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New research shows that a lack of sleep is a growing health problem around the world, and not just in developed countries.
It was found that Bangladesh, South Africa and Vietnam have extremely high levels of sleep problems. On the other hand, India and Indonesia reported relatively low levels of sleep problems.
Sleeplessness has been linked to such chronic illnesses as cardiovascular disease and diabetes. Sleep deprivation may impair physiological functions, for example, appetite or neuro-regenerative responses, and the immune system, which may actually explain the association of sleep with occurrence of many chronic diseases.
On the other hand, some people can actually sleep too much, such as the elderly, making them more prone to disease, weight gain and risk of heart problems.
Sleep is a key player in age-related health concerns, including Parkinson’s, Alzheimer’s and Sleep Apnea. Helping your loved one find a healthy rest balance can help.
The findings underline the importance of addressing sleep disorders in the care of patients with Parkinson’s, and indicate that working memory capacity in patients with Parkinson’s potentially can be improved with training.
Alzheimer’s may reverse a person’s sleep-wake cycle, causing daytime drowsiness and nighttime restlessness. These sleep disturbances often increase as Alzheimer’s progresses. Eventually, round-the-clock naps might replace deep, restorative nighttime sleep. The Mayo Clinic recommends how to a promote good night’s sleep.
Sleep apnea, the disruption of sleep caused by obstruction of the airway, interferes with sleep’s effects on memory. As many as one in three elderly men have at least a mild case of sleep apnea. 300 elderly women who were mentally and physically fit, with an average age of 82, led Kristine Yaffe, a professor of psychiatry at the University of California-San Francisco, to find that one in three women had sleep apnea. The women with sleep apnea were 85% more likely to show the first signs of memory loss.
Dr. Cheryl Phillips, geriatrician and senior VP or LeadingAge, blogged about the very serious dangers of over-medicating dementia patients. This issue is seen as critical around the world and sends a global message for change. Rather than paraphrase, here is Dr. Phillips’ blog in her own words:
Federal officials are working to place compassion at the center of how our nation aims to treat elderly patients suffering from dementia.
The Centers for Medicare & Medicaid Services (CMS) has announced that they’ll coordinate an effort to dramatically reduce the use of antipsychotic drugs among dementia patients in nursing homes. The agency’s plan acknowledges that these powerful pharmaceuticals are often overused — and represents a valuable first step toward improving the way we treat people with this condition.
But government alone shouldn’t dictate how we deal with dementia. Families and caregivers must also recognize when medication is appropriate — and when it’s not.
More than five million Americans are afflicted with Alzheimer’s and related dementias. Coping with a loved one suffering from the disease is an immensely trying experience — one that can leave even the most stoic among us desperate to try anything to alleviate a family member’s suffering.
It’s no surprise, then, that nearly 40 percent of dementia patients living in nursing homes receive antipsychotic drugs. Overall, some 14 percent of nursing home patients are on antipsychotics. These are alarmingly high numbers, given how ineffective — or even dangerous — the drugs can be.
For starters, antipsychotics have not been approved by the federal Food and Drug Administration to treat dementia. No drugs have. Only about 20 to 30 percent of elderly dementia patients who take an antipsychotic drug show even marginal improvement.
For such unimpressive results, the potential harms are significant. For every 53 patients treated with such a pharmaceutical, one will die. And for every nine to 25 patients that benefit from an antipsychotic, one will die.
As a result, the FDA has issued a rare “Black Box Warning” stating that patients administered the drugs face a risk of death 1.6 to 1.7 times greater than those who take a placebo.
And yet, a blind faith in the effectiveness of antipsychotics that’s not borne out by the science remains. Abandoning this belief is a necessary first step toward improving the way we treat dementia — and saving lives.
To do so, we must first change the way we think about the illness. Many view dementia as the cause of a number of behaviors that need to be corrected or controlled. This misconception fits our cultural penchant for pills quite nicely. For instance, Grandpa George’s loud incoherence or Aunt Esther’s refusal to calm down are symptoms that need to be alleviated through medicine — or so the thinking goes.
