Misc Advice

Antipsychotic drugs and the elderly – Oasis study

June 13, 2017Filed Under: Elder Law, Misc Advice, Senior Health and Wellness

OASIS Study

Antipsychotic drugs are known to have a number of severe side-effects, but they carry even greater risks for the elderly and those diagnosed with dementia or Alzheimer’s. Unfortunately, antipsychotic drugs continue to be used as first-line treatments for the control of challenging behaviors in elderly patients.

A 2015 study in JAMA Psychiatry found that elderly patients prescribed antipsychotics had significantly higher mortality rates than previously thought, and that mortality was found to increase as doses increased. In addition, a research article, published in the Journal of Clinical Psychiatry, Mark Olfson and his colleagues concluded that about 80% of the prescriptions to those over 65 were for atypical antipsychotics concluding that more than three-quarters of elderly patients receiving antipsychotics do not have a psychiatric diagnosis and the likelihood of taking these drugs increases with age.

In an effort to reduce the use of antipsychotic drugs in nursing home residents, researchers tried training staff on innovative methods to meet the needs of residents with dementia. “This intervention focused on treating the residents as human beings with needs, not as patients with problems,” said lead author Dr. Jennifer Tjia.

The new study included 93 nursing homes in Massachusetts. Staff, including nurses, nursing assistants, dietary staff and receptionists, were trained to recognize that difficult behavior by residents with dementia is a sign that they have unmet needs. The program, called OASIS, provides employees with the knowledge, skills and attitudes to meet the needs of residents with dementia using drug-free methods, according to the report.

After nine months, results from nursing homes using OASIS were compared with those at over 800 nursing homes in Massachusetts and New York that were not enrolled in the program. Nursing homes enrolled in the OASIS program had a 7% drop in antipsychotic prescriptions, compared with a 4% decline at the other nursing homes.

“We don’t medicate babies when they cry or act out, because we assume that they have a need that we need to address. However, when people with dementia are unable to communicate, the current approach medicates them when they have undesirable behaviors,” said Tjia. She is an associate professor of quantitative health sciences at the University of Massachusetts Medical School.

“The OASIS program asks nursing staff to create care plans that include what residents can do, shifting away from the model that focuses on what they can’t do,” Tjia added in a university news release. “This is a fundamental shift in how to think about caring for persons with dementia and we showed that it is effective.”

OASIS trains and implements programs across the nation to utilize a person-centered approach to dementia care for residents in nursing homes. OASIS teaches staffers that aggressive behavior by a resident who is no longer able to speak may be that person’s way of communicating pain, and to search for the source of the pain. The program also teaches staffers to comb residents’ pasts to learn their preferences, hobbies, and accomplishments, tapping bedrock emotions that endure long after memory fades. That helps workers tailor activities and surroundings for each resident, to make the place familiar and comforting.

Improve Balance in the Elderly and Prevent Falls

December 19, 2016Filed Under: Elder Law, Long Term Care, Misc Advice, Senior Health and Wellness

Falls are the leading cause of death from injury among seniors, and the risk increases with age. Fully one third of those over age 65 fall each year, and many suffer severe or even fatal injuries.

Researchers at the Mobility and Brain Function Program at the Institute for Aging Research (Harvard Medical School) are concentrating on understanding what causes older adults to fall, which will hopefully lead to development of preventive measures. They have found a direct correlation between balance and reduction of fall risk in older adults.

In a recent article, Dr. Brad Manor, the program’s director, explains that as we grow older, our ability to efficiently perform multiple tasks at the same time start to slowly deteriorate. Even the simplest of simultaneous activities, such as walking and talking, can disrupt our balance and put us at risk for a serious fall-related injury.

Mobility, the researchers conclude, is both physical and mental. The physical part relies on the ability of your muscles and reflexes to create the movement necessary to help maintain balance. The mental part relies on your ability to pay attention to the world around you, your short-term memory of where your legs and feet are located related to the ground, and your ability to make the correct decision to change your movements when needed, such as when a sidewalk is wet or covered with snow.

