Dementia is a non-specific syndrome in which affected areas of brain function may be affected, such as memory, language, problem solving and attention. Dementia is not a disease in itself. When dementia appears the higher mental functions of the patient are involved initially. Eventually, in the later stages, the person may not know what day of the week, month or year it is, he may not know where he is, and might not be able to identify the people around him.

The most common form of dementia, Alzheimer’s disease, accounts for 50-75% of all cases of dementia. Another 20-30% is due to blood vessel disease (“multi-infarct dementia” or “mini-strokes”). The remaining cases result from a variety of less common disorders.

As the disease progresses, a person with Alzheimer’s disease may experience hallucinations and/or delusions. Hallucinations are when the person sees, hears, smells, tastes, or feels something that is not there. Delusions are false beliefs that the person thinks are real.

• Sometimes hallucinations and delusions are signs of physical illness. Keep track of what the person is experiencing and discuss it with the doctor.
• Avoid arguing with the person about what he or she sees or hears. Try to respond to the feelings he or she is expressing. Comfort the person if he or she is afraid.
• Try to distract the person to another topic or activity. Sometimes moving to another room or going outside for a walk may help.
• Turn off the television set when violent or disturbing programs are on. The person with Alzheimer’s may not be able to distinguish television programming from reality.
• Make sure the person is safe and does not have access to anything he or she could use to harm anyone.
• Discuss with the doctor any illness the person has had or medicines he or she is taking. Sometimes an illness or medicine may cause hallucinations or delusions.

Keeping the person safe is one of the most important aspects of care giving. Some people with Alzheimer’s disease have a tendency to wander away from their home or their caregiver. Knowing how to limit wandering can protect a person from getting lost.

• Make sure that the person carries some kind of identification or wears a medical bracelet.
• Consider enrolling the person in the Alzheimer’s Association Safe Return program if the program is available in your area.  If the person gets lost and is unable to communicate adequately, identification will alert others to the person’s medical condition.
• Notify neighbors and local authorities in advance that the person has a tendency to wander.
• Keep a recent photograph or videotape of the person with Alzheimer’s to assist police if the person becomes lost.
• Keep doors locked. Consider a keyed deadbolt or an additional lock up high or down low on the door. If the person can open a lock because it is familiar, a new latch or lock may help.
• Install an “announcing system” that chimes when the door opens.

Caring for Someone With Dementia
Because of the intensity of care that may be required, it is often difficult for even a loving family to provide all the “around the clock” care that a family member suffering from dementia may need. If friends or family wish to provide these services it is very important for them to be aware not only of the person’s needs, but also of their own needs.

It is not uncommon for a spouse or children to feel that they have an impossible choice between being utterly overwhelmed (if they try to provide all the care) or feeling they are betraying their relative (if they send them to a nursing home). This often leads to the care provider becoming exhausted.  Because of this it is often helpful to investigate local resources to help the care provider.

“Consuming more vitamin E through the diet appears to be associated with a lower risk of dementia and Alzheimer’s disease, according to a report in the July issue ofArchives of Neurology, one of the JAMA/Archives journals. A report in SeniorJournal.com yesterday shows new testing has also found that higher levels of vitamin D also seem to protect against these memory-robbing diseases.

Oxidative stress – damage to the cells from oxygen exposure – is thought to play a role in the development of Alzheimer’s disease. Various research indicates that antioxidants, nutrients that help repair this damage, may protect against the degeneration of nervous system cells.

“Although clinical trials have shown no benefit of antioxidant supplements for Alzheimer’s disease, the wider variety of antioxidants in food sources is not well studied relative to dementia risk; a few studies, with varying lengths of follow-up, have yielded inconsistent results,” the authors write in explaining their pursuit of this research.

Elizabeth E. Devore, Sc.D., of Erasmus Medical Center, Rotterdam, the Netherlands, and colleagues assessed 5,395 participants 55 years and older who did not have dementia between 1990 and 1993.

Participants underwent a home interview and two clinical examinations at the beginning of the study, and provided dietary information through a two-step process involving a meal-based checklist and a food questionnaire.

The researchers focused on four antioxidants:

•    vitamin E
•    vitamin C
•    beta carotene
•    flavonoids.

The major food sources were:

• Vitamin E – margarine, sunflower oil, butter, cooking fat, soybean oil and mayonnaise;
• Vitamin C – oranges, kiwi, grapefruit juice, grapefruit, cauliflower, red bell peppers and red cabbage;
• Beta Carotene –  carrots, spinach, vegetable soup, endive and tomato; and
• Flavonoids – tea, onions, apples and carrots.