But folks displaying the disruptive behaviors associated with dementia are more often trying to communicate with those around them. Their “acting out” signifies their frustration at their inability to do so.
Consequently, people interacting with them — whether family members or professional caretakers — ought to try first to understand what the patient is trying to convey. Then, they can take appropriate action.
For instance, yelling, wandering, or resisting care are not symptoms of psychosis and will not be resolved through the use of antipsychotics or other medications.
But if a drug is judged necessary, keeping close tabs on it is imperative. A checklist can be helpful. Is the person showing signs of improvement? Are they better able to engage with others and with their surrounding? Can that individual get by on a lower dose? Is the medication even working at all?
All too often, families and caregivers fail to ask these questions. That’s a mistake. Given the risks associated with antipsychotics, determining how to address dementia-fueled behaviors without drugs is vital.
Fortunately, there’s a growing body of evidence that supports the effectiveness of behavioral modifications and non-pharmacological interventions to treat dementia. This new approach isn’t just something for nursing home staffers or professional caregivers to consider — it’s important for us all. Odds are that we all know someone who suffers from the condition — or someday will. Decisions about their potential paths of treatment may fall to us.
CMS is right to try to reduce the use of dangerous antipsychotics in dementia patients. But it will not succeed without a shift in the way we all think about this debilitating condition.
[Photo Credit: dvortygirl, Flickr]
The Woodstock care home in the Hague has recently made headlines for housing residents that are chemically dependent and have been termed “long term addicted with untreatable addiction”. One of the goals of the facility is to alleviate homelessness in the elderly, as well as to promote social order and safety. The facility is managed under the direction of the municipal government as well as local health care manager Parnassia. The facility uses multiple parameters as admission criteria, and provides treatment for multiple co-morbidities. While residents must enter a behavioral agreement to ensure safety, they are permitted to continue to consume chemical substances in the program. “Our criteria state you can only get into Woodstock if you’re over 45 and after a medical examination declares you are beyond rehabilitation,” said psychiatrist Nils Hollenborg. (For beautifully haunting photos of residents, see these photos from Peter Van Beek). Municipal authorities argue that providing stability for this population helps reduce petty theft.
While “hard” drugs may not be on the menu, chemical dependency may be an emerging issue in elder care. The U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) released a report in 2009 that documented an increase in drug use among persons ages 50 – 64. As the “baby boomers” age, it is probable that elderly service providers will have to confront the issue of substance abuse among elders, as people who have consumed cannabis across their lifespan need services and supports. Complicating the issue from a provider policy standpoint, some states in the U.S. now allow for medical use of cannabis. Therefore, homes and care providers in California or Colorado might legally allow residents to consume cannabis while in their care. Such a home would be in compliance with state law but in violation of federal law. Residents of an advanced age may feel that rehabilitation in no longer a viable option and may prefer to continue their consumption. What do you think? Will “baby boomers” demand acceptance of chemical dependence as they age? What impact do you see this having on the aged care industry?
Would routine testing for dementia identify potential sufferers before they or their families realise they are affected?
In findings published last year, a US team assessed the impact of screening – coupled with further evaluation – on diagnoses in veterans aged 70 and older who had no indication of memory loss. Participants were given a brief test, in which they had to perform tasks such as drawing a clock and recalling certain words. Of the 8,063 people who accepted screening, 2,081 failed and 580 agreed to further evaluation. In total, 902 – or 11% – of people were diagnosed with cognitive impairment, compared with 4% in clinics without the program, the researchers said. Among those who failed the screening and accepted further evaluation, 432 were diagnosed with dementia. Of 118 patients who passed the initial screen but still requested further evaluation, 82 were diagnosed with dementia.
While this study illustrated that persons who self-described as non-symptomatic could in fact be suffering from cognitive impairment, it raises important questions about the value and risks of screening. Evidence is emerging that early diagnosis and intervention could have some positive effect on outcomes. Still, the question exists on whether the cost of additional screening of false positives is offset by savings from early intervention. The researchers, led by Dr. JRiley McCarten, suggest that further investigation is needed to draw conclusions.
