Dementia May Be Caused By Brian Inflammation

Do medications like Ibuprofen and Naproxen help clients with dementia by relieving brain inflammation?

I was reading this article on the Huffington Post, and I thought you might be interested in reading it, too.

Scientists may have discovered the key to halting Alzheimer’s. This is very exciting since I have been watching several of my clients with dementia do much better with activities of daily living and memory when they are on a daily dose of Ibuprofen or naproxen. Most of these anti inflammatory medications were started to alleviate some forms of painful arthritis. Benefits of these medications has been twofold, by also relieving brain inflammation.

 Changes in my clients have been noticed by their families and caretakers.  The clients are able to hold much better conversations, walk better, remember family members, and be  less overwhelmed by sundowning.

This has been very exciting to watch but hard to discuss with physicians who continue to prescribe dementia medications that most often have little or no impact on my clients day to day activities.  Most of the time side effects from Aricept and Namenda have been far worse than benefits.

One of my clients has been on Ibuprofen 200 mgs three times a day and another client is on Aleve once a day.  Both clients are speaking much clearer, less forgetful, walking better, and easier to manage during the evening when they are sundowning.  Please consider this simple fairly safe alternative to someone you are working with who is exhibit signs of dementia.

Resource: Huffington Post


Housekeeping, Food shopping and laundry for an Irishman

Pulling the family alongI admitted a very nice Irish gentleman who was visiting Ireland when he had a heart attack and stroke. He proceeded to need a quadruple bypass.

After two months at a hospital in Ireland he returned to the US in a Lear jet. He was transferred to a local hospital then sent for rehabilitation at a facility for two months. With his dogged determination to walk again he came home with a walker.

He is authorized for a CNA one hour a week for light housekeeping, laundry and food shopping.

I went in to interview this kindly gent for a care plan. His niece was driving two hours from her home to do his food shopping every other week. He said sometimes he still needed some extra things from the store to tide him over but can’t get them until his niece comes up again. I found him Pea Pod , a wonderful food delivery service that for a nominal fee is ordered online and delivered, sometimes the driver will even put the food in cabinets and the refrigerator for a at no extra cost.  This gentleman had a computer and was very happy he had a means of being self sufficient and relieving his dear niece from some of these taxing duties so their time together would be less stressful and more fun.

He is having his laundry done by a service that picks up on Mondays and delivers on Wednesday.

When I left the aide will be expected to change his sheets and clean his bathroom weekly. Also, she will dust and mop the floors in the living room and kitchen and keep the kitchen clean.  He has lifeline that alerts his emergency contact if he falls.  He has a walker which he appears to use correctly and a shower chair to sit on when taking a shower. He has a held hand shower ($10.00) which he can shower himself with.

He has loving family that is willing to bring food or visit. They call often and now can enjoy his visits without the burdens of food shopping, laundry and housekeeping.

I left confident this Irish sweetheart was as safe as he can be!

Medicare: Admitted or Not Admitted? What is observation?

Hospitals routinely fail to tell patients they’re under observation.

If  a patient has been under observation — for all or part of a hospital admission— he or she is responsible for the entire cost of rehab. Under the rules, Medicare picks up the whole tab for the first 20 days in an approved skilled nursing facility for rehab or other care, but only if someone has spent at least three full days in the hospital as an admitted patient.

It is no laughing matter.  Post-hospital nursing home care stays aren’t covered by Medicare unless an individual has been an inpatient for at least three days.

Michael, a Medicare patient of ours was hospitalized for a kidney biopsy. He was kept for five days for several problems associated with the biopsy.  He was transferred to a skilled nursing home for rehabilitation and after 45 days discharged home. The nursing home sent him a bill for >$30,000.00.

The hospital never admitted him but kept him under observation and never told him of his status.

Observation patients:

  • Without other coverage pay 20 percent of hospital outpatient services, which isn’t required for inpatient care
  • Are generally cheaper than inpatient care for insurers and hospitals, but the opposite can hold true for some patients
  • Doesn’t prohibit observation care up to 72 hours with Medicare but, longer stays can trigger an investigation by the Centers for Medicare and Medicaid Services into why the patient wasn’t admitted

Patients need to know their status 

If a hospital admits a patient who Medicare feels should’ve been placed under observation, Medicare can refuse to pay the hospital for care. Private insurers also emphasize outpatient care to reduce costs, but most don’t require a three-day inpatient stay to cover nursing home care. With the federal health care law looking to hospitals to reduce high readmission rates, some say hospitals will be more likely to keep patients in observation rather than send them home too early or admit them.

