How often do we see our residents acting out? A lot. Do we ever wonder if it’s the drugs they are taking? Perhaps we should.

Ramona Lamascola thought she was losing her 88-year-old mother to dementia. Instead, she was losing her to overmedication.

Last fall her mother, Theresa Lamascola, of the Bronx, suffering from anxiety and confusion, was put on the antipsychotic drug Risperdal. When she had trouble walking, her daughter took her to another doctor — the younger Ms. Lamascola’s own physician — who found that she had unrecognized hypothyroidism, a disorder that can contribute to dementia.

Theresa Lamascola was moved to a nursing home to get these problems under control. But things only got worse. “My mother was screaming and out of it, drooling on herself and twitching,” said Ms. Lamascola, a pediatric nurse. The psychiatrist in the nursing home stopped the Risperdal, which can cause twitching and vocal tics, and prescribed a sedative and two other antipsychotics.

“I knew the drugs were doing this to her,” her daughter said. “I told him to stop the medications and stay away from Mom.”

Not until yet another doctor took Mrs. Lamascola off the drugs did she begin to improve.

At work, we should ask the nurses if our residents are taking any new meds; if they are, we should ask if there are specific or not-so-specific side effects WE should know of, and report. So many times older people are drugged up and we think this is WHO the person is…I once worked with a woman who was DX with dementia- but she wasn’t demented. It was her meds. It took months to figure things out, but she ended up being discharged from the nursing home. If it weren’t for the excellent nurses who were very aware of drug interactions and side effects, the poor lady most surely would have died in the facility.

Residents with dementia: Who are WE to decide who they have relationships with? This is a thought provoking article.

Bob’s family was horrified at the idea that his relationship with Dorothy might have become sexual. At his age, they wouldn’t have thought it possible. But when Bob’s son walked in and saw his dad’s 82-year-old girlfriend performing oral sex on his 95-year-old father last December, incredulity turned into full-blown panic. “I didn’t know where this was going to end,” said the manager of the assisted-living facility where Bob and Dorothy lived. “It was pretty volatile.”

Because both Bob and Dorothy suffer from dementia, the son assumed that his father didn’t fully understand what was going on. And his sputtering cell phone call reporting the scene he’d happened upon would have been funny, the manager said, if the consequences hadn’t been so serious. “He was going, ‘She had her mouth on my dad’s penis! And it’s not even clean!’ ” Bob’s son became determined to keep the two apart and asked the facility’s staff to ensure that they were never left alone together.

After that, Dorothy stopped eating. She lost 21 pounds, was treated for depression, and was hospitalized for dehydration. When Bob was finally moved out of the facility in January, she sat in the window for weeks waiting for him.

People with dementia should have rights too. But until we loosen up a little, they won’t.

An article about the difficulties many have with finding placement for their loved ones who have dementia. And behaviors.

“After going from crisis to crisis, Joan is finally in a place where they have the time and training to really help,” said her husband, Terry, 76, a retired math teacher and businessman from Shoreview. “How many places can you get kicked out of? Let’s see, for us it was four in one year.”

The combination of dementia and behavioral problems can overwhelm families.

The combination can even overwhelm care facilities, said Annette Peterson, an Alzheimer’s Association counselor in Bloomington who talks every day with weary and sometimes frantic family caregivers.

To meet the needs of people with dementia, and who tend to be “violent”- facilities must have enhanced staffing ratios and dementia-specific activity based programming/care. The facility needs to be designed to allow for freedom of movement while ensuring the safety of wandering residents. Meals should be served buffet style and not at specific times. Routine is good for some with dementia but not all. Ware-housing these people with the non-memory impaired will not result in good outcomes. In the future, facilities will need to copy the model written about in this article.

You should read this. And be thankful for how some people handle such things with grace and composure.

Former Justice Sandra Day O’Connor’s husband, suffering from Alzheimer’s disease, has a romance with another woman, and the former justice is thrilled — even visits with the new couple while they hold hands on the porch swing — because it is a relief to see her husband of 55 years so content.

The article is much longer and goes into depth about how older people value love and relationships. This is a very positive story.

A new book written by a woman who worked as an aide. Celia Berdes, of The Direct Care Clearinghouse writes an excellent review, which I am quoting some portions from here- as readers hopefully know, the red text is a link to the DCCH site:

Dancing with Rose: Finding Life in the Land of Alzheimer’s (York: Viking, 2007), a new book by Lauren Kessler, is the best book yet written on the lives of old people in residential care and the people who care for them. It is not the first book about working as a nurse’s aide: Sallie Tisdale’s 1987 classic, Harvest Moon: Portrait of a Nursing Home, was based on the author’s work as an aide, and more recently, Thomas Edward Gass’ Nobody’s Home: Candid Reflections of a Nursing Home Aide (2004) gave a highly personalized and excessively candid report. Dancing with Rose, by contrast, balances the personal with the public, and Kessler tells her story with such skill and sensitivity that the reader will find it hard to put the book down.