The findings were published in the Journal of the American Geriatrics Society.
A new study from the Arts Health Institute in New South Wales, Australia, found that weekly clowning sessions were as effective as standard antipsychotic medication in reducing agitation among people with Alzheimer’s disease. For the study, a specially trained “Elder Clown” conducted weekly humor sessions using a host of laughter-inducing tools that ranged from music and mime to visual sight-gags, irreverent jokes and funny props. Between these sessions, trained staff members continued to conduct humor therapy with residents. By the end of the study there was a reduction in both physically and verbally aggressive behavior. In addition, residents showed signs of reduced agitation at least 26 weeks after therapy began.
IAHSA and Alzheimer’s Disease International are sponsoring a study tour in California October 2012 that will explore research and treatment protocols for early stage dementia as well as provide a shared learning experience through site visits to communities providing care for individuals with Alzheimer’s and related dementias. Please join us on this important tour.
Alzheimer’s Disease International [ADI] recently published the 2011 World Alzheimer’s Report entitled The benefits of early diagnosis and intervention.
This is the third such report issued by ADI, with the first two aimed at helping to reset health and social care policy worldwide while increasing awareness of the burden of Alzheimer’s disease and dementia to society. For the 2011 report ADI commissioned an independent research group to collate and review, for the first time, all of the available evidence relating to early diagnosis and early intervention, including recommendations to be considered by policy makers, care givers and family members.
In October 2012, IAHSA and ADI will be cosponsoring a study tour in California with a theme Alzheimer’s Disease: Research Meets Care. The tour will explore research and early treatment protocols for early stage dementia as well as provide a shared learning experience through site visits with communities providing care for individuals with Alzheimer’s and related dementias.
Final details are being worked out but if you would like more information please contact IAHSA at firstname.lastname@example.org.
Two recently published studies reveal interesting links between music and memory and could be promising news for the millions affected by dementia around the world.
The first of these studies was carried out by researchers from Boston University School of Medicine (BUSM) and published in the journal Neuropsychologia. For this study, researchers had “a group of healthy elderly people and a group with Alzheimer’s view a series of simple song lyrics on a computer screen, first with the words being sung by a young woman, then with the words being spoken by the same woman, and finally with no accompanying sound at all.” They then compared how well these groups remembered the songs. The researchers found that “[a]fter seeing and hearing four-line selections from the 80 test lyrics … those [subjects] with Alzheimer’s, significantly improved their recall [after hearing the songs sung].” In contrast, for subjects in the control group, “the effect of hearing lyrics spoken or sung or merely appearing as text yielded the same result.” To make sure subjects would have no knowledge of the songs beforehand, the researchers used “only children’s songs written in the last few years.”
The second of these studies was released today in the journal Neuropsychology. For this study, researchers at the University of Kansas Medical Center assessed the verbal functioning, memory and attention skills of a group of 70 participants. The participants were then divided in three groups: “One group had no musical training, one had one to nine years of musical study, and the third group had 10 or more years. None of the participants had Alzheimer’s disease, and all had similar levels of education and fitness.” In this case, the researchers found that: “[t]hose who had studied music the longest performed best” in their assessments tests. This group was “followed by the next group of musicians” and “the non-musicians scored lowest on all tests.” They add that “[t]he score differences between higher- and lower-level musicians weren’t statistically significant, but there were significant differences between high-level musicians and non-musicians.” The study thus concluded that there is “a strong predictive effect of high musical activity throughout the life span on preserved cognitive functioning in advanced age.”
Share your thoughts on these findings with IAHSA!
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According to a recent report from the Alzheimer’s Association, nearly 15 million unpaid caregivers help someone with Alzheimer’s and other forms of dementia in the USA, a 37% increase form last year. Collectively, these workers provide 17 billion hours of unpaid care, which the reports values at US$ 202.6 billion. If Alzheimer’s and dementia caregivers were the only residents of a single state, it would be the fifth-largest in the USA. These staggering numbers help illustrate the impact that Alzheimer’s disease and other forms of dementia can have on both the American and global economy.