The number 1 error with hospitals using observation is they’re not clear with the patient [how] they’re being admitted.

Patients should know whether they are an inpatient or outpatient, and should ask that question. But nationally, there is no formal protocol for communicating this.  The word “admitted” — often associated with inpatient care — can be accurately used for observation, causing further confusion.

Ask your Doctor what you admission status is: Admitted or Observation

Patients who know their rights know they must be admitted to the hospital by 12:01 AM to qualify for a one day admission.  Many of my patients are told this by me and are aware they must speak up and demand to be admitted or possibly pay high hospital co-pays and be unable to afford a skilled nursing facility.

Palliative Care vs. Hospice Care

Hospice CareMany of my clients are not sure what the difference is between palliative care verses hospice care. If I have someone dying form Lou Gehrig’s Disease who may be concerned they will need to go to the hospital for fear of respiratory distress palliative care would be the best option for this client. Palliative care would enable this client to have a home health aide and nurse from the palliative care program. Some equipment and medications may not be available to a palliative care client like a hospital bed or morphine, but medical equipment and medications  can be easily obtained from the medical supply store and pharmacy in your area. If I have a client who knows there is no life saving techniques for a disease like cancer or congestive heart failure they may be comfortable staying at home and dying with loved ones around in their own bed. Hospice care would be best for this situation since it would offer the client and family a full range of services eliminating the need for further hospital or doctor visits. Both palliative care and hospice care nurses can pronounce a client at the end-of-their-life so they will go from the home, hospital or nursing home directly to the funeral home.

There are differences between Palliative Care verses Hospice Care … and yet, there is a relationship between the two.

By definition, palliative care focuses on relieving symptoms that are related to chronic illnesses, such as cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer’s and other dementias, AIDS, Amyotrophic Lateral Sclerosis (ALS) and other neurological diseases.

Palliative Care can be used at any stage of illness — not just the advanced stages.

Hospice care is palliative by nature. The illness, however, has progressed to a point where curative treatment is no longer desired or beneficial. Hospice care supports the patient and their families while focusing on relieving symptoms and offering comfort from pain, shortness of breath, fatigue, nausea, anxiety, insomnia, constipation, etc.

Treatment Differences

Treatments are not limited with palliative care and can range from conservative to aggressive/curative.

Hospice care treatments are limited and focus on treating symptoms only: alleviating pain and symptoms without eliminating the cause of symptoms. The goal is no longer to cure, but to promote comfort.

Treatment Timing

Palliative care can be considered at anytime during the course of a chronic illness.

With hospice care, Medicare requires that a physician certify that a patient’s condition is terminal. The physician must certify that a patient’s life expectancy is six months or less.

Place of Treatment

Both palliative and hospice care can be delivered at any location, home, nursing home or hospital. Palliative care services are typically provided through regular physician and nursing visits.

Hospice care services are more inclusive than palliative care services. Hospice care includes physician services, nursing services, social worker, spiritual care, bereavement care and volunteers. In some cases physical, occupational, speech and dietary therapy services, as well as other counseling services deemed necessary as part of the hospice holistic care plan to manage terminal symptoms and provide support for the individual and their family.


The NationalHospice andPalliative Care Organization provides quality resource materials and information.

The National Hospice Foundation and the Hospice Foundation offer valuable supporting resources as well.

Many Doctors Do Not Support Life Support When it Comes to Themselves

We live in an age of marvelous medical technology and wonder drugs which have transformed the art of care and life support. Keeping patients alive at all costs is at the heart of our health care system. Yet in many cases, the aggressive treatments required to do this for critically ill patients does little to enhance their quality of life and often serves to prolong a painful and undignified dying.

Many of the people on the front line of providing this highly medicalized ending wouldn’t necessarily opt for it for themselves.

A recent study of more than a thousand doctors, published in the medical journal Plos One, found that almost 90 percent of young doctors wouldn’t want to receive CPR or cardiac life support if they were terminally ill and their heart or breathing stopped.

Commenting on the Plos One report in her NPR blog, writer Katherine Hobson wrote: “Everybody dies. But when doctors’ time is up, they are different from the rest of us. They ‘go gently’ rather than opt for aggressive end of life treatments. They have seen the suffering of their of their patients at the end of life, and want no part of it.”