Over an average of 9.6 years of follow-up, 465 participants developed dementia; 365 of those were diagnosed with Alzheimer’s disease.

After adjusting for other potentially related factors, the one-third of individuals who consumed the most vitamin E (a median or midpoint of 18.5 milligrams per day) were 25 percent less likely to develop dementia than the one-third of participants who consumed the least (a median of 9 milligrams per day).

Dietary intake levels of vitamin C, beta carotene and flavonoids were not associated with dementia risk.

Results were similar when only the participants diagnosed with Alzheimer’s disease were assessed.

“The brain is a site of high metabolic activity, which makes it vulnerable to oxidative damage, and slow accumulation of such damage over a lifetime may contribute to the development of dementia,” the authors write.

“In particular, when beta-amyloid (a hallmark of pathologic Alzheimer’s disease) accumulates in the brain, an inflammatory response is likely evoked that produces nitric oxide radicals and downstream neurodegenerative effects. Vitamin E is a powerful fat-soluble antioxidant that may help to inhibit the pathogenesis of dementia.”

Future studies are needed to evaluate dietary intake of antioxidants and dietary risks, including different points at which consuming more antioxidants might reduce risk, the authors conclude.

The study was supported by a grant from the Netherlands Organization for Scientific Research (Dr. Breteler) and by a training grant from the National Institutes of Health and by a U.S. Fulbright Fellowship to the Netherlands (Dr. Devore). “

The adult children may pick up on other signals. Perhaps their parents have started complaining that they don’t have enough funds. Maybe they are neglecting to pay their regular bills. As a result, they get late notices, have overdrafts, their utilities are cut off, or they have credit card problems. Maybe they have credit balances as a result of paying some bills twice.

Or maybe they notice that their parents have started making large, unplanned withdrawals or new automatic payments to charities or other unknown organizations. They also may pick up on the fact that their parents suddenly have new “friends,” or newly rekindled family
ties, that overstep boundaries.

What You Can Do
In many cases, it is a good idea for at least one of the children to add themselves onto their parents’ financial and other accounts as a person of interest, thus providing an informal means of monitoring their parents’ finances. This can alert children to potential problems such as late fees, missed payments for mortgages, utilities or other obligations, or large withdrawals from savings for unspecified reasons. Of course, setting up automatic bill payments and online banking can go a long way towards resolving these issues.

It may also be a good idea to set up direct deposit for all of their sources of income that permit it, such as Social Security, pensions and IRAs, thus reducing the number of trips that they have to make to the bank. If parental savings are inadequate, then now may be the time to assist them with this, as well, since this will give additional funds the greatest amount of time to grow.

How to Talk to Your Parents About Finances

1.      Start by acknowledging that talking about finances, be it planning for health needs, estate planning, including making a will, purchasing insurance, developing trusts or transferring assets is important for the entire family. It is important both financially and emotionally. Younger generations have to know the amount of resources likely to be transferred to do their own financial planning. They also have to know the resources older adults have available for their own needs in case younger family members have to plan to take care of their elders. The emotional benefits come from people feeling trust and honesty from each other, as well as sharing responsibility for actions.

2.      You can emphasize the benefits of planning such as not losing all assets if a nursing home is needed or unnecessary taxes being paid if a will and estate planning are not done.

3.      You should talk about your wishes that your parents are well taken care of in their old age and that they should use appropriate assets for themselves. This part of the discussion may also include having other family members (borthers, sisters) involved.

4.      Directly addressing emotional stumbling blocks can help all family members begin to overcome them.

5.      Older adults need to know that two or three generations have a stake in asset transfers between generations. Family members may not realize how a parent’s estate may affect the financial planning of their children for the grandchildren.

Financial Questions to Tackle

• What is the person’s financial situation?
• Has the elderly person transferred any assets?
• Is there a list of assets, their value, their locations?
• Are there other sources of income? Annuities, stocks, interest, IRA’s, CD’s, safe deposit box?
• Is there a private pension? Is it mailed directly to a bank? Which one?
• What is the social security amount? Is it directly deposited? Where?
• What are the debts? Mortgages, car payment?
• Is there a need to apply for SSI, Supplementary Security Income?
• Is medical coverage adequate?
• Is there a prescription plan? Long term care insurance? Medicare? Medicaid?
• What is the “time frame” in your state for transferring assets before being qualified for Medicaid?
• Is there a will, a living will, a power of attorney, a durable power of attorney that lasts beyond incapacitation? Where are they kept?
• Is there an insurance policy? Where is it kept?

