Glenner CEO Talks About Dementia Experience on U-T TV

Glenner Memory Care Centers CEO Anette Asher discussed what life is like for people with dementia today during a segment on the U-T TV program “Spotlight San Diego.”

Anette Asher spoke at length with show host Scott Kaplan about the organization and the importance of understanding what life is like for someone with memory loss as we are struck by the first wave of a “silver tsunami” due to an aging society.

“Thirty years ago people didn’t really understand what Alzheimer’s is,” Asher said. She then compared the stigma of dementia to alcoholism in the 1970s before Alcoholics Anonymous educated the public on alcoholism as a disease. “Millions are turning 65 each year … and if a heart attack or cancer or another illness doesn’t get them, they are likely to develop dementia as they age,” she said.

During the segment Kaplan was put through a brief version of the Virtual Dementia Tour conducted by staff at Silverado Senior Living in Escondido. He wore goggles to impair his vision, special gloves that limit dexterity and a device to impede his hearing. “I think if people had more sensitivity to what these folks were feeling and experiencing . . . I had no idea,” he said at the end of the segment.

You can view the archived video here.

1 in 3 U.S. Seniors Die with Dementia

An alarming statistic has everyone talking: A third of U.S. seniors now die with dementia.

Note they don't necessarily die of dementia, such as Alzheimer's. Instead there may be other contributing factors, but it certainly doesn't help with self-care if you suffer from a memory impairment. You may not remember medications for other life-threatening illnesses or you may no longer eat properly or exercise regularly, which both contribute to a host of illnesses.

The rate of deaths related to Alzheimer's disease rose 68 percent from 2000 to 2010, according to the report. At the same time, deaths from other major diseases, such as heart disease and HIV/AIDS, have declined.

"Alzheimer's disease is a public health crisis that is here," said Beth Kallmyer, vice president of constituent services for the Alzheimer's Association, said in a U.S. News & World Report article. "One in three seniors is dying with Alzheimer's or another dementia. For other major diseases, the death rate is going down because the federal government funds and invests in research. We have not seen that same commitment for Alzheimer's disease."

The report also notes the price caregivers "pay" for loved ones with Alzheimer's. Last year more than 15 million people were Alzheimer's caregivers -- and that's just one form of dementia. If they were paid for the 17 billion hours of care they collectively provided, it would amount to $216 billion. Kallmyer said direct, out-of-pocket costs come to $34 billion.

"The cost of care is a challenge, and not everyone has access to the services they need," she said.

In the same article, a physician with the Center for Brain Health at the Cleveland Clinic said, "Alzheimer's is going to affect all of us individually. Soon, we'll all have someone we know or someone in the family or even ourselves with Alzheimer's disease. It's something we all need to be prepared for."

Are we as a nation and society ready for the 14 million Americans who will develop Alzheimer's by 2040?

The cost on our healthcare system will be enormous, and the emotional and financial toll of families will be equally devastating. Reports like this draw much-needed attention to the public health crisis afoot. It's critical families plan ahead and understand the great demands that will be placed upon them, and how services like our adult day programs can help.

'Can You Hear Me Now?'

A study published yesterday in a popular medical journal showed people with hearing loss are more likely to develop dementia.

Almost everyone experiences some type of hearing loss during the aging process (a recent hearing aid specialist told me recently he now has more customers under 50 than over 50 thanks to earbuds!). But in this study published online in the JAMA Internal Medicine, researchers found the connection between hearing loss and mental decline more pronounced.

Johns Hopkins University researchers looked at 1,984 adults in their 70s and 80s who had no impaired memory at the onset of the study. Most, though, had some hearing loss. Six years later, 609 men and women eventually showed signs of mental impairment based on standard tests. Those who had hearing problems earlier in the study were 24 percent more likely to show a mental decline than those who did not.

"On average, researchers believed that people with hearing impairment would take 7.7 years to develop mental impairment, whereas people with normal hearing would take 10.9 years," according to a CBS News report.

"It could also be that if you're constantly having to expend more (mental) energy decoding what you hear, then it comes at a cost,'' said the study's author, Dr. Frank Lin. "Hearing loss doesn't directly contribute to dementia, but leads to cognitive load on the brain."

