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Helping Those Who Forget…Remember

May 30, 2019

Midge watches cows being milked on a dairy farm.

Donna paints watercolor masterpieces with just one touch.

Frank belts out tunes on the karaoke machine.

All call the Woodside Neighborhood, a dementia-specific personal care community at the Presbyterian SeniorCare Network Washington campus, home. Each has a different interest that sparks special moments in their lives – many of these moments they do not recall on a daily basis.

With the help of It’s Never Too Late (iN2L), an interactive computer system that engages residents regardless of their cognitive level, the Woodside team is able to rekindle passions like painting, and bring back lost memories of the days on the farm.

Photo Caption: Donna, a resident in the Woodside Neighborhood, enjoys “painting” on the iN2L

iN2L doesn’t just impact one of our residents, it impacts all of them,” says Susan Lawrence, lifestyle engagement coordinator at Presbyterian SeniorCare Network. She reminisces, “I remember one of our residents who was a ‘War Bride’ from England. She moved to the U.S. and never got to go back home. We received this information from her family and pulled up the Earth view of the town on iN2L. She couldn’t remember the name of her hometown, but when she saw the local Post Office, she leaned in to get closer to the screen. We watched her eyes light up in a moment of recognition and she began sharing stories about her father and her time ‘at home.’ Talk about an impactful moment of remembrance – and all because of the iN2L.”

iN2L provides an element of engagement that you can’t get from anywhere else.

“We have fun with the iN2L. But what’s most important is that we engage. They remember; even if it is just for one moment,” says Susan.

Doing your homework before joint replacement leads to a better recovery

May 30, 2019

Meeting with a physical therapist and educating yourself before you have joint replacement surgery can help you to have a quicker, less stressful recovery.

Patients who meet one-on-one with a physical therapist (PT) and educate themselves prior to knee or hip replacement surgery feel better prepared to leave the hospital and report less pain and joint stiffness during recovery compared to those who did not, according to a study by Hospital for Special Surgery (HSS). The study evaluated the effect of a face-to-face counseling session coupled with web-based education on patient satisfaction and functional outcomes.

The goal of the education session was to manage patient expectations of the surgery and recovery before undergoing the surgery—rather than after the surgery, when they might be dealing with fatigue, pain or anxiety—so they were able to better absorb and retain the information. Researchers followed 126 patients who underwent knee or hip replacement for osteoarthritis.

All patients attended a group education class before surgery—the standard of care for those scheduled for joint replacement at HSS. They were then randomized into two separate groups. In group one, 63 patients attended the one-on-one education session with a physical therapist in addition to the group class and were granted access to an informational web portal featuring videos. The control group of 63 patients attended the standard group class and received a booklet about what to expect after joint replacement—with no further education.

Using patient satisfaction and patient-reported scores to measure pain, joint stiffness and function both before and after surgery, researchers determined that the patients who attended the extra one-on-one PT counseling session indicated they were better prepared to leave the hospital after surgery and were overall more satisfied with the preoperative education they received. Almost 97 percent of these patients accessed the informational web portal, and all of them said they would recommend it for patients undergoing the same procedure.

Almost 70 percent of patients from the group that did not receive the supplemental educational session or web portal access believed they could have benefited from additional education before surgery. Patients who received one-on-one counseling also needed fewer physical therapy sessions in the hospital before discharge and met PT discharge measures sooner, including being able to get out of bed, walk with or without an assistive device and go up and down stairs independently.

The upshot of this research is that, if you are considering joint replacement surgery, ask to meet one-on-one with a physical therapist BEFORE your surgery if that is not your doctor’s standard approach. And take advantage of any and all learning materials your doctor may give you—specifically online videos and information.

The more you know, the better your recovery may be.

The Problems With Do-It-Yourself Online Wills

May 29, 2019

These documents could save money, but can lay estate planning traps
By Marguerite C. Lorenz

As a professional trustee and executor, I have seen hundreds of estate-planning documents, including some from do-it-yourself online services. I appreciate that using a DIY site to draft a will can save money and time. But I’m also concerned that sometimes doing it this way could lead to expensive and unpleasant estate planning mistakes.

I recently saw one DIY estate-planning service that had typos on its site and its estate-planning “packages” had the same document labeled with three different names. Worse, the packages I looked at were missing a key estate planning document which very few users would know to ask about.

This service, like many other DIY estate-planning sites, has attorneys on staff, but access to specific help for your personal documents is rarely available. If personal advice is offered, it then appears to cost a great deal more to receive.

But what if you don’t know which questions to ask?

Online DIY Wills Vs. Hiring a Professional

For some people with complicated personal and financial lives, today’s complexities may not be fully addressed with a do-it-yourself service for wills and trusts. While many of us would prefer to fill in the blanks in silence than have to talk to anyone about our doubts or concerns, sