CT Scanner, Crash Cart (Photo credit: Civilian Scrabble)

The blog piece, How Doctors Die, It’s Not Like the Rest of Us, But It Should Be by Ken Murray, MD, has come up repeatedly in more than one of my San Francisco support groups .. and around the internet .. and newspapers, and blogs, ..

It’s not a frequent topic of discussion, but doctors die, too. And they don’t die like the rest of us. What’s unusual about them is not how much treatment they get compared to most Americans, but how little.

An interesting read, and something to think about when planning for yourself and your loved ones.  Just a bit of the ripple effect created by this article can be explored in the related article section below, but the Time article by Shannon Brownlee nicely expands on the themes begun in Ken Murray’s article.

Related articles

• Time: What Doctors Know – And We Can Learn – About Dying
  (ideas.time.com)
• The Washington Post: How Doctors Die, cont’d
  (washingtonpost.com)
• The New Old Age Blog: When Doctors Face Death
  (newoldage.blogs.nytimes.com)

Cross Sections of Thigh

(Originally found on reddit.com) http://i.imgur.com/ERxmt.jpg

Related articles

• Use it or Lose it: A Graphic Illustration (bettermovement.org)

Antibody Rendering (Credit: Image courtesy of Rensselaer Polytechnic Institute)

Sciencedaily.com recently post this article about the development of an Alzheimer’s antibody. According to Assistant Professor of Chemical and Biological Engineering Peter Tessier and his colleagues at Rensselaer Polytechnic Institute and with funding from the Alzheimer’s Association, the National Science Foundation (NSF), and the Pew Charitable Trust, a new method for designing antibodies in a “surprisingly simple” way has produced some promising results.

Using antibodies to attack and eliminate offending proteins, like APoE4, is nothing new and the buzz around this type of treatment did not appear without promising initial results. However, upon further trials, some of the early attempts have resulted in only “okay” results often due to dangerous side effects like brain swelling.

So whats the big deal? Well, it seems that the ability to easily design antibodies is the breakthrough here. Easier methods for designing antibodies may mean more designs, and more deigns may mean that researchers will be able to eventually create more targeted antibodies. In the case of the “Rensselaer” study, the most promising antibody developed using the new method only attacks the toxic, sticky “Alzheimer’s protein” rather than the building blocks of the Alzheimer’s protein.

Read the original Sciencedaily.com article by clicking below and check out the other links below for a bit of background on antibody treatment for Alzheimer’s:

Researchers design Alzheimer’s antibodies: Surprisingly simple method to target harmful proteins.

Related articles

• NPR Radio Broadcast – All Things Considered
  April 12, 2005 — A small study being presented at the American Academy of Neurology meeting in Miami suggests that treating Alzheimer’s patients with a type of antibody may halt or even reverse progress of the degenerative disease.
•  Wall Street Journal Health Blog – Shirley S. Wang
  June 17, 2008 — Mixed Results for Experimental Alzheimer’s Antibody
• Alzheimer’s Vaccine Triggers Brain Inflammation When Brain Amyloid Burden Is High
  November 15, 2011 — (medicalnewstoday.com)
• Researchers look to immune therapy to treat Alzheimer’s
  

  December. 11, 2011 — (theglobeandmail.com)

From Huffington Post: http://www.huffingtonpost.com/marguerite-manteaurao/alzheimers_b_833644.html

Some surprising points covered in the CDC’s fact sheet on falls:

• Falls are the leading cause of death among adults 65 and older.
• Over the past 10 years, fall related deaths have risen sharply among older men and women.
• Moderate to severe injuries (ie. lacerations, hip fractures and head trauma) occur in 20 to 30% of the falls reported. Many falls aren’t reported at all.
• Almost 20,000 fall related deaths were reported in 2008
• In 2009 2.2 million non-fatal falls were treated in U.S. Emergency rooms.
• Falls can be a downward spiral. Injuries and the fear that result  from falling can limit individuals’ activities. This can lead to reduced mobility and reduced physical fitness which then increases the risks of further falls.
• Men fall more than women but women experience fractures more often then men.

For people at home with mobility issues, identifying fall hazards could stave off the potential for serious injury, hospitalization and even early death.  Any care management professional worth their salt should do a fall prevention “sweep” of the home as part of their original assessment. Below are many of the things I look for in a client’s home; it should be handy in your own home or the home of a loved one at risk for taking an unwanted trip.