Dear Abby

Dear Abby,

I hope you know how much you meant to people, especially those who held on to your words, whether in their heart to comfort them in hard times or in a clutched clipping during confrontations. I personally once left the newspaper opened to your column on someone's desk at work in the hopes he would take the hint about dealing with an office boor. It was anonymously signed, and I never let on that it wasn't me who wrote it.

Your advice column saved many a relationship from ruin and forced others to end before people were ruined. And your wit often made us laugh. You made those of us who felt isolated, ridiculed, hurt and angry know we were not alone. That there was at least one other soul out there willing to publicly come clean and seek your counsel. We all realized your advice was but the first step in a long process, but it was an important one. And having your backing and blessing gave people the courage to make the often painful and scary changes in our jobs, our homes and our families to become better people and therefore a better society.

We are also grateful to you and to your daughter, who took over your column as your Alzheimer's Disease advanced, for keeping attention on the need to better understand and to better assist those with dementia. Those of us who you helped were sad to hear about your passing yesterday, at age 94, even if it was expected. You did a lot of good while you were here with all of us, and we hope you remain in good spirits where your soul is now and that you know how much we will miss you.

Signed,

Anne in San Diego

Aerobic Exercise Better Than Alzheimer's Medications

There's an excellent article and video on the New England Cable News Web site about one woman's journey through early-onset Alzheimer's Disease. For those unfamiliar with the term, it's an Alzheimer's diagnosis in someone younger than 65.

Early-onset can be especially difficult for families because the afflicted often are still working and may have children in the home. Our last blog post discussed the impact that has on adolescent and teenaged children.

It's difficult to say if early-onset Alzheimer's is actually on the rise or growing because of more awareness of the disease. Currently, of the 5.4 million people with Alzheimer's, 4 percent are early-onset. That seems a small number, but it still represents hundreds of thousands of people.

We wanted to highlight one section of the NECN report, because it underscores something we've been saying about how to help yourself reduce the risks and symptom of dementia: exercise regularly.

According to Dr. Geoffrey Kerchner: "The one thing we've identified so far that does seem to slow down the disease process is aerobic exercise. As old fashioned as it sounds, it is more effective than any medication that's been invented."

The piece then quotes Kerchner as saying exercise may also be able to help delay the age the disease develops if you're at risk.

NECN: Early Onset Alzheimer's: One Woman's Story

How We Make Memories

So often we at The Glenner Memory Care Centers blog focus on how memories are impaired through disease and disorders. So today we thought we'd feature a piece in the Johns Hopkins Health Alerts e-newsletter on how we normally create memories. The following is from that article on memory and emphasizes three stages in a complex process.

Memory Acquisition: Learning new information activates neurons (nerve cells) in the brain. Communication among these nerve cells encodes the information, creating a temporary neuronal pathway that holds the information as a short-term memory. If you perceive something visual or spatial, such as a picture, the pathway is created in the right parietal lobe; if you're reading, the pathway forms in the area of the brain that processes language, the left temporal lobe. Focusing attention on new information promotes the encoding process, which then helps it solidify from short- to long-term memory during consolidation. That means that if you have a problem remembering something, maybe you weren't concentrating on it too hard in the first place.

Memory Consolidation: For information to be retained long term, the neural pathway formed during memory acquisition must be strengthened. The replaying of events in the brain strengthens the pattern of neuronal activity, as more elaborate connections (or synapses) are formed among the neurons.

Memory Retrieval: In order to recall something, the brain must reactivate the nerve pathways where the specific memory is stored. Frequently retrieved memories are usually easier to recall, whereas infrequently retrieved information often takes longer to emerge and may require a prompt of some kind, such as a related piece of information.

What happens as we age. With the onset of middle age, many people become more distractible and less able to fully concentrate on new information. This deficit weakens the memory acquisition process. The brain also becomes less efficient in consolidating new memories. Some researchers suspect that it may also take longer to "reassemble" a memory during the retrieval process.

When It's Time to Take Away the Keys

This morning local news media reported an elderly man with dementia was missing from him home in unincoporated El Cajon. He had been last seen driving a red pickup out of town.

The good news is the man was found near the U.S.-Mexico border and is presumably now safe and secured. But reports like this one are unsettling on a couple of levels.

First, the border patrol officer is quoted as saying Mr. Heil suffers from "early-onset dementia." But he's 86 years old. Early-onset is a more rare form that strikes people under 65. What we suspect is Mr. Heil recently was diagnosed with dementia, which is much different.