In an effort to find ways to prevent falls by seniors, researchers at the Center have started looking at exercises that target both the physical and mental fundamentals in mobility. They found that the purposeful movements and fluid repetitious motions in Tai Chi not only boost muscle function but also stimulate the mental functions that make mobility easier. Yoga and dance also have great mind-body interactions and work well to improve balance in older adults. While walking on a treadmill, riding a bike or strength training are all beneficial exercises, they were found to not have the balance component necessary to most effectively prevent falls.

Often, older adults will fall, become injured and then be less active. This chain of events causes further balance deterioration and greater risk of suffering another fall in the future. Dr. Manor stresses that it’s never too late or too early to start exercises to help improve balance and prevent the debilitating results that can come with a balance-related injury later. He does caution that any balance-based exercise should be done in a group or with a partner for safety reasons, and to check with your doctor before beginning a new exercise.

Shared (with permission) from ElderCounsel

Designating a guardian of your child

November 28, 2016Filed Under: Child Custody, Estate Planning, Misc Advice, Post Divorce/Custody Issues

A question I get fairly often is: “If I die can I designate someone other than the biological parent to care for my child”.

The short answer: Yes, but it probably won’t matter.

The long answer: When creating your Last Will and Testament, you will be asked who you want to be the guardian of your child if you die while that child is a minor. In situations where the parents are married/together, the parents may contemplate the case where they die in the same accident. Often times the parents choose an aunt or uncle or close friend to be the guardian. Otherwise, it is usually a given that the child would go to the living parent in the case that only one spouse/partner passed away.

Things get a little more dicey when you are divorced or not together with the other parent and you don’t think that parent is fit to take care of the child on his/her own. You are free to name whoever you want as a guardian in your Last Will and Testament, however, at the end of the day the law prefers parents to raise their children. If you die the Probate Court will be made aware of your designation. However, in order to have the Court designate someone other than the parent as a guardian, the person seeking to be the guardian would have to prove that the parent is unfit. Then, the Court would have to analyze whether placing the child with the want-to-be guardian is in the best interest of the child. Proving a parent is unfit is a substantial burden to prove. As you can see, there are several hurdles that must occur before your wishes will be able to be honored.

If you have concerns, it is recommended to name your preferred guardian in your Last Will and Testament because if the other parent is unfit, you will want the Court to know your preferences.

Holidays and Divorce

November 17, 2015Filed Under: Child Custody, Dissolution, Divorce, Misc Advice

The holidays are here! Can you believe it? For divorced/living separate families, this time of the year can present a whole host of new challenges and anxieties. While you were married or together you may have split Thanksgiving between two or even three events with various parts of your extended families. You may have spent Christmas Eve with your family and Christmas Day with his family. You may have agreed to stay in town for Thanksgiving every year and celebrate with your family and go to Chicago to visit his parents every year for Christmas. When a breakup happens, it is inevitable that your yearly traditions will change. These changes may be hard on you, your children, your former spouse or significant other, and the extended families involved.
A common way that separating individuals handle holiday division is by implementing the Court’s standard order. The standard order serves, among other things, to divide up holidays with the children between the mother and father. For example, during even years the mother may have the children until 9pm on Christmas Eve and the father may have the children at 9pm on Christmas Eve through the day after Christmas. This arrangement works well for a lot of individuals, especially those in a high conflict situation where sitting down and negotiating is simply not an option. Keep in mind that your family is not bound to follow the Court’s standard order. The parents can make any agreement that works best for their family. I recommend if at all possible that parents first consider their holiday traditions and try to tailor their agreement around those traditions if such traditions exist. This consideration and specific tailoring of the holidays may bode well for your children’s adjustment to the separation. If concessions are made and your holiday schedule looks different than before, that is okay too. Overtime new traditions will develop. You may also need to have a talk with your extended family and come up with alternative plans. Hopefully your family will be understanding and willing to modify their holiday traditions so that your children can be included in the celebration! At the end of the day, it really is all about your attitude and willingness to be flexible that will make or break this holiday season. I wish you and your family peace and happiness!

Antipsychotic drugs and the elderly – Oasis study

Improve Balance in the Elderly and Prevent Falls

Designating a guardian of your child

Holidays and Divorce

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