But First, Talk to a Doctor …
… especially if abrupt changes occur to one’s balance, strength, and/or a general change to the way someone normally walks (aka: gait changes). An abrupt change could be the result of a serious medical condition. What we are talking about here is a gradual decline in mobility that has probably been noticeable for some time, perhaps there is a history of falling or a recent fall. Even in the case of a gradual change, doctors may want to rule out new or undiagnosed medical conditions.

Review Medications & Supplements 
Make sure that doctors understand how side-effects and drug interactions (including over-the-counter medicines) may express within an elderly patient. Consult with or switch to an trusted doctor is a Geriatric Specialist. Consider an osteoporosis screening and consult with doctors on making sure that vitamin D and calcium levels are appropriate.  Also, talk to the pharmacist, explain mobility and balance issues and to ask for advice when introducing a new prescription or over-ther-counter medication.

Physical Therapy & Exercise
Explain the mobility and balance changes to a Doctor, once other medical conditions are ruled out s/he may offer a referral to a Physical Therapist for a balance assessment – if the doctor doesn’t offer physical therapy (PT) go ahead and ask for a referral.  A Physical Therapist can assess balance, recommend a cane or walker and devise a training and exercise plan. The plan usually consists of about three to six sessions. PT sessions are usually covered by Medicare or insurance, and Physical Therapists will often make house calls since mobility is the issue at hand.

Treatment for Balance and mobility issues generally involve a good amount of strength building in the legs; cane or walker training if applicable; techniques for getting in and out of chairs, beds and vehicles. The therapist may also recommend ongoing exercises to maintain and increase strength and balance – ask them to if they don’t.

When Jack LaLanne yelled, “use it or lose it” he was talking about balance too. Weight bearing exercise strengthens muscles and bones. Stronger legs help us recover from a misstep or stumble and, of course, strong bones protects us from fractures when a fall takes place.

Eye Glasses
Keep that eye glass prescription up to date. The CDC recommends considering a dedicated pair of single vision distance glasses used when walking outside. Check with an Optometrist about current glasses and whether they are appropriate for someone with mobility issues.

Fall Prevention Sweep in the Home
Tidy up, Rearrange & Lighting
Remove clutter! Clear walk ways and hallways. It is natural for newspapers, mail, and other items to accumulate near that favorite chair, get a magazine rack or a waste can to keep things tidy.  Rearrange and remove furniture to accommodate canes and walkers.

Make sure furniture is conducive to mobility needs – will that side table collapse if it has to be used for support in an unbalanced moment? Get rid of it or replace it with a sturdier table.  Identify potential low lying hazards in case a fall does happen. That beautiful marble fireplace hearth and that cute, crocheted brick door-stop can be lethal. Make sure rugs, mats and floor runners don’t ripple or slide easily, it is probably safest to just remove most of them.

Finally, make sure the lighting is adequate around the home. Brighter bulbs don’t have to mean new lamps and fixtures – compact fluorescent light bulbs burn brighter and cooler than incandescent predecessors.

Fall Hotspots
Bathrooms, hallways, bedrooms and of course stairways are especially tricky areas. To increases independence and decrease falls install permanent grab bars in showers, tubs and near the toilette. Banisters in hallways are very useful and don’t forget to double check the strength of that thirty year old banister in the stairway. It is often a good idea to install a second banister on the other side of the stairway too.

If falling out of bed is a problem take a trip to the medical supply store. Half bed rails are easy to install and help people move, stand and stabilize themselves when getting in and out of bed. Special high impact bedside mats can be used to soften landings. Low rise beds are available, but beds can also be lowered by removing the box spring if the bed frame cannot be adjusted.

Clothing & Shoes
While polyester is virtually indestructible, we are not.  Those rose colored, poly-knit, bell-bottoms still look fresh off the rack .. but tripping over that hem just isn’t worth the fashion statement. Check all pant hems, house coats and robes to make sure they are not too long.  A trip to the tailor could save a trip to floor.

Well fitted comfortable shoes are very important in preventing falls.  I suggest you burn loose fitting slip-0ns and flip-flops (or at least passionately slam-dunk them into the nearest trash can), slippers and sandals are safer with heel straps. Go to a shoe store that knows how to measure feet and fit shoes (probably not Payless or DSW). Ask a podiatrist for referrals to good shoe stores.

Finally, reducing fall risk takes plain old observation. Watching how someone moves around their space may reveal unforeseen obstacles. Try to take a look around with fresh eyes, it is natural to miss hazards in an environment that we are accustomed to.

In part two of this post (coming soon), we’ll look at a few more statistics and what fall prevention looks like in managed care communities and nursing homes.