But that's not what prompted this post. It's that Mr. Heil (and his family) knew he had dementia and that he frequently was lost and confused and yet allowed him to continue to drive. This made Mr. Heil a danger to others every time he got behind the wheel.

While it may be difficult to do, it is important that families come together to take the keys from a parent, spouse or sibling once they are diagnosed with dementia and especially if they display symptoms that could cause them to become disoriented on the road.

In July 2010, we posted some tips on how to do this. One tip we wish to underscore is calling your Division of Motor Vehicles and requesting an elder driver be retested. You can ask a physician to make the call if you can't. The driver is never told of the tip and instead receives a letter asking him or her to come in to their local branch to be retested.

Mr. Heil's disappearance had a happy ending, and we're grateful for that. But his case also serves as a warning that families - and neighbors if an elder resident lacks nearby relatives - need to be more heavyhanded when it comes to driving.

Should Margaret Thatcher's Dementia Make the Movie?

We're taking a break from all of the holiday photos and videos to bring attention to an upcoming movie that features Meryl Street [shown in photo] as Margaret Thatcher, the controversial former prime minister of England. "The Iron Lady" shows many facets of the world leader, including her mental decline as the result of Alzheimer's Disease. She is still living with the disease today.

And that's drawn criticism from both ends of the political spectrum. Thatcher's daughter disclosed in 2008 that her mother had dementia, so the movie provides no new revelations. But some close friends take issue with the inclusion of her latest years in the biopic.

“I was strongly against the film depicting a living person with dementia. That was very upsetting for her friends and family,” Charles Moore, the authorized biographer of Thatcher who will publish his book upon her death, said in a telephone interview with the Wall Street Journal. “It’s an extremely unkind thing to do.”

Other prominent world leaders, such as the late President Ronald Reagan, also had the fatal disease. Unless the family chooses otherwise, the mass media generally respects their wishes to keep the matter private.

In doing so, however, it also may leave the impression that people with Alzheimer's or another form of dementia no longer "exist" in our society - which is far from the case. At present, the Alzheimer's Association estimates half of all adults 85 and older have dementia, most likely Alzheimer's. And people more frequently live well into their 80s and 90s if they manage their health well in earlier years.

Such extended longevity does and will continue to put enormous stress on existing resources, from health care and housing to families charged with caring for a member with memory impairment. This movie also reminds us that Alzheimer's is an equal opportunity disease, striking all segments of society.

And yet, each journey through the disease is a highly personal one. Put yourself in the Thatcher family's position, and you must wonder if this is how they want their matriarch to be remembered.

Making Music Really Helps the Brain

So often we think of residential homes, particularly skilled nursing facilities, as a place where dreams die. But, of course, those familiar with such places know that isn’t true and that many people learn to make the most of their time there.

That’s why we wanted to share this story in today’s New York Times about an aging musician who came to a Buffalo nursing home after a struggling career as a pianist and discovered a new audience eager to hear and watch him perform.

Music therapy is an important part of our Glenner Alzheimer’s Family Centers. Not only does it provide a source of entertainment, but it also has been known to improve the quality of life for everyone in the family. It promotes social engagement and often leads to fewer visits to the doctor and less medication.

“Creative expression actually builds capacity in our brains,” says Gay Hanna, Ph.D., the executive director of the National Center for Creative Aging, said during a Webinar yesterday.

Anne Hastings, Ph.D., is director of the University of Wisconsin-Madison’s Center on Age and Community. She noted that storytelling in all its forms improves cortisol levels in both caregivers and loved ones. Moods improve and challenging behaviors decline.

“Having a sense of meaning and purpose is a protection against dementia,” she notes.

Engaging in artistic expression – be it the visual or performing arts – can improve brain cell activity and provide an outlet when others appear to be closing in due to dementia. She notes singer Glen Campbell, who this summer publicly announced he had Alzheimer’s. He now has difficulty with daily tasks but can continue to perform on stage.

“The power of the arts is integral to our being as humans,” Dr. Hanna says.

The story of Boyd Lee Dunlop in today’s newspaper demonstrates these principles. It also shows that people can have enriched, satisfying lives well beyond their working years and even after they are unable to age at home anymore. Thank you, Mr. Dunlop, for that note of hope.