Dementia is a non-specific syndrome in which affected areas of brain function may be affected, such as memory, language, problem solving and attention. Dementia is not a disease in itself. When dementia appears the higher mental functions of the patient are involved initially. Eventually, in the later stages, the person may not know what day of the week, month or year it is, he may not know where he is, and might not be able to identify the people around him.

The most common form of dementia, Alzheimer’s disease, accounts for 50-75% of all cases of dementia. Another 20-30% is due to blood vessel disease (“multi-infarct dementia” or “mini-strokes”). The remaining cases result from a variety of less common disorders.

As the disease progresses, a person with Alzheimer’s disease may experience hallucinations and/or delusions. Hallucinations are when the person sees, hears, smells, tastes, or feels something that is not there. Delusions are false beliefs that the person thinks are real.

Sometimes hallucinations and delusions are signs of physical illness. Keep track of what the person is experiencing and discuss it with the doctor.
Avoid arguing with the person about what he or she sees or hears. Try to respond to the feelings he or she is expressing. Comfort the person if he or she is afraid.
Try to distract the person to another topic or activity. Sometimes moving to another room or going outside for a walk may help.
Turn off the television set when violent or disturbing programs are on. The person with Alzheimer’s may not be able to distinguish television programming from reality.
Make sure the person is safe and does not have access to anything he or she could use to harm anyone.
Discuss with the doctor any illness the person has had or medicines he or she is taking. Sometimes an illness or medicine may cause hallucinations or delusions.

Keeping the person safe is one of the most important aspects of care giving. Some people with Alzheimer’s disease have a tendency to wander away from their home or their caregiver. Knowing how to limit wandering can protect a person from getting lost.

Make sure that the person carries some kind of identification or wears a medical bracelet.
Consider enrolling the person in the Alzheimer’s Association Safe Return program if the program is available in your area. If the person gets lost and is unable to communicate adequately, identification will alert others to the person’s medical condition.
Notify neighbors and local authorities in advance that the person has a tendency to wander.
Keep a recent photograph or videotape of the person with Alzheimer’s to assist police if the person becomes lost.
Keep doors locked. Consider a keyed deadbolt or an additional lock up high or down low on the door. If the person can open a lock because it is familiar, a new latch or lock may help.
Install an “announcing system” that chimes when the door opens.
Caring for Someone With Dementia
Because of the intensity of care that may be required, it is often difficult for even a loving family to provide all the “around the clock” care that a family member suffering from dementia may need. If friends or family wish to provide these services it is very important for them to be aware not only of the person’s needs, but also of their own needs.

It is not uncommon for a spouse or children to feel that they have an impossible choice between being utterly overwhelmed (if they try to provide all the care) or feeling they are betraying their relative (if they send them to a nursing home). This often leads to the care provider becoming exhausted. Because of this it is often helpful to investigate local resources to help the care provider.

Always There wanted to share this article with you published by our local chapter of the ALzheimer’s Association. We thought this information is very insightful and helpful. For more information, contact the Alzheimer’s Association at 800-272-3900.

Making this decision can be a complicated and emotionally wrenching experience for you and the senior. For caregivers, it can be heartbreaking to recognize that the strong, self-sufficient adult they have known for years is no longer capable of taking care of themselves. It also means a real loss of freedom and flexibility and may require you to develop creative strategies to accomplish daily errands and tasks. For the senior, it can be equally difficult to acknowledge and accept that physical, emotional or mental changes have reduced their independence.

There are numerous factors to consider when making this decision. But first, recognize that loss of sight, hearing loss, memory loss, confusion, incontinence and depression are not normal aspects of aging. In many, if not most cases, these are treatable conditions. Failure to identify them as being treatable could place elderly patients at risk of unnecessary functional decline. Have you or the senior discussed the senior’s problems with a physician? And, if the first physician dismissed them as being due to old age, did you see another physician for a second opinion? (A surprising number of doctors don’t have the training to help seniors overcome their problems.)

It is important to balance the safety of the senior with the needs of both senior and caregiver to retain as much independence as possible. As a result, you should include as many people as you can in the decision-making process, even the senior. You may also want to consult with other caregivers, such as family members and friends; paid caregivers who know the senior’s abilities and limitations; and elder care professionals such as doctors, nurses, and social workers.

The following questions can guide you in making the decision. If the answer to any question is “no,” it may no longer be possible for the senior to be left alone, even for a short period of time. Instead, moving into an assisted living facility may be appropriate.

