Archive for October 2011
A Treatment for Alzheimer’s? Encouraging Results from a VA Study
A VA study indicates that the use of nasal insulin spray can improve memory, thinking skills and functional ability for people with Mild Cognitive Impairment (MCI) and Alzheimer’s Disease.
Researchers in previous studies had found that low insulin levels in the brain might be a contributor to Alzheimer’s. The nasal spray quickly delivered the insulin directly to the brain, with no apparent side effects.
104 adults participated in the study, with some receiving the insulin and others receiving a saline placebo. The results were sufficiently encouraging to support broader trials to study the use of this therapy to either prevent Alzheimer’s or slow its progression.
The Study was conducted by a team at the Geriatric Research, Education and Clinical Center at the VA Puget Sound Health care Center, and led by that National Institute on Aging, which is part of the National Institutes of Health (NIH). Results were reported in the Archives of Neurology, published on September 12, 2011.
Social Security and Medicare Updates
It has already been widely reported that there will be a Cost of Living increase to Social Security benefits in 2012, for the first time in three years. This 3.6% increase affects disability benefits under the SSI and SSDI programs, as well as Retirement Benefits.
For a single person on SSI, this will increase her maximum monthly benefit from $674 to $698. And a retiree with a monthly benefit of $1,600 will receive almost $700 more over the course of the year. That person should wait a few more weeks before deciding on where to spend that extra cash. Medicare had been prohibited from increasing the Part B premium during the two years when there was no cost of living increase, but that ban has now been listed. While some feared that the agency might hold back between a quarter and a third of the additional benefit for this purpose, the increase of $3.50 per month only amounts to about 10% of the COLA increase.
In another change, Medicare has added a week to the Open Enrollment period during which you can add, or drop, Part D (prescription drug) coverage; change your carrier for your Part D and/or Medicare Advantage Plan, or switch from an Advantage plan to Original Medicare. However, they have also moved the dates up significantly. Whereas last year, changes could be made from November 15 through December 31, this year, the enrollment period opened on October 15, and remains open through December 7, 2011. The changes will become effective on January 1, 2012.
Health Benefits for Elder Caregivers
Having someone who “needs” you gives you reason to get up in the morning. The psychological rewards of feeling purposeful and needed can’t be overstated. That being said, providing care to an elderly relative 24/7 can be a stressful and exhausting experience, one that could cause illness and a shortened lifespan for some. I have often counseled caregivers to take care of themselves too, or they may not be around to take care of their loved one.
Although caregiving can take a toll on someone’s health and wellbeing, there apparently are some significant physical benefits as well. A new study described in “Caregiving’s Hidden Benefits” by Paula Span (www.newoldage.blogs.nytimes.com) showed that a group of caregivers, who were followed over eight years, had lower mortality rates, maintained stronger physical ability and did significantly better on memory tests than non-caregivers. Caregiving is physical, and exercise improves physical health and cognition.
This is good news! However, regardless of the benefits, caregivers should continue to be encouraged to practice good self-care. This includes periodic respite, where care is relinquished to someone else for periods of time, and regular checkups with their primary physicians.
Does Money Sometimes Motivate Medical Decisions?
A recent study in the highly respected New England Journal of Medicine (http://www.nejm.org) reports that a significnt number of patients with Alzheimer’s disease or other terminal conditions are moved from their care facilities to the hospital for tests or treatment that do not make medical sense. It appears that some percentage of these moves are motivated by the fact that Medicare will pay a premium to the nursing home when it takes the patient back after a period of hospitalization.
In addition to enduring the trauma of the move, these patients are more likely to have a feeding tube inserted or to develop a pressure wound (bedsore) than those patients who remain in their care facility. And many of the conditions for which these individuals are moved could be treated just as well in the nursing home.
Many of us who are involved in caring for the elderly, either in our families or through our professions, react by thinking “they needed a study to tell us that?” Unfortunately, for all the focus in The Patient Protection and Affordable care Act on reducing hospital readmissions, there is minimal attention to preventing unnecessary first admissions.
As with most medical decisions at the end of life, the best prevention is to have your medical directives in place, and to make sure the agent in your health care power of attorney understands that you do not wish to endure unnecessary hospitalizations at the end of your life. The ability to honor our loved one’s wishes can be the best gift we can give them at this sacred time of life.
Delirium vs Dementia
When I was ten years old, my 40-year-old mother suffered a massive stroke. She lived to age 76, but not without significant challenges. My once soft-spoken, easy-going mother would suddenly become belligerent and combative with my father. After we had been through this several times, we came to understand that it was the hallmark of a urinary tract infection (UTI) and knew we had to get her to the doctor for diagnosis and treatment. Unfortunately, many people dealing with this issue think it is the hallmark of early dementia in elders, or progression of dementia in someone diagnosed with mild cognitive impairment. In fact, it is delirium, not dementia.
Delirium, also known as acute confusion, is a sudden change in mental functioning and behavior. It can present as agitation, disorientation and sometimes even hallucinations. There can be many causes for these changes. Before deciding that someone is experiencing signs and symptoms of dementia, seek medical advice to rule out a treatable physical condition. A course of antibiotics brought the mother we all knew back to us.