Article: Rhythms Flow as Aging Pianist Finds New Audience

Alzheimer's Hits the Workplace in a Big Way

The other day a group of social workers gathered informally and the discussion turned to Alzheimer's. More people are being diagnosed at an earlier age when they are still working. Today's Chicago Tribune illustrates the struggles of those diagnosed with early-onset Alzheimer's Disease in an article about the tough choices that must be made by both employees and their employers and co-workers.

The article also taps into an even larger concern: caregivers trying to hold it all together at work while their loved one is mentally and maybe physically deteriorating at home. Consider this passage:

At Harris, Rothenberg International, a provider of employee-assistance programs for corporate clients, there has been a 100 percent increase since 2009 in the number of calls for help dealing with employees who have Alzheimer's or with employees who are saddled with demanding caretaking responsibilities for a loved one.

"The recession is keeping some people at work long after they intended to retire because they have to work," said Randy Martin, director of clinical services at Harris, Rothenberg. "A lot of people also want to keep working simply because of desire. Whatever the reason, employers are encountering more people with dementia in the workplace."

And this:

"Sixty percent of caregivers for people with dementia are employed full- or part-time," Martin said. "It's a major drain on their ability to focus at work. They need all kinds of support to help care for their parent or spouse or relative."

Many caregivers do not realize there's an option between in-home care and assisted living or a skilled nursing facility. Adult day care programs can bridge the gap in care while a spouse or adult child is at work. If you or someone you know is in this situation where the cost of caregiving is seriously impacting their ability to work, consider contacting one of our adult day care centers to determine if one of our programs is an ideal solution. You can contact us at 619-543-4700.

Article: Alzheimer's Forces Workers to Make Tough Choices

Our Dawn DeStefani Answers Your Alzheimer's Questions

Tomorrow at 10 a.m., Dawn DeStefani, our director of programs and services here at The George G. Glenner Alzheimer's Family Centers, will be the guest on Alzheimer's Speaks, a Web-based talk radio program hosted by Lori La Bey.

You can access the online interview live here.

There's also a call-in number to ask Dawn questions about ways to improve the quality of life for everyone in the family when dealing with a loved one with memory loss. We look forward to listening in and even hearing from you tomorrow morning.

Inheriting Alzheimer's Disease

The top story in today's online version of The New York Times involves a Columbian family with strong genetic links to Alzheimer's Disease, which tends to grab hold of their brains by their 40s and leave them seriously impaired by their 50s. From tests being conducted on members, scientists hope to find new treatments to counter the terminal disease well before symptoms start to show. It's a fascinating tale worth reading. Some family members have made serious choices for fear of "spreading" the disease. One father voluntarily was sterilized once he realized he could pass on the fatal illness.

Consider this passage from another family member being treated at an Arizona facility:

“Psychologically it’s very tough,” said their daughter Natalia Agudelo, 24, who also traveled to Phoenix.

“After they lose memory, what remains are their instincts like animals,” she said, adding that her father can still chew and make other instinctive movements. “Until his last moment, we’ll be there seeing what more we can do to help, what more we can do to love.”


Natalia and her younger brother and sister may have inherited the mutation from their father or, if their mother is a carrier, from her as well. As a result, Natalia has decided not to have children.


“I love babies, and I’d be so happy with children, but having a child isn’t just ‘Oh, how cute,’ ” she said. “You have to be realistic and be clear that the disease is very tough. They say in Medellin, ‘Don’t go spreading the Alzheimer’s around.’ ”

Article: Hoping to Crack Alzheimer's, Together As a Family

Photo of Natalia courtesy of NYTimes.com

When Is Enough Enough?

This morning a report is out showing moderate amount of alcoholic beverages might stave off Alzheimer’s and dementia. This is potentially good news to those who like a glass of wine with dinner or to have a beer with friends on the weekend.

Others studies have proven that those who drink too much are at greater risk of Alzheimer’s and dementia. Here we’re referring to alcoholics who drink (now or at an earlier stage of life) to excess on a regular basis.

What can be confusing is determining what amount of alcohol may carry benefits and what amount may carry risks.

The new Loyola Study suggests heavy drinkers consume 3-5 drinks per day, implying that those in the “safe zone” to actually improve their cognitive longevity imbibe 1-2 drinks per day at most. Though no solid rationale is given for why a little helps, the study suggests smaller amounts of alcohol have health benefits, including opening up blood vessels that allow more blood to flow to the brain.

