Forum Focus: Medication Management

Heath Care Group COO Todd Shetter welcomes caregivers to the town hall forum.

We had an excellent turnout yesterday at the Town Hall Forum titled "Caregiver Tools for Survival," sponsored by Health Care Group and our organization, The George G. Glenner Alzheimer's Family Centers, Inc. The event also was supported by AARP and Southern Caregiver Resource Center.

Caregivers from throughout San Diego County gathered at the Ramada Inn Conference Center in Kearny Mesa to gain valuable advice from experts on Alzheimer's behavior and medication management and transititioning from home care to residential care.

Throughout the coming week we'll share some of the information in those sessions, starting today with medication management.

Dr. Ron Belville, a pharmacist who has worked in the long-term care industry for 35 years, stressed the need to make a list of every medication and over-the-counter remedy, even vitamins, that someone is taking. Note any changes in behaviors and bring that list to both the patient's medical doctor and pharmacist to validate that specific medication schedule.

Geriatric psychiatrist Dan Sewell warned that some medications used to treat one stage of dementia may not be necessary in another, advanced stage. Therefore it's important for caregivers to regularly review all medications with primary care physicians and/or pharmacists.

Dr. Belville also noted that most pharmacists will create daily medication packets upon request, and usually for a small fee. This means those who are time-pressed or concerned about getting each day's medications right can now receive some professional assistance in the form of prearranged pills in weekly or monthly segmented plastic containers.

Help Create A Grand Plan for Alzheimer's

Efforts are underway to create a California State Plan for Alzheimer’s. This collaborative project is being guided by a public-private partnership involving the Alzheimer’s Association’s California Council and the State of California Health and Human Services Agency’s Alzheimer’s Advisory Committee. The purpose is to develop a policy roadmap for the next 10 years to address the growing needs of Californians and their families living with Alzheimer’s.

As part of this process, a number of community meetings are taking place around the state, including one hosted by the San Ysidro Health Center on June 19, which will be focused on Hispanic caregivers. In addition, a statewide online survey for Alzheimer’s family caregivers (former and current) has just been launched.

We encourage everyone reading impacted by Alzheimer's to take the online survey.

For more information, you can visit the San Diego Alzheimer's Association. The deadline for completing the survey is May 31, 2010. Thank you for taking the time to help map our future.

Reading Really Is Fundamental

The New York Times Blog "The New Old Age" last week had a great post about the importance of reading by and to Alzheimer's patients.

According to the piece by Milt Freudenheim, "Researchers have found in a number of studies that reading can improve a patient’s quality of life. The meanings of written sentences can be understood by — and prompt cogent responses from — even those who have difficulty handling verbal exchanges."

For caregivers, books can provide a great outlet for some quality time with a loved one, especially those in the advanced stages of the disease. Experts say it's important to read material that is personally relevant. There also are books written expressly for caregivers to read aloud, which are mentioned in the post. There also are some great suggestions in the comments section, such as Dr. Seuss's I Had Trouble in Getting to Solla Sollew because it relates to troubles in life.

(By the way, Dr. Seuss's real-life widow, Audrey Geisel, is a major supporter of the George G. Glenner Alzheimer's Family Centers programs!)

Dementia Hits a High Note

The May issue of Living with Dementia magazine features an article about an opera that explores dementia from different points of views. "The Lion's Face" will premiere in England and Wales this spring. It's a collaboration between The Opera Group and The Institute of Psychiatry at Kings College.

The performers spent time with dementia patients and their caregivers as the show was being developed. Noted Simon Lovestone, a professor of old age psychiatry at the Institute:

"What really captured my imagination was the opportunity to work with some artists who were interested in reflecting aspects of the disease we might not have otherwise thought about, back to clinicians and scientists. I think this use of poetry and music will help us to look at Alzheimer's disease in a different way and will energise my colleagues and I in our battle with this devastating disease."

Says the project's promoters: "At the heart of the project are a series of off-stage events where scientists, artists, audiences can exchange ideas and discuss the opera and latest research into dementia."

For more on The Lion's Face: The Lion's Face Web Site

New Link Between 'Fat Gene' and AD

Major news outlets are discussing a research study showing a link between a variant of an 'obesity gene' known as FTO and Alzheimer's Disease. The variant, which apparently also can accelerate brain shrinkage, is believed to be carried by at least a third of all U.S. residents.

You can read an abstract of the study here.

In a Reuters article on the findings, researcher Paul Thompson of UCLA said the following:

"In all the maelstrom of activities you do, exercise and a low-fat diet are genuinely saving your brain from both stroke and Alzheimer's."

According to the article, Thompson's team compared MRI images taken of the brains of 206 healthy people between age 55 and 90 at 58 centers taking part in a five-year Alzheimer's Disease Neuroimaging Initiative. Their goal is to find ways for people to resist the mind-robbing disease.

A key takeaway is for all of us to maintain a healthy lifestyle that includes eating healthful meals in moderate portions and daily exercising.

Creating a 'Peaceful, Happy Place' -- on DVD

This morning's local newspaper has a business article on an Escondido entreprenuer who has created a 30-minute DVD for Alzheimer's patients. Actually, it's to benefit their caregivers by providing them a few minutes to tend to small tasks or peacefully watch alongside their loved one.

"Serenity Serenade" costs $22 and is available through online outlets listed in the article.

Read more: Company has DVD to help dementia sufferers

Mom Remembers More Than You May Think

In case you missed it, there was an item on National Public Radio's "Morning Edition" this week about the impression our visits leave on Alzheimer's patients.

NPR: Emotions Outlast the Memories

Often people are reluctant to spend time with someone suffering from serious dementia, believing the visit will not be remembered soon after it ends. But new research suggests that while the details of the stay may be quickly erased, the emotional response remains - even if the person cannot quite articulate what's behind the pleasant feeling.