The Plos One report noted:

Advances in modern biomedicine have resulted in unprecedented increases in longevity and to some extent in compression of morbidity. However, they have failed to significantly improve health status in the last two years just prior to death resulting in millions of Americans living with the tremendous burden of major chronic disease(s) at the end-of-life.

Doctors are charged with helping their patients get better, or at the very least keeping them alive. With that as a yardstick, death represents failure. It might be healthier to learn from the experience of board-certified health care chaplains and view a comfortable death as a success.

The death that the doctors in the study would choose for themselves is one that’s natural and gentle, which, it turns out, is also what seriously ill patients would choose for themselves.

This choice should be made clear well in advance, with health care advance directives that allow adults with decision-making capacity to communicate and document their health care decisions.

A health care proxy lets a person appoint their health care agent to act in their behalf and make medical decisions for them in the event that they’re unable to do so for themselves. A living will lets them spell out their wishes in the event of a life-limiting condition. This could range from requesting the use of all available treatments, to the stopping of treatments, or anything in between.

Having health care advance directives is important not only to patients, but to the medical professionals charged with their care. It helps the doctor make the life and death decisions that are an awesome responsibility.

The modern version of the Hippocratic Oath that doctors take contains this relevant thought: “Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.”

Resource: Huffington Post, Plos One

Competent to be Incompetent

The law presumes that every adult is competent and is best able to pursue her own best interest, until she is proven incompetent.

What is incompetency?

Mental incompetency is hard to define and even harder to identify. Generally, it means that a person has impaired or very limited ability to remember, to reason, to see the consequences of actions, and to plan for the future.  “Incapacity” is another word frequently used to indicate a person’s inability to make decisions for herself.

There is no bright line dividing those who are competent from those who are not. A person can be competent to make some decisions but not others.

Dangerous Driver

What about mental disorders?

A person’s mental illness or mental disorder does not automatically mean that the person is mentally incompetent. Many people who have mental illness can still make good decisions for themselves. Some people with mental retardation have the capacity to make decisions and to handle their own money.

Can a person who is questionably competent still make decisions?

A person who is in the early stages of a progressive disease like Alzheimer’s disease, or one who has mental retardation, mental illness, or a head injury may well be competent enough to express her opinions about certain matters. Especially with Alzheimer’s disease, which progresses differently in each patient, the person may retain some mental functions while losing others.  In deciding whether the person is competent to make a particular decision, one should ask:

  • How complicated the decision is;
  • Whether her answer  is consistent with the way she has lived her past life;
  • and, How dangerous the consequences are.

How do physicians or health care professionals test for competency?

They test both mental and physical functioning when they decide if someone is able to make competent decisions. Different procedures may be used depending on the source of the problem. For example, a person’s competency may be questioned if the person has mental retardation, mental illness, severe head injuries, or a recent appearance of confusion or memory loss.

They may do a history and physical, lab tests to rule out any infection or metabolic disorder, a mini-mental test to determine memory.  Sometimes they may refer the person to a neuro-psychiatrist to have a more in depth evaluation of the persons mental capacity.

What if the person is making bad choices but deemed competent?

You wish they would not drive but their argument is honest.  I have been driving all my life. I just go to the store and come home.  I have many patients like this, they do not take their medications correctly, they do not have good food in the refrigerator, they do not bathe regularly, they are incontinent and have a slight odor.  They refuse to use a walker because the neighbors may see them. But they do not have a problem answering all the right questions regarding date, time, who the President is and so on.  Sometimes we have to call in Protective Service, but I have found if the person has capacity, they can continue to live in their own home at their own peril. In the medical profession, we call these individuals COMPETENT TO BE INCOMPETENT.

Nutrition to Control Disease Symptoms

nutritionWe are always told about dieting to lose weight, with great emphasis on what not to eat. Thinking about starting a meal plan that is nutritious for your body that will also manage your disease symptoms. If you’re a diabetic your diabetic diet should be controlling your sugar intake. If you have cardiac disease your cardiac diet  will use the least amount of salt to manage your blood pressure and weight. If you have IBS you need to follow an IBS diet every day to make the pains and dumping feeling go away. If you have celiac disease, inflammation around your body, migraine headaches, or serious abdominal pain you might want to consider a gluten-free diet. If you eat the food that keeps your body in check, you will find you are more apt to manage your weight.