While the number are certainly concerning, an article about the report published on USA Today helps better understand the disease’s impact on caregivers. It highlights the story of 22 year old Keri Roaten, who cared for her grandmother Eavie for five years at home. In the article, Keri mentions how she “did everything from bathing her to keeping her from roaming around, to feeding her. I took care of the bills, grocery shopping — everything she had been doing.” During this time Keri “was still in high school.” Later on, Keri “gave up cheerleading and a college opportunity” and oversaw “all of her grandmother’s medical needs.” Despite the sacrifice, Keri mentions that “she does not regret” her efforts. She finished her interview by stating that she never received “caregiving support resources or help for her” from physicians. “Knowing there were resources would have helped me a lot,” she said.
As shown on the video below, Alzheimer’s is the sixth-leading cause of death in the United States, and the only one among the top 10 that has no prevention or cure. Worldwide, the total estimated costs of dementia were US$604 billion in 2010.
Share your thoughts on this report with IAHSA. How has Alzheimer’s and other forms of dementia affected your community? Your country? Do you know an unpaid caregiver? What steps can be taken to give them more support?
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We have previously written about South Korea’s Alzheimer’s challenge. However, a new report by researchers at Hallym University highlights a new challenge: a growing rate of elderly suicides. According to the report’s findings “the suicide ratio for those aged over 65 jumped to 77 per 100,000 population in 2009, an over five-fold surge from 14 recorded in 1990. The surge is much higher than the suicide rate for the 15-34 age group that recorded about nine people per 100,000 in 2009, down from 23 in 1990.”
Kim Dong-hyun, the study’s main author, believes the reason for the increase in suicides in the growing economic hardship for Korean seniors. He says: “[a]s our society has polarized since 2000, seniors who have lost their economic power have found it hard to stand on their own feet … I think sick and isolated elderly who have no regular income are making extreme decisions so as not to add burden on their children in this nuclear, aging society.”
According to the Yonhap News Agency, South Korea currently “ranks first in the suicide rate among the member countries of the Organization for Economic Cooperation and Development (OECD), with 24.3 people out of every 100,000 having taken their own lives in 2008.” Taken together with a report by Statistics Korea which estimates that “the ratio of those aged 65 or older to the nation’s total population will likely grow to 38.2 percent in 2050,” these rates could translate into a great increase of elderly suicides over the next few daces. Kim says: “[a]s a considerable number of seniors faces aging without much preparation, senior suicides can become a social disaster in the future.”
Share your thoughts on this report with IAHSA. What steps can be taken to decrease elderly suicides in South Korea? Have you observed a similar phenomenon in your community?
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In 2008, Spanish cartoonist Paco Roca released his comic “Arrugas” (Spanish for wrinkles), a graphic novel about effects of ageing and Alzheimer’s. His work earned him Spain’s “Graphic Novel of the Year Award” in 2008 and sparked debates about how to best care for the elderly.
Arrugas intoduces us to Emilio, a former bank director, as he enters a retirement home where, “life barely happens with objective or illusions, where a bunch of seniors simply spend their last days away from their loved ones.” Through him and through the other residents in Emilio’s community, the reader learns about the realities of adjusting to life in a nursing home. According to Metrópolis Libros, the story tells us the resident’s “miseries, cheats, attempts to fool their doctors and nurses” as well as “the way they interact with one another … their humour, revelry, nonconformity and idealism,” all of which “transports the reader to the soul of each of the seniors.” In the nursing home, Emilio eventually discovers that he has been diagnosed with Alzheimer’s disease. His diagnosis then allows reader to follow him through his treatment and his efforts to avoid being moved to the community’s second floor, where the residents believe that life simply comes to an end.
Arrugas will be released as a full motion picture this fall, under the title Wrinkles. Take a few seconds to view the trailer, which was released last week, and share your thoughts with IAHSA.
For more Information: (In Spanish Only)