Senior Health and Wellness

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.

Warning: An Alzheimer’s Tsunami is Coming and We Must Prepare

April 24, 2017Filed Under: Education, Elder Law, Long Term Care, Medicaid Planning, Senior Health and Wellness

Warning: An Alzheimer’s Tsunami is Coming and We Must Prepare

That’s the message from Andrew Tisch, chairman of Loews Corporation, co-founder of the

political reform group No Labels, and Vice Chair of the U.S. Global Leadership Coalition.

In a recent article, Mr. Tisch describes how we are unprepared for the enormous costs we will

soon be facing from a huge upswing in our aging population and the resulting number of

Alzheimer’s patients.

As he points out, in 2010 there were 11.4 million Americans over the age of 80. By the year

2050, due to the power of modern medicine, there will be over 32 million. But amid that laudable

success is a glaring problem: One in two people who reach their 80s will get Alzheimer’s, and

the American health care system isn’t even remotely prepared to deal with that.

The annual cost to care for people with Alzheimer’s and other dementias is already $226 billion,

with Medicare and Medicaid picking up 68% of the costs. If recent trends continue, he states, the

annual cost of Alzheimer’s could reach $1 trillion, in current dollars, by 2050, costing Medicare

and Medicaid almost $700 billion—about one-fifth of the federal government’s current budget.

Mr. Tisch calls for Washington to dramatically increase the amount of federal money going to

Alzheimer’s research. While disease research of all kinds is worthy and important, he states,

Alzheimer’s stands apart for the destruction it wreaks on families and finances. Five million

Americans currently have Alzheimer’s and the disease’s impact spreads far beyond those who

have it. Every person with Alzheimer’s requires three people—children, spouses, friends and

health care workers—to serve as caregivers. This can be a full-time job, and it often takes a

financial, emotional and physical toll on the caregivers and their families.

The National Institutes of Health (NIH) allocated almost $1 billion to Alzheimer’s research last

year, but funding is behind what researchers need and what other diseases already receive. The

treatments available now only treat symptoms and do not prevent, slow or reverse the disease.

Researchers believe a significant boost in funding could lead to breakthroughs in the coming

years. Dr. Greg Petsko of Weill Cornell Medical College states that “if NIH doubled research

funding for Alzheimer’s tomorrow, it would kick the whole machinery of grant making and

academic and pharmaceutical company research into a higher gear.”

President Trump’s budget proposal includes an 18% cut to the NIH budget as part of a broader

effort to slash discretionary spending. However, a bipartisan group of a dozen senators have

written a letter to President Trump asking him to increase funding for Alzheimer’s research. As

Mr. Tisch puts it, a potential cure for Alzheimer’s should not go undiscovered for lack of a few

billion dollars in a $4 trillion-dollar annual budget.

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

Preventing Dehydration in the Elderly

December 5, 2016Filed Under: Education, Long Term Care, Senior Health and Wellness

Preventing Dehydration in the Elderly

Our bodies become dehydrated when we lose more water than we take in. Staying hydrated allows the body to regulate temperature through perspiration, maintain blood pressure and eliminate waste. Dehydration may show only small signs outwardly, but it can have dire consequences on the body, especially in the elderly.

Severe dehydration can lead to confusion, impaired cognition, falling, urinary tract infections, constipation, pneumonia, bedsores in bed-ridden patients, and even death. It can accelerate or cause emergency hospitalization and/or increase the length of hospital stays.

Why Dehydration is Common in the Elderly

As we age, the amount of water in the body decreases.
The elderly are often less thirsty, which leads to consuming fewer fluids.
They may be on medications that act as diuretics or cause them to sweat more.
As we get older, our kidneys are less able to conserve fluid, especially during water deprivation.
Specific conditions can contribute to dehydration. These include comprehension and communication disorders, reduced capacity and incontinence.
Frail seniors, and those with decreased mobility, may have a harder time getting up to get a drink when they are thirsty. They may rely on caregivers who don’t sense they need fluids.
Illness, especially if it involves vomiting and diarrhea, can quickly cause an elderly person to become dehydrated.

How to Spot Dehydration

Outward symptoms of dehydration can include confusion, difficulty walking, dizziness or headaches, dry mouth, sunken eyes, inability to sweat or produce tears, rapid heart rate, low blood pressure, low urine output and constipation. Urine color should be light and clear; dark urine or infrequency of urination is a common sign of dehydration. You can check for dehydration by pulling up the skin on the back of the hand for a few seconds; if it does not return to normal almost immediately, the person is probably dehydrated.

How to Prevent Dehydration

Not everyone needs to drink eight glasses of water every day. Generally speaking, larger people need to drink more fluids than smaller ones, and it doesn’t have to be just water. Many fruits (especially watermelon), vegetables and soups are mostly water-based. Coffee, tea and flavored waters also count. Some seniors may need to be encouraged to drink even when they’re not thirsty. Include drinks at mealtimes and offer them throughout the day. Keeping a water bottle next to the bed or a favorite chair can help those with mobility problems.

Information borrowed from ElderCounsel (with permission).

Antipsychotic drugs and the elderly – Oasis study

Warning: An Alzheimer’s Tsunami is Coming and We Must Prepare

Improve Balance in the Elderly and Prevent Falls

Preventing Dehydration in the Elderly

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