• Do they understand how to leave the home if necessary? Do they know where the door is located and how to exit the building?
• Will they stay home or near the house rather than wander off?
• If they go outside, do they know where they live and how to get back inside?
• Can they identify signals, such as smoke from the kitchen or fire alarms, that would alert them to potential dangers?
• Do they know how to access emergency services? Do they know how and when to dial 911? Would they be able to communicate over the phone? Can they physically get to a phone no matter where they are?
• Do they have frequent life-threatening medical emergencies that require immediate intervention? Do they know where any medication they might need is located? Can they reach it? Do they have the capacity to select the right medicines in the correct amounts?
• Do they have the judgment to identify who they should and should not let into the home? Will they know to allow family, friends and emergency personnel into the home?
• Can they prepare themselves something to eat if they get hungry? Do they know how to use the stove, and will they remember to turn it off?
• Can they get to the bathroom and use the toilet on their own? If not, have alternatives been worked out?
• Are they afraid to be alone for an hour or more? Do they become clingy when caregivers depart and make frequent telephone calls if they are alone?

If you decide that it is still safe to leave your senior at home alone, you should regularly reassess the situation. Caregiving is a dynamic process — you need to be aware of any and all changes in the elderly person’s condition and abilities. Even if you think they can be left home by themselves, pay attention to their desires; if they fear being alone, it could be a sign that at some level they know they are not capable of coping with any emergencies that might arise.

Animal lovers have always known it. Now health researchers are confirming it: animals are good for your health.

Just 10 minutes of physical interaction with a beloved pet can lower blood pressure and increase finger temperature—both clear signs of relaxation—according to a number of research studies.

Benefits to people with high blood pressure have been documented as well. A recent study showed that pets can do what medicine cannot. It involved two groups of stockbrokers who were already being treated with ACE-inhibitor therapy.

The study found significant differences in their physiological reactions to stress tests. Those with pets were about half as reactive to stressors. This study demonstrates the health effects of pets in conjunction with medication. That’s significant because it’s well known that this type of medication plays an important role in controlling resting blood pressure, but does not control blood pressure related to stress.

Another study of people with borderline hypertension shows equally encouraging results. Two groups were evaluated for their reactions to psychological stress tests and monitored for several days. The group with dogs in the home reduced resting blood pressure (to within normal range) and reactivity to stress, as well as ambulatory blood pressure, even while at work. The lowest blood pressure was recorded on the day participants took their dogs to work.

Shamu, the Dentist’s Friend
A therapy dog can prove helpful to children undergoing potentially stressful medical and dental procedures. One study showed that a therapy dog named Casey lowered behavioral distress in two- to six-year-olds visiting a pediatric clinic. Casey simply sat on the floor of the exam room, and the children were free to pet and interact with her. Parents told the researchers that their children had “never behaved this well at the doctor’s.” One mother said: “I can’t believe she isn’t crying. She always cries, and we have to hold her down for the doctor to look in her ears.” Having the children more relaxed during their examinations made diagnosis and treatment easier for the health professionals and parents alike.

Another of the studies showed that seven- to 11-year-old children who expressed fear and anxiety prior to their dental visits had significantly less behavioral distress when Shamu, a therapy dog, was present. For example, there was less crying and struggling, compared to the behavior of a similar group who were not exposed to Shamu. The dog sat on a stool and the children frequently hugged her tightly.

Since fears developed in childhood can follow one into adulthood, reducing fears through such approaches can have lifelong benefits.

Alzheimer’s Helpers
Several studies on Alzheimer’s patients living in special-care units revealed that residents were less agitated and expressed more socially interactive behaviors when therapy dogs were present. This proved especially true in the late afternoon or at sundown, when agitation tends to escalate. After Sadie, a golden retriever therapy dog, came to live on one unit, agitation behaviors decreased and remained lower for weeks. Sadie quickly adapted and became good friends with Bill, one of the residents. When Bill became agitated, Sadie seemed to know almost intuitively that he needed her and tried to help him become calmer.

Although the study of human/animal relationships began only about 25 years ago, many treatments and interventions involving pets and therapy animals have now been subjected to the rigors of scientific research.

As America’s population ages and pressures on healthcare spending increase, the healthcare system may find the important and relatively inexpensive role of animals increasingly valuable in maintaining and improving human health. For more information on the health benefits of animals, visit www.deltasociety.org. Delta Society is an international nonprofit organization that unites people who have mental and physical disabilities and patients in healthcare facilities with professionally trained animals to help improve their health.

Dr. Baun is the Lee & Joseph D. Jamail Distinguished Professor at the University of Texas Health Science Center at Houston School of Nursing, and Ms. Dapper is Vice President of Program Operations for Delta Society.

Brain Healthy Eating
A brain-healthy diet reduces the risk of heart disease and diabetes, encourages good blood flow to the brain, and is low in fat and cholesterol. Like the heart, the brain needs the right balance of nutrients, including protein and sugar, to function well. A brain-healthy diet is most effective when combined with physical and mental activity and social interaction.