All diets that are healthy include protein ( meat, fish, eggs, legumes) vegetables, fruit, sometimes dairy and carbohydrates.  A little salt and a little sugar in moderation are usually acceptable.

Plan your Diet Program

Take your time in deciding to start a meal plan. Know what you need to eat every meal time. Should your meal plan be three meals a day or four smaller meals a day? During your planning phase make some recipes and eat some foods that will be beneficial to your health.. Read about you diet and what participants eat. See if the program has menus or frozen foods. The American Diabetes Association has great recipes to help with controlling sugar intake. The American Heart Association is another source. The International Foundation For Functional Gastrointestinal Disorders is a source for serious IBS pain.  Most disease management programs are associated with helpful diet tips.

Record your Blood Pressure, Blood Sugar and Weight Daily

Keep a 30-day chart and see how your blood pressure, weight and blood sugars go up and down as you follow your diet.  Don’t make losing weight your priority.  You are eating to maintain nutrition to manage a disease, your weight will most likely stay in check as you learn to eat the right foods for your body.

Good luck and stay with it, even if some days you slip.

Resources:  American Heart AssociationAmerican Diabetes Association, International Foundation For Functional Gastrointestinal Disorders, National Foundation For Celiac Disease

Alzheimer’s Disease: How Alzheimer’s Disease Affects Our Brains

A scan showing a normal brain vs. a brain with Alzheimer's.

When caring for someone with Alzheimer’s Disease we need to remember that there is a very severe and destructive loss going on in the brain.

It is obvious the brain on the right is very different. We can clearly see that this brain is smaller and there are holes in it. Because of this, it also weighs less. A normal brain weighs approximately 3 lbs. A person who dies from Alzheimer’s Disease has a brain that weighs approximately one lb.  This physical deterioration is why there are so many severe changes in the person with Alzheimer’s Disease.  These changes are caused by the disease and not the person.

Most people develop what are called Plaques and Tangles as they age.

Those with Alzheimer’s Disease develop far more. They are formed from two different proteins called tau (pronounced like cow) and beta amyloid (pronounced Bayta-ammeloyd) that are usually a normal part of the work of our brains. In the brain of someone with Alzheimer’s, something goes wrong, causing the “tau” proteins to form tangles inside the brain cells. The beta-amyloid proteins form plaques. Both of these structures are very small.  We can’t see them with just our eyes. They are only visible with a very powerful microscope after death. More and more plaques and tangles appear as the disease progresses.

The tangles and plaques eventually affect our memory, vision and language.

It affects our ability to speak, swallow, walk, direct our hands to pick up something.  All aspects of the brain are affected and with this severe deterioration progressive physical changes follow.  A person with Alzheimer’s also loses their ability to control emotions, insight and they may be impulsive.  It may cause delusions, hallucinations, paranoia, aggression or sexually inappropriate behavior.

Medicare: What’s not covered.

Medicare isn’t intended or designed to provide nursing home or in-home care, so there are significant gaps in these areas. Families can’t rely on Medicare to pay for 24-hour at-home care, meals, delivery services, and many of the personal services provided by home health aides. 

What will Medicare pay for?

medicareUsually a hospital or nursing home will discharge someone home with what is called Visiting Nursing Services or VNA. This service is paid for by Medicare. This service is made up of nurses, physical therapists, occupational therapists, social workers and home health aides all taking orders from your physician. This group of professionals are involved in assisting the client to reach maximum potential at home from surgery, a stroke, or any other debilitating diseases or problems. They are usually involved for 4-6 weeks depending on the diagnosis and the progress the client makes.

What does Medicare not pay for?

It does not cover activities of daily living like food shopping, laundry, meal prep, light housekeeping or assist with transportation to doctors offices. Medicare may assist in some medication set up by the visiting nurse association but rely on the family or individual to become compliant with this task.  The biggest problem with Medicare is that when the VNA say they are done with rehabilitation they give little notice and the family or individual are left on their own for bathing and managing all necessary activities of daily living.

How do I get the necessary help to keep someone safe?

During this time, I recommend  a referral to a state agency or licensed private agency in your area to see if the client is eligible for personal care and homemaking services. Even if it is for a short time, it will help with a smooth transition for the individual to continue to progress.  A home health aide two to four days per week for just one to three hours per day can make a huge difference in helping with safety, anxiety and a smooth transition.  Look at our website: to see what services are available through a private agency.