More:

The leading players are nurse’s aides, and Kessler does an excellent job of capturing them and their work experiences. She tells how some seem to have an aptitude for caring, often relying on their experiences of mothering or other kinds of nurturing. She pinpoints the role of attitude, how for some each new task is taken up with a sense of mission, while for others it is just another chore. She describes the special skills that they use in giving Alzheimer’s care, how they must intuit needs that cannot be expressed and witness residents’ decline without looking away. She describes in fine detail the effect of doing everything–cleaning, feeding, laundry, toileting–for more than ten residents per shift. Without flinching, she describes the challenges of low-wage work, the incessant search for a little step up, the hanging-by-a-thread arrangements for childcare and transportation that enable women to do this sort of work. And she describes what it means for workers to care for residents who always, ultimately, die.

Dancing with Rose leads us to this inescapable conclusion: that caring aptitudes and attitudes of skilled direct care workers are the most important components of high quality care. In a call for systemic reform, Kessler asks us to think about our own aging: ”If I do need help when I get older, if it becomes impossible for me to live independently, how do I want to live? Do I want to be cared for by an overworked, underpaid woman with so many chores to accomplish on her shift that she can barely spare a minute to talk to me?

To read the entire review go here- the Direct Care Clearinghouse.

Sounds like an excellent read, and it’s pretty inexpensive too!

I think this is a good idea but not everyone else does.

One of the greatest fears for families of Alzheimer’s patients is that an older relative might wander off, and then forgets how to get home again. Could a microchip implanted under the skin of an Alzheimer’s patient be the answer to relocating that loved one? Planting a tiny computer device in a human being is an idea that has aroused a lot of strong feelings. VOA’s Melinda Smith explains.

Ida Frankel is one of millions of Americans living with Alzheimer’s disease. Her husband David describes one of her symptoms. “She was being very forgetful. She would, half the time, repeat the questions over and over again.”

A microchip inserted in Ida Frankel’s arm will not help her memory. But its manufacturer, Verichip Corporation, hopes it might help provide important medical information if she is lost or winds up in a hospital emergency room.

Scott Silverman is the company president. “When an Alzheimer’s patient presents [is taken to] in an emergency room, or is found wandering in a certain location, once their arm is scanned it would immediately designate who they are, their identity, and the fact that they are an Alzheimer’s patient.”

The Verichip is a tiny device that contains an identification code. By scanning the microchip, the company says emergency personnel could then tap into the patient’s medical information.

For many years microchips have been used to keep track of livestock and find lost pets. But opponents, like Katherine Albrecht, say keeping track of a human being violates the notion of civil liberty. “I don’t think that because it is useful in animals is a reason why we should do it to human beings. There is a distinction between an animal and a human being.”

Why is this not useful in humans?

I don’t understand the problem.

Special Dementia Programs and building design make for a more meaningful admission to a nursing home- if there is such a thing.

After Gail Aylward was diagnosed with Alzheimer’s disease, she moved into a condo with her brother and daughter. A few years later, she started to wander.
[…]
Once thought of as cold, sterile environments, many nursing homes are trying to feel more like home. And, within the cozier settings are features to make life easier for patients.
At Dillworth, brightly painted doorways point out where walls end and patient rooms begin.

Parc Provence in Creve Coeur, the area’s only nursing home exclusively for people with Alzheimer’s and other forms of dementia, arranges patient areas in a circular pattern. The formations eliminate blind corners that can be unsettling to these patients, said Dr. David Carr, medical director at Parc Provence.

Many Alzheimer’s patients lose weight or become dehydrated because they struggle to eat independently. At Dillworth, fire-engine red plates help patients distinguish mashed potatoes and chicken from the plate itself. Parc Provence prepares food on each floor so the aromas will stimulate patients’ appetites.

To keep patients from leaving the unit, Dillworth has carpet squares near the door that are arranged like a checkerboard. To an Alzheimer’s patient, the different colors make the floor appear uneven, so patients steer clear.

There’s also an effort to recreate family life. Patients can bake cookies, do laundry, set the table or exercise. While folding towels, the ladies will often reminisce about their lives before Alzheimer’s.

One thing not mentioned too often in these articles is the activity programs. They must be altered to work with this special population. The everyday average activity program doesn’t serve our Dementia residents well; I have been very impressed with the programming offered at most special care units like this.

The Alzheimer’s Association has recommendations for End of Life Care for People With Dementia. This is the 3rd part of a series.
I read through this, and although long, it is well worth the time. In PDF form, I recommend printing it before reading.

Dementia Care Practice Recommendations for Assisted Living Residences and Nursing Homes

Some Highlights of interest:

• It is important that residents and families consider the following care decisions and the relationship of each of them to the resident’s care goals during planning for the end of life:

Cardiopulmonary resuscitation
Invasive medical procedures and tests (e.g.,surgery, blood tests, dialysis)
Hospitalization
Use of intensive care units and ventilators
Artificial nutrition/hydration
Use of antibiotics
Use of preventive health screenings, medications and dietary restrictions

EXAMPLE: Colonoscopies and mammograms may not be advisable for residents who are at the end of life and cannot benefit from or understand these sometimes uncomfortable procedures.

