clear connection between anxiety in midlife and dementia later on, researchers report in BMJ Open.

“If people are living with moderate to severe anxiety we would encourage them to seek help,” said senior study author Natalie Marchant of University College London in the UK.

“Therapies already exist that have been shown to be effective for treating anxiety (for example talking therapies and mindfulness-based interventions), and while we do not yet know whether they would also reduce risk of developing dementia, alleviation of anxiety symptoms and stress would be a definite benefit to (the) patient,” Marchant said by email.

The study wasn’t a controlled experiment designed to prove whether or how anxiety might directly contribute to the development of dementia. Researchers were also unable to formally pool all the data from the four smaller studies, so they couldn’t calculate the magnitude of the increased dementia risk associated with anxiety.

It’s possible dementia might follow an anxiety diagnosis in middle age because moderate to severe anxiety appears to increase stress hormones, and chronic elevation of these hormones may consequently damage brain regions such as those associated with memory, Marchant said.

Scientists don’t yet know whether treating anxiety, and thus reducing the chronic elevation of these hormones, would reduce risk for dementia, Marchant added.

Anxiety can also be a symptom of dementia, and that makes it difficult to firmly establish whether it’s also an independent risk factor for dementia, said Dr. Costantino Iadecola, director of the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine in New York City.

“Anxiety disorders need to be treated in their own right, independently of potential associations (causal or not) with cognitive impairment later in life,” Iadecola, who wasn’t involved in the study, said by email. “I would stress the importance of treating anxiety disorders as an essential step in maintaining mental health, not because of possible links to dementia, which remain unproven.”

The current study isn’t designed to explain how anxiety and dementia might be connected, Iadecola added.

“We cannot say with confidence that anxiety is a cause (risk factor), an early manifestation of the dementia, or only coincidentally associated with it,” Iadecola added.

SOURCE: bit.ly/2HCKWXP BMJ Open, online April 30, 2018.

SOURCE: Reuters

Researchers propose new Alzheimer's definition based on biology

Apr 10, 2018

(Reuters) - Alzheimer’s researchers have proposed a radical change in the way the disease is defined, focusing on biological changes in the body rather than clinical symptoms such as memory loss and cognitive decline.

The new research framework, released on Tuesday by the Alzheimer’s Association and the National Institute on Aging, is meant to provide scientists with a common language for describing the disease in research studies based on measurable changes in the brain that set Alzheimer’s apart from other causes of dementia.

“Much of the general public views the terms dementia and Alzheimer’s disease as interchangeable, but they are not,” said Dr. Clifford Jack of the Mayo Clinic in Rochester, Minnesota, who helped craft the guidelines published in the journal Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association.

The proposed changes follow guidance announced earlier this year by the U.S. Food and Drug Administration and the European Medicines Agency to encourage the testing of new Alzheimer’s medicines based on biomarkers, rather than on clinical symptoms.

The moves would allow companies to test drugs in people before symptoms appear, offering a better chance of intervening before the disease has destroyed too many brain cells.

Under the proposed research framework, Alzheimer’s would be characterized by three factors: evidence of two abnormal proteins associated with Alzheimer’s - beta amyloid and tau - and evidence of neurodegeneration or nerve cell death, all of which can be seen through brain imaging or tests of cerebral spinal fluid. It also incorporates measures of severity using biomarkers and a grading system for cognitive impairment.

The hope is that the new definition will help researchers pick better subjects on which to test new Alzheimer’s treatments, which may help improve drug companies’ search for treatments.

So far, experimental Alzheimer’s drugs have had a dismal track record, with more than 100 failures, including most recently a treatment from Merck, while Pfizer said in January it was quitting the field.

Most of these drugs have focused on removing beta amyloid from the brain. Recent imaging studies have shown that about 30 percent of the people who have taken part in clinical trials for Alzheimer’s drugs did not have beta amyloid in their brains.

Jack said the new framework puts Alzheimer’s more in line with other diseases, such as hypertension or diabetes, and it will allow researchers to study interventions that interfere with the underlying changes that lead to Alzheimer’s dementia.

Reporting by Julie Steenhuysen in Chicago; Editing by Chris Reese

SOURCE: Reuters