Reduce your intake of foods high in fat and cholesterol. A high intake of saturated fat and cholesterol clogs the arteries and is associated with higher risk for Alzheimer’s disease. Use mono- and polyunsaturated fats, such as olive oil, for example. Try baking or grilling food instead of frying.

Physical Activity For Brain Health
Physical exercise is essential for maintaining good blood flow to the brain as well as to encourage new brain cells. It also can significantly reduce the risk of heart attack, stroke and diabetes, and thereby protect against those risk factors for Alzheimer’s and other dementia.

Aerobic exercise improves oxygen consumption, which benefits brain function; aerobic fitness has been found to reduce brain cell loss in elderly subjects. Walking, bicycling, gardening, tai chi, yoga and other activities of about 30 minutes daily get the body moving and the heart pumping.

Staying Brain Healthy
Like other parts of your body, your brain may lose some agility as you get older. It can deteriorate even more if you don’t take care of it.  By concentrating on your diet and proper exercise, you can reduce the risk and enjoy a higher quality of life as you age.

Family conversations on such topics make all generations uncomfortable.  Yet, they need to occur and often the sooner they do the better.  In fact, these talks should take place when things are going well, before there is a crisis and decisions need to be made hastily.  Adult children need to listen uncritically and treat their parents with the respect and dignity they deserve.

A recent AARP study found that most elderly parents actually feel better about having these kinds of discussions as part of their planning for the future.  Such discussions, they say, help them live life the way they wish.

Here are suggestions on ways for children to handle such conversations:

• Approach the subject indirectly.  For example, “I know you’re taking lots of pills.  How do you keep track of them?  Would a pill organizer from the drug store help you?”

• Be direct, but non-confrontational.  “You know, Mom, I’m worried that you seem to be unsteady on your feet.  I’m wondering how we can help protect you from falls.”

• Watch for openings.  “Dad, you mentioned having problems with your eyesight.  Have you seen the eye doctor lately?  Does it seem to affect your driving?”

• Share your feelings.  “You’ve always been so independent, Mom.  I imagine it’s hard to ask for help.  You know you can always ask us for help if you need to, or we can find someone who can.”

Here are some other recommendations for children of elderly parents to consider:

• Make a list for your parents with questions or concerns they can prepare prior to the conversation.

• Expect some resistance.  Above all:

-       Respect your parents’ feelings if they make it clear they want to avoid the subject.  Try again at a later time.

-       Push the issue if health or safety is at risk, while recognizing your parents’ right to be in charge of their lives.

-       Act firmly, but with compassion.  For example, “Dad, we need to deal with this now.”

-       Hold a family meeting where everyone discusses concerns and together develops a mutually agreeable plan – giving your parents a sense of involvement and control over their lives.

-       Involve other people your parents respect.  This may include a member of the clergy, an attorney, or a close family friend.

-       Look for community resources that can help a parent remain independent, including home care, meal delivery or transportation.  For example, most people refer to remain in their current home and today there are options that bridge the spectrum from living totally independently to being in long-term care.  Many elderly people, even those with early-stage Alzheimer’s, manage to live within the comfort and familiarity of their homes because of the various community services that now exist.  Many, for example, prefer live-in care, with a trusted caregiver, over being moved to a nursing home.  Senior only independent housing, Continuing Care Retirement Communities (CCRCs) and assisted living all offer housing options.

• Focus on key points and ask your parents for their own thoughts regarding their current needs and concerns and their worries about the future – rather than guessing, which can lead to bad mistakes and hard feelings.  Ask about the location of such important documents as insurance policies, wills, health care proxies, living wills, trust documents, tax returns, and investment and banking records.

• Keep it positive and treat them as equals.  Even if they make what you consider an unsafe choice, it doesn’t necessary mean they are no longer capable of living independently.

• Expect that the discussion will be ongoing rather than a “one shot” deal.  Each time the topic is revisited, it should become more comfortable.

• Step back and evaluate.  This might include suggesting that your parents talk with a third party – an estate planner, financial expert or attorney – if you think they could use some expert advice.

Physicians and geriatric social workers warn that there are a number of danger signs that indicate that an elderly person needs extra help or an immediate change in their living arrangement.  As a result, note any marked change in personality or behavior.  However, no major lifestyle changes should be made without discussions with the elderly loved one, other family members, and health professionals.

Once the ice is broken, it will become easier for parent and child to hold discussions. Initiating that talk is often the most difficult part.  Don’t put it off any longer.