Commented neuropsychology graduate Justin Feistein: "Telling them a simple joke, calling them up on the phone, giving them a visit, could actually have these enormous positive benefits."

Calling All San Diego Caregivers

Join us for a Town Hall Forum titled “Caregiver Tools for Survival” from 8:30 a.m. to 12:30 p.m. on Thursday, April 29, at the Ramada Inn & Conference Center in San Diego (5550 Kearny Mesa Road, San Diego, CA 92111). To RSVP, call Health Care Group at 858-565-4424.

Spend the morning with medical experts from the ActivCare Medical Advisory Board and the George G. Glenner Alzheimer’s Family Centers, where you'll learn how to empower and protect yourself and your loved one. A continental breakfast is included.

Topics include:

• Alzheimer’s behavior management
• Medication management
• Exploring adult day care centers
• Easing the transition from home care to residential care
• Protecting yourself and your loved ones

Our Glenner Alzheimer’s Family Centers will provide free adult day care that day for those who register at least a week in advance for this important program. Call us at our Hillcrest Center (619-543-4704) or South Bay Center (619-420-1703) to reserve a spot.

Raised Risks for People with Parkinson's

Last month a study advised people with degenerative nerve disease to undergo regular skin cancer screenings.

While it's a good idea for anyone considered at risk of skin cancers to be screened regularly for abnormalities, researchers at the University of Nebraska Medical Center in Omaha urge those with Parkinson's disease to be especially vigilant. That's based on their findings that melanoma occurs more often in patients with Parkinson's than in the general population.

The study was conducted at 31 different North American centers and included 2,106 patients with Parkinson's disease, who undersent various examinations and, when applicable, biopsies of suspicious moles or growths. Of that group, 20 had localized melanomas and another 68 had a history of melanoma, according to the Archives of Neurology (March, 2010).

Interestingly, the study noted that 85 percent of patients had taken levodopa, but researchers found no evidence this related to melanoma risks.

Preparing for a Disaster

Our Glenner Alzheimer’s Family Centers are located throughout San Diego County, which, as many of you now know, was impacted by a 7.2 magnitude earthquake emanating from nearby Mexicali on Easter Sunday.

Damage to the Southern California area was minimal, but the event served as a good reminder for caregivers to have an Emergency Preparedness Plan. Afterall, 75% of all American households are at risk for one or more natural distasters, according to The Hartford Group and the MIT AgeLab.

The following advice is from The Hartford and the MIT AgeLab’s guidebook, The Calm Before the Storm: Family Conversations about Disaster Planning, Caregiving, Alzheimer’s Disease and Dementia. It’s based on extensive interviews nationwide with caregivers.

1. Talk with Family & Friends. Establish a disaster support network with multiple lines of support in case disaster strikes them too.
2. Meet with Professional Caregivers. If your loved one attends an adult day care, resides in a skilled nursing facility or receives home health care, review the agency’s policy in the event of a disaster.
3. Research Where You Would Go. Discuss the best evacuation plan for your situation. It may be to stay with non-impacted family or friends, a hotel or an American Red Cross shelter. Know what you can bring from home in any of these settings.
4. Consider ‘Special Needs’ Shelters. Some parts of the country offer shelters specifically designated for people with health issues who cannot function in a regular emergency shelter environment. Ask your health care provider or local American Red Cross where the nearest special needs shelter is typically located in your community.
5. Plan for Pets. Find out if pets are allowed and, if they are not, find out if there’s a place that will accept animals. Separating from a pet during a crisis is difficult; for people with Alzheimer’s it can be quite traumatic because pets provide reassurance and have a calming effect.
6. Develop a Disaster Kit. Along with the typical emergency items like flashlights, portable radio, batteries, bottled water and canned goods, kit contents should include: current photo of your loved one and some identification; ID bracelet for them to wear; insurance cards; a list of all medications, allergies and special needs and enough medication to last 7 to 10 days; eyeglasses and hearing aids and batteries; names and phone numbers for all doctors and pharmacies; financial information to access bank accounts and checks, along with a copy of a power of attorney and medical directives. Finally, make sure you, as a caregiver, include your own ID, insurance cards, prescriptions, etc.

California ADHCs In Jeapordy

As advocates for quality adult day health care, we wanted to draw some attention to Budget Item 4260 currently before California legislators, who are seeking ways to close a huge budget gap. The Governor is proposing to eliminate ADHC facilities statewide to save money. But, in the long run it will cost the state far, far more.

Here’s why:

The loss of more than 7,600 jobs from center personnel layoffs will add $94 million to the state’s Unemployment Insurance Fund. In addition, almost 14,000 working Californians will be forced to quit to care for their loved one, further adding to the loss of income tax revenue.

Thousands more elderly, mentally ill and Alzheimer’s patients will be forced to use already overwhelmed Emergency Rooms and nursing homes for medical crises. This shift to hospitals and nursing homes is conservatively estimated to cost the state $221,400,000 in Medi-Cal State General Fund costs. That almost $89 million more than the Governor’s proposed $134,700,000 General Fund savings from ADHC closures.

California also will lose $216 million in federal matching funds – free money the state an ill afford to turn down.

As the California Association for Adult Day Services notes: “The ‘paper savings’ generated by eliminating all of the state’s 327 Adult Day Health Care facilities will cost more in dollars and lives than it saves.”

CAADS is instead supporting an alternative bill (AB 2073) which would amend eligibility criteria to conform with federal laws and to clarify definitions. This makes criteria legally compliant with federal laws while continuing the state Legislature’s policy of targeting ADHC to the most needy beneficiaries.

You can read a brief history of Adult Day Health Care in California here.

And this editorial on why closing Adult Day Care Health Centers is a bad idea.