November is NATIONAL FAMILY CAREGIVER'S MONTH

NATIONAL FAMILY CAREGIVER'S MONTH  is designated as a time every year to thank, support, educate and empower family caregivers. "This year we are encouraging people to speak up during National Family Caregivers Month." said Suzanne Mintz, NFCA president and CEO. "One of the most important attributes on being an advocate for your loved one is the willingness and the ability to speak up and keep your eye on the ultimate goal, protecting not only the health and safety of your loved ones but for yourself as well."

More than 50 million people, provide care for a chronically ill, disabled or aged family member or friend during any given year.

Informal caregiving is the foundation of America’s long-term care system. Each day, in every State and community, family members, friends and neighbors provide extraordinary levels of assistance to persons of all ages with chronic illnesses and disabilities. Caregivers manage tasks ranging from assisting with basic personal care and homemaking to carrying out more complex health-related interventions.

Unpaid caregivers may be found in every community. They come from every walk of life. They contribute an  estimated economic value of about $350 billion each year.

They are male and female, young and old, and may or may not possess adequate financial resources to meet their own daily needs or the needs of those for whom they care.

Through the Looking Glass with Alzheimer's

Life goes on for the caregiver and sufferer through the looking glass.

The dread diagnosis of Alzheimer’s does not mean your life is over. You can still live a happy life, but you will need to make  changes and accept that  some things will be more difficult and very different.

• Try to live a healthy lifestyle with a balanced diet, excersize, and getting enough sleep. This will help your brains to function at their best.

• Look after your emotional well-being by seeing friends and family, a counselor, joining a support group, or starting a journal or blog.

• Both of you will experience a range of  thoughts and emotions as you come to terms with the diagnosis - denial, anger, frustration, depression. It's  important to acknowledge and deal with these emotions.
  

• Speak with your friends and family and neighbors and let them know how they can help. Keep them informed as things progress.  Set up some form of respite.
  

• Try to keep doing activities that you enjoy and make adjustments to changing abilities.  It can help to stick to a predictable routine. Create easy to follow systems.

• Hold on to some sense of humor.
  

Maine's Dirigo Choice Experimental Health Insurance Plan

Maine requires community rating ( all the insured pay the same premium for the same insurance coverage under each policy choice ) and no discimination due to pre existing conditions.  This has driven insurance companies out of the Maine market and increased premiums by those few insurer's willing to cover Maine citizens.

In an attempt to improve the situation the legislature enacted Dirigo Choice which was designed to provide access and subsidies, particularly for small business, the self employed and individuals without any coverage. Due to the instability of the funding mechanism the program has been closed for two years to new subscribers. It is currently managed by Harvard-Pilgrim (a non-profit). The rising costs of medical care have driven up the monthly premiums and increased the amounts to be paid out of pocket.
As members drop out due to age, attrition, inability to pay premiums or return to covered employment, the number of covered members is declining. For those without other healthcare insurance options Dirigo has been a lifesaver.  In the early days of Dirigo Health many potential members were not able to pay the full upfront premium and then wait to be reimbursed for their subsidy amount later.  That system has since been corrected.

As we look at expanding health insurance coverage to more Americans much can be learned by looking at the states that have tried to do just that.
We know that Senators Collins and Snowe will give thoughtful consideration to the plans being formulated in Washington and will throw a life ring to those who need the help of a public option.
Harvard Pilgrim                         Dirigo Health - Maine People's Alliance

Keeping Current with the Science of the Brain and Dementia

~ Alzheimer's Disease Cooperative Study  ~  
From the National Institute on Aging (NIA)
and the University of California at San Diego (UCSD)

This study addresses treatments for both cognitive and behavioral symptoms.  The information can be a bit technical but keeps us informed about recent research into Alzheimer's. You can join the Information Network by going to  http://www.adcs.org/Research/registry.aspx and sign up for their monthly newsletter.

Another useful site is The Alzheimer's Disease Education and Referral (ADEAR) Center Web site will help you find current, comprehensive Alzheimer's disease (AD) information and resources from the National Institute on Aging (NIA).
http://www.nia.nih.gov/Alzheimers/

An Informal Mental State Exam can help record strengths and areas of concern in Alzheimer's

In your role as a caregiver, companion and observer you may want to utilize from time to time a standardized method of evaluation. Although the Mini Mental State Exam and its scoring guidelines are useful, the MMSE shouldn't be used independently to make a diagnosis. Only trained clinicians -- such as physicians, nurses, and psychologists -- should give and score the MMSE.  A diagnosis of Alzheimer's can only be made after a complete diagnostic workup rules out any other possible cause for the person's symptoms.

Caregivers may find it useful to observe the progression of Alzheimer's and to flag areas of concern to address with the physician.  Another older useful test is the Blessed Test.

MMSE - Mini Mental State Exam
The clinician asks the person the following questions:
Orientation
What is the year?                 What is the season?
What is the date?                  What is the day?
What is the month?              What state are we in?
What county are we in?        What town are we in?
What room are we in?           What floor are we on?