The Arts Health Institute is part of The Dementia Collaborative Research Centers funded by the National Health and Medical Research Council of Australia.

Cornell University researchers may have solved a 100-year puzzle: How to safely open and close the blood-brain barrier so that therapies to treat Alzheimer’s disease, multiple sclerosis and cancers of the central nervous system might effectively be delivered.
- ScienceDaily – Sep. 13, 2011

This research was performed on mice; however, researchers have already found that humans like mice produce a molecule called adenosine and findings show that adenocine receptors can be activated to open and close the blood-brain barrier in both mice as well as humans. This means drug therapies, which currently are blocked on a molecular level by the blood-brain barrier, could be allowed to pass through increasing their effectiveness.

Adenosine has previously been FDA-approved for use in humans (currently for heart imaging). Could this provide a shortcut for researchers and drug developers?  It will be interesting to see.

Read the Science Daily article here: Breaching the blood-brain barrier: Finding may permit drug delivery to the brain for Alzheimer’s, multiple sclerosis and brain cancers.

The article, Letting Go of My Father, authored by Jonathan Rauch and originally published on April 2010 in The Atlantic, was recently presented by a member of one of AMI’s family caregiver support groups.   She explained that this article gave her the words that she had been trying to find but unable to form. This voice by proxy seems not only the author’s intent, but also a request.He lays out his own journey, unprepared, into care giving for his sick 80 year old father.  Mr. Rauch’s account zig-zags through the difficult processes that both providing care and accepting help demand, while it voices the isolation that family care givers often feel when they think their only choice is to go it alone.

I emerged from the whole experience not a little indignant. The medical infrastructure for elder care in America is good, very good. But the cultural infrastructure is all but nonexistent. How can it be that so many people like me are so completely unprepared for what is, after all, one of life’s near certainties?

Mr. Rauch estimates “millions of middle-aged Americans” need to be informed and supported but instead remain “invisible caregivers.” Rauch says the care giver’s silent problems are likely to require a cultural change; one he compellingly likens to Betty Fredan’s book, The Feminist Mystique, where “suddenly they realize they all share the same problem, the problem that has no name.”

. . . Well worth the read . . .  Link to the article: Letting Go of My Father – The Atlantic.

Today, I learned that the ABC game game show, Wipeout is a major hit among several of the residents in one San Francisco assisted living dementia community. It is 8:30 PM and most residents are either already in or on their way to bed. It is a time so quiet in most assisted living communities that one might think the building has been evacuated. I am here late checking on a resident who has trouble sleeping through the night; keeping her up past 9:00 PM helps to minimize late-night wandering which is often accompanied by heightened confusion and paranoid delusions.

Still frame from ABC

Upon entering the “pod” I find the resident in question watching Television with a few other residents. It seems instantly clear that they are all actively watching the show, they are glued to the action, reacting and some even interacting with the program. Frankly, the monkey parts of my brain are immediately grabbed by the brightly colored, live-action video game that is Wipeout. The residents and I both giggle on cue when an exhausted, mud covered, contestant, face-plants on one of the padded, bright red, mechanized contraptions. The on-duty caregiver emerges from one of the resident rooms and reports with a smile that, “they don’t want to go to bed when this is on.” As the caregiver runs through a half-dozen different memorable reactions and interactions that take place among her residents while they are watching this show, one mostly non-verbal woman groans empathetically as a contestant falls into a pool of mud for the third time. I ask, “Anybody here want to do that?” The group quickly and unanimously answer, “No!”

For the sake of science, let me describe this audience. This is a group of five women who’s dementia related symptoms would each respectively fit into what the Alzheimer’s Association would call the fifth, sixth or seventh stage of Alzheimer’s. Some are verbal while some rarely speak a recognizable word. A couple are roamers and a couple more are agitated sundowners. While there is a range of skills and deficits among the individuals, these are all people who sadly and unquestionably need to be under secure, twenty-four hour supervision and care. However, this show seems to work for them all.

It is generally considered bad form for any community, especially a dementia community, to include a television show in their activities, because it is rare that the person with dementia can track a narrative .. there lies the beauty of Wipeout. It has no narrative, it is all slap-stick and action. Perfect. Yes, television is weak stimuli, but anything offering a confused, sundowning person a break from their agitation is a worthwhile addition to the activity schedule.

*** *** ***

]]> http://agingmattersinc.com/2011/08/02/maybe-television-can-be-an-activity/feed/ 0 agingmattersinc Wipeout Logo df8c44411e6913688f627a857a7bfe77