The opposite effect from heavy drinkers is the result of the alcohol damaging brain cells and therefore raising the stakes for the person to develop dementia.

The Loyola University researchers also do not recommend non-drinkers take up alcohol to help stay mentally active. Instead, they should focus on a sound exercise and diet regime that also keeps the blood flowing and brain in good shape.

'The Unkindest Cut'

Last night we listened online with others as guests on KALW’s “City Visions” discussed what will happen to the 34,000 to 37,000 families impacted by the elimination of Adult Day Health Care in California. From the experts and those who called in to the segment titled "The Unkindest Cut," it’s apparent there’s already some movement.

One hospital ER worker has seen an increase in elderly patients since a nearby adult day health care center closed due to budget cuts. Another noted that there’s now a 4 to 6 months waiting list for skilled nursing homes in her area since the local ADHC closure created sudden demand for a limited number of beds.

To those locally who are wondering about our Glenner Centers: We intend to remain open!

The first half of the live broadcast focused on how we reached this point, with the legislature first voting to eliminate ADHC and then the governor vetoing it’s replacement, Keeping Adults Free from Institutions (KAFI).

Assembly member Mariko Yamada (D-Davis), who chairs Chair of the Assembly Committee on Aging and Long-Term Care, told the audience she never would have voted as she did had she suspected Gov. Jerry Brown would veto KAFI.

“It is a vote that I will regret for the remainder of my career,” she said.

During the show, Yamada noted the “silver tsunami” that’s arrived -- referring to the vast number of Baby Boomers turning into senior citizens and requiring more long-term care options. Even with the large number of ADHC recipients today, she said, “we do not have the capacity to place everyone that would need to be institutionalized.”

Someone who operates an ADHC within the Chinese community of San Francisco called to say 43 percent of residents in his area live alone, do not speak English and do not want to give up their family doctor, let alone move to a facility. “We provide medication management and we remind them to take medicine at hime. If we’re eliminated, I worry they will become confused with medications.”

Michelle Pope, who operates Alzheimer’s Services of East Bay, was more blunt in her predictions.

“I think it’s going to be catastrophic,” she said. Ninety percent of those served at her ADHC have caregivers who work. “It’s short-sighted to throw our seniors and their communities under the bus when they need us most,” she said.

Yamada agreed. “People will have to make a choice between their jobs and taking care of their loved ones, and that is a choice no one should have to make, especially in this economy.”

You can listen to the broadcast later this week when it is posted on at www.kalw.org.

'Planet of the Apes' Stars James Franco ... and Alzheimer's

The new science fiction thriller Rise of the Planet of the Apes opened to great reviews this weekend. While we typically don't endorse movies on our blog, we did want to point to something in this one that might be of interest. A key element of the plot is Alzheimer's.

We won't delve too much into the plot, but do know that the disease and search for a cure plays a vital role in the film. James Franco plays a scientist with both personal and professional reasons for wanting to eradicate Alzheimer's: his father has the disease. Someone did their research because in many ways Franco's caregiver role seems realistic, as does how the disease plays out in his father, played with aplomb by John Lithgow.

We could go on and on, but we hate spoilers. So we'll leave with just one other interesting tidbit that may or may not have influenced the story line: The wildly popular 1968 original of the Planet of the Apes starred Charleton Heston, who died of Alzheimer's Disease in 2008.

Upcoming Radio Program on ADHC Elimination

We wanted to pass along information on an upcoming program that is of interest to all of us in California, whether your loved one is currently enrolled in Adult Day Health Care or not.

This is from the California Association of Adult Day Services:

Tune in Monday August 8th from 7:00 to 8:00 PM for a live radio program on KALW in the Bay Area on City Visions hosted by Joseph Pace on ADHC elimination.

CAADS member Micheal Pope, Executive Director of Alzheimer's Services of the East Bay, and Elizabeth Zirker, Staff Attorney with Disability Rights California will be interviewed along with Assembly Member Mariko Yamada, Chair of the Assembly Aging and Long Term Care Committee.

The tentative title of the show is "Unkindest Cuts: The Threatened Closure of California's Adult Day Health Centers."

I encourage you to tell friends, colleagues, and interested constituencies about the show and that they are invited to call in or e-mail questions. I am aiming to send you a more detailed description of the show by tomorrow that you may forward.