What do I look for in an agency?

Refer to our guide Ten Tips For Finding Good Homecare

Resources:  Ten Tips For Finding Good Homecare, Medicare


Helping Elders with Poor Appetites

poor appetiteLoss of appetite and changes in appetite are a natural part of aging, but it’s still important to make sure seniors get enough nutrients. Here I will give some advice on what to do if you can’t get an elder to eat.

Poor appetite doesn’t necessarily indicate a problem, but there are some warning signs to watch out for, and some easy things you can do to help your loved ones get the right nutrition.

Why has my parent’s appetite changed?

Although it’s normal for appetite to change with age, there are a number of different factors that can also cause elderly appetite changes:

  • Lack of interest in food due to changing taste buds, depression or loneliness
  • Lack of energy to cook
  • Loss of appetite due to health conditions
  • Medication side effects

Sometimes it just seems impossible to get your mom or dad to eat.

By putting small snacks or fruit on a table next to them while they watch TV or read gives them a chance to find delectable food without sitting at a formal meal. Consider nutritious snacks, I suggest cutting up squares of cheese, crackers, fruit like grapes, blueberries, apples cut to mouth size pieces, breakfast bars, small sandwiches etc.  If your loved one likes chocolate, cookies or special sweets indulge them. Small servings won’t hurt them and they will be thankful. One family I know makes up a basket for their mother and she loves looking through it and picking out her own breakfast bar, cheeses etc.  They enjoy going to the store and finding healthy foods to fill her basket. For healthy nutrition keep meals small, maybe an egg and toast for breakfast, soup and milk for lunch and meat and potatoes for dinner.

What’s normal and what should I be concerned about?

The aging process brings with it a host of normal physiological, perceptual and other changes that can lead to decreased appetite in the elderly, including:

  1. A lower metabolic rate and lessened physical activity means seniors need fewer calories.
  2. Dental problems or gastrointestinal changes (like lactose intolerance) that go along with age can effect the appetite.
  3. Changes to the sense of smell, taste and even hearing can affect the enjoyment of food.

However, if your loved ones are making poor food choices because of their changing tastes, or if they aren’t getting enough to eat, then that’s cause for concern. It’s critical for seniors to get the right nutrition for their changing dietary needs, because vitamin or nutrient deficiencies can cause significant health problems.

Changes to taste or appetite also occur in conjunction with some serious illnesses, including:

  • Head and neck cancers
  • Salivary gland dysfunction
  • Thyroid disorders
  • Mouth and throat infections or periodontal disease
  • Parkinson’s and Alzheimer’s disease

Any unexplained changes to your loved ones’ dietary health, including unexpected weight loss, weight gain, or general malaise, should be checked out with a physician.

How can I stimulate appetite in my senior parent?

poor appetiteIf you’re concerned about a lack of appetite in your elderly loved ones, there are a few practical things you can do to help them get enough nutrition:

1. Increase nutrient density, not portion size. 

Do not increase the volume of food, rather, increase the nutrient density of the foods they serve. Don’t intimidate them with a huge helping, in other words—but you can often add healthy extra calories in the form of olive oil, a little peanut butter or avocado.

2. Set a regular eating schedule.

Our bodies tend to thrive off regularity, as do our hunger and thirst signals, so when we stray from our usual patterns, so does our appetite.  Start slowly, adding a small beverage and/or snack during a normal meal time. This can help get the body’s hunger signals get going again.

3. Encourage social meals.

poor appetiteFor people of any age, just the prospect of eating alone can reduce appetite. For seniors, accessibility and availability of social contact can be even more of a problem. Check out the meal options at senior centers, temples or churches, and community centers, as well as meal “dates” with friends, family or caregivers. Even meal delivery services can help.

4. Be aware of medication side effects.

If the problem is dry mouth chewing sugarless gum, brushing often or using an oral rinse prior to meals can improve taste sensation, and ultimately nutrient intake.” If meat is tasting “off”—and a common complaint is that some medications make foods taste metallic—then try other sources of protein like beans or dairy. If water doesn’t taste right, try adding herbs, or sliced fruits or veggies like lemon or cucumber.

5. Consider using an appetite stimulant.

Some seniors have had success with prescription appetite stimulants. First, though, consult a health care provider to make sure it’s appropriate.

Reference :  Loss of Appetite in Elderly: Causes and How to Cope bySarah Shwartz


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