EXAMPLE: Risks and benefits of medications may change when a resident has a limited amount of time to benefit from the positive effects.

EXAMPLE: Dietary restrictions may be modified when residents have difficulty swallowing or are not eating
enough to maintain their weight.

EXAMPLE: Forgoing weighing the resident when he or she is actively dying.

About Staff Training:

• Staff education and training is an essential part of the delivery of quality end-of-life care for individuals with dementia. It is important for staff members to adopt an attentive, anticipatory and investigative approach to caring for very vulnerable individuals who can no longer manage their own care.

NOTE: Residences that have contracts with hospices or palliative care services may request the hospice to provide palliative care training to staff.

• Good preparation for the unique challenges of providing quality end-of-life care requires that staff have training in caring for people with dementia, which covers:
Dementia as a terminal illness
Effective communication with residents who have dementia

Communication with the resident, proxy decision maker and family regarding advance care planning,end-of-life decisions and when the resident has begun the dying process or has a prognosis of death

Culturally appropriate communication and care for residents and families

Need to honor advance directives and the treatment choices of proxy decision makers for legal and ethical reasons, despite one’s personal beliefs about the appropriateness of care decisions

Physical and behavioral symptom assessment as well as pharmacological and nonpharmacological approaches to care at the end of life.

Wander Guard type devices have been in nursing homes for years now. The tech is just catching on for the other markets- esp. family caregivers. This might be a good thing since wandering is one of the top reasons people with Alzheimer’s are placed into nursing homes.

HAINESPORT, N.J. (AP) - It looks like a toy, but the bracelet locked around Bob Melnick’s wrist gives his wife some peace of mind: If this Alzheimer’s patient wanders off and gets lost, he’s wearing a tracking beacon to help bring him home.

“I’m a marked man,” joked Melnick, of Hainesport, N.J. “The police can pick me up anywhere.”

Wandering is one of the most frightening symptoms of advancing dementia, and the Alzheimer’s Association estimates it will happen to nearly 60 percent of patients.

A mini-industry of technologies promises to find lost Alzheimer’s patients - from simple radio-wave beacons that cost $10 a month for batteries, to more-sophisticated GPS devices that can cost hundreds of dollars.
[…]
Radiofrequency “tags” are a hot topic for assisted-living facilities. Patients wear a sensor read by receivers on doors that sound an alarm when someone strolls too far.

Then there’s the more traditional beacon like Melnick’s, which emits a radiofrequency signal for rescue workers to hunt.

“That kind of technology is the most flexible, because it doesn’t require GPS or infrastructure. But it doesn’t work if you don’t notice the person is gone,” Kautz said.

Whatever the transmitter, there’s the question of how to ensure the patient doesn’t wander off without it. Some systems require carrying cell phones; others come in hard-to-remove jewelry; one company sells sneakers implanted with a GPS chip.

The best technology will alert caregivers as to when they’re loved ones/patients exit, and then send signals as to where they are.
And the devices must be subtle and barely noticeable to the person since they will try to remove them.

A word of caution, from those of us who work or have worked with these devices: Don’t become too reliant upon them. Don’t have too much peace of mind…one breakdown in the system is all it takes for an elopement to occur. And they occur often.

A study is being done on the effects of certain dietary supplements on Alzheimer’s Disease.

The University of Michigan is seeking volunteers to participate in a national study to determine whether taking supplements like fish oil or omega-3 capsules slows the onset of Alzheimer’s disease.

Millions of Americans spend money on the daily supplements. While there’s some evidence that they work, they’ve never been evaluated in such a rigorous, scientifically controlled study.

A total of 51 health centers across the country are part of the study, funded by the National Institute on Aging, which is part of the National Institutes of Health. U-M is the only health center participating in eastern Michigan.

Men and women who are at least 50 years old and have been diagnosed with mild to moderate stages of Alzheimer’s disease are being recruited for the study. Sixty percent of study participants will be randomly assigned to take capsules of DHA daily for 18 months, while the rest of the participants will take an inactive placebo.

DHA is a specific type of omega-3 fatty acid thought to protect cells in the brain from an amyloid protein that is a leading culprit in the progression of Alzheimer’s disease.

The participants’ health will be assessed during the study period. Neither the participants, nor the researchers, will know who gets which substance until the end of the study.

Determining whether the supplements really work is important because five million Americans have Alzheimer’s, and that number is expected to increase rapidly in the coming decades.

“It’s a devastating disease,” said Dr. R. Scott Turner, associate professor of neurology at the U-M Medical Center who is leading the study. “Millions of people are affected and our goal is to try to, first, prevent further decline in someone who has memory problems, to keep them out of nursing homes, and to determine whether all the money spent on (the supplements) is really money wasted or money well spent.”

For more information or to take part, call 734-647-7760 or follow the link to the DHA study at www.med.umich.edu/alzheimers.