Short-Term Memory (Retention)
The clinician names three objects (for example, apple, table, and hat) and asks the person to repeat the three words all at once. If the person can't do this correctly, the clinician can repeat the words until the person learns them (a maximum of six tries is permitted).

Attention
The person is asked to count backwards from 100 by 7s, or to spell the word “world” backwards.

Short-Term Memory (Recall)
The person is asked to repeat the three objects named earlier (apple, table, and hat).
Language

The assessment of language
First, the clinician holds up a pencil and a watch (separately) and asks the person to name the objects.
Second, the person is asked to repeat the phrase, "No ifs, ands, or buts."
Third, the person is asked to follow a three-stage command (Take this paper in your right hand, fold it in half, and hand it back to me.).
Fourth, the person is given a piece of paper with the command "Close your eyes" written on it and is asked to do what the paper says.
Fifth, the person is asked to write a spontaneous sentence.
Sixth, the person is asked to copy a simple design.

Scoring
24 – 30: "normal" range
20 – 23: mild cognitive impairment or possible early-stage/mild Alzheimer's disease
10 – 19: middle-stage/moderate Alzheimer's disease
0 – 9: late-stage/severe Alzheimer's disease

Dealing with Medications - oh those blister packs

For some reason one of Gordon's medications arrived in blister packs instead of the usual Rx bottle.  After first checking that it was the correct pharmaceutical and dosage the next task was to get the packs open.  Not so easy !  After trying various implements I made the discovery that if you separate the units down the middle along the dotted line you can fairly easily peel off the paper label and get the pills out.  I put them in the old bottle relabeled with the new Rx information.

You also have the right to request non childproof snap caps on your medication vials.  Of course all meds must be secured from unauthorized fingers, be they young or old.

Cleaning out our meds is one of the tasks we do at the seasonal time change.  Old, out of date bottles should be discarded or recycled and any left over drugs disposed of safely. Maine offers a safe disposal program with cooperating pharmacies that provide stamped envelopes so customers can send in unused, unwanted prescriptions to be destroyed. It's part of a first-of-its-kind program to keep drugs from being tossed out or flushed down the toilet and getting into the environment.    www.safemeddisposal.com

Save Your Brain - Eat Those Yellow Curries

Curcumin     {Botanical name: Curcuma longa; Family: Zingiberaceae, the ginger family} 

is the source of the spice Turmeric and is used in curries and other spicy dishes from India, Asia and the Middle East. Similar to many other herbal remedies, people first used curcumin as a food and later discovered that it also had impressive medicinal qualities.
Turmeric has been used historically as a component of Indian Ayurvedic medicine. It is an anti-oxidant and anti-inflammatory. The rhizome  is cooked and ground to produce the spice.

Researchers at the Jackson Lab in Bar Harbor observed that systemic treatment of mice with curcumin significantly reduces amyloid-ß plaques and actually reversed structural changes within the brain. Curcumin offers a promising new approach for clinical research into treating and perhaps ultimately preventing Alzheimer’s disease in humans.

Alzheimer’s disease is one of many diseases that are called neurodegenerative diseases—they involve dysfunction or death of brain tissue.  A diet rich in turmeric may help prevent or reverse brain damage in Alzheimer's.  Seems worth a try.
More recent studies showed that combining curcumin with vitamin D3 enhaces it's efficacy.

Citation :

Mishra S, Palanivelu K. The effect of curcumin (turmeric) on Alzheimer's disease: An overview. Annals Indian Academy Neurology .   Read more - - -

America’s Healthy Future Act of 2009

In the current version of the Finance Committee's Chairman's Mark there is no mention of Alzheimer's and only two of dementia. 

1. It would establish within the Centers for Medicaid and Medicare Services (CMS) a program to test and evaluate patient-centered delivery and payment models. The Center would consider models that target beneficiaries with multiple chronic conditions and at least one of the following: (1) an inability to perform 2 or more activities of daily living; and (2) a cognitive impairment, including dementia.

2. Dementia and Abuse Prevention Training. The Chairman‘s Mark would add staff training requirements for nursing homes. The Secretary would revise initial nurse aide training, competency, and evaluation program requirements to include dementia management training and patient abuse prevention.

The Finance committee will vote on the bill this coming week. The draft will have to be merged with other committee's efforts before going to a full Senate vote later this month. Later it would be off to conference with the House version.

Full text of the bill >>>


http://finance.senate.gov/sitepages/leg/LEG%202009/091609%20Americas_Healthy_Future_Act.pdf

Caps and Belts and Bolo Ties

Every morning as we go through the lengthy ritual of dressing for the day Gordon always seeks out his Greek Fisherman's cap, his belt and wallet, and bolo tie.  He's not able to thread his belt through the belt loops of his pants and so wears it outside around his waist.  His cap stays on all day (except for the dinner table). The bolo tie goes on under or over his shirt and his wallet must go in his pocket.  These are comforting supports - almost talismans - to help his feeling of security and proper place in the world.  It's very unsettling to him if any of these articles are forgotten.  Dressing etiquette has been condiderably relaxed in the interest of  pride and confidence.