For your information, the studio call-in line is (415) 841-4134, and comments and questions can be emailed in advance or during the show to feedback@cityvisionsradio.com.

You can listen live on www.kalw.org (click listen live, then click either windows streaming or mp3). You can also listen live at the time
the show airs on cityvisionsradio.com. A day or two after the show there will be a link to listen to the program which in turn you can link to
any other website.

More News on the Alzheimer's Front

Here’s today’s rundown of recent news from the international conference in Paris and research publications.


Lifestyle changes can help reduce Alzheimer’s. A new, theoretical analysis finds that about half of the risk factors for Alzheimer's disease are potentially changeable, and that reducing them could substantially decrease the number of new cases of disease worldwide. The study, presented at the International Alzheimer’s Association conference and published today in a medical journal, is the first known analysis that tries to quantify and compare how risk factors are associated with Alzheimer's.

For Alzheimer’s patients, antidepressants no better than placebos. Two antidepressants commonly prescribed to people with dementia appear to be no better than a sugar pill at easing the symptoms of depression in Alzheimer’s patients, according to a new study published today in the Lancet. Zoloft (sertraline) and Remeron (mirtazapine), which are both available as generics, also generated more—and more severe—side effects than placebo, leading the researchers to suggest that these and other antidepressants should be reserved for dementia patients whose depression fails to respond to more conservative treatments, such as psychotherapy.

Predicting Alzheimer’s: Would you want to know? This is a topic we’ve tackled on this blog before, but it was a major area of discussion in Paris. Nice Q&A on whether it’s good to know you have an incurable disease years before it hits its stride.

What's New[s] in Alzheimer's

There’s a lot of news about Alzheimer’s research coming out of an international conference taking place in Paris. We thought today we’d highlight some of the findings here, just in case you don't have much time to sift through the wealth of news yourself.

1. Brain swelling may be common with Alzheimer’s drugs. An experimental drug that may reduce the beta amyloid protein in Alzheimer’s patients also causes brain swelling in some beta testers.
2. Eye test for Alzheimer’s could revolutionize diagnosis. Researchers find the blood vessels in the retina are different for those with Alzheimer’s.
3. More evidence that football is bad for your brain. NFL players are much more likely to develop MCI, an early stage of Alzheimer’s, based on a voluntary study. In fact, 35% of former players showed signs of dementia by the average age of 61; in the general population, only 13% have Alzheimer’s.
4. Aspirin may have improve memory-thinking skills. Though the anti-inflammatory may reduce the risks, much more research is needed.

Alzheimer's Brought Dad and Daughter Together

So often when we hear of relationships being strained by dementia that we fail to realize sometimes they actually are strengthened.

This week's selection for National Public Radio's Story Corps that aired today is about a daughter who never got along well with her straight-as-a-pin father until he developed Alzheimer's Disease. Dad was a former Marine who ran a very tight ship, and daughter wanted life on somewhat looser terms. So she left home at 18 but  later in life became close to her father, maybe because now his life was a bit more messy too.

Charles Brooks was 78 when he was diagnosed with Alzheimer's. And his condition brought a change to his relationship with his daughter.

"All of a sudden, he turned to me — because he knew that if he had every single drawer out from the dresser on the floor, I really couldn't care less," Betsy says. "So he didn't really hide from me."

In fact, the pair spent more time together, Betsy recalls.

"We would sit on the back porch and eat pistachio nuts and share a beer," she says. And I could tell him my secrets. And I got to enjoy all the good that was in him."

It's a beautiful story. Give it a listen.

Alzheimer's Claims Another Icon

Today the world lost another icon when actor Peter Falk passed away. He'd had Alzheimer's disease for several years, according to his daughter.

Some of us who are old enough, welcomed Falk into our living rooms as we watched him solve murder mysteries in his own unique way on the long-running television series "Columbo." He also played a role in the iconic 1980s film The Princess Bride.

Some news reports mentioned a 2008 legal battle that began when Falk's daughter went to court seeking conservatorship once her father's dementia had progressed to a certain point. He apparently had named his wife legal guardian after he was first diagnosed with Alzheimer's disease.

The Falks' situation underscores the need for all families to decide on a course of action well before a parent or spouse is in need of a higher level of care. This includes legal preparations such as assigning power of attorney and preparing advanced health directives in the event they are needed. This is good advice for any family but especially so for those whose parents have begun to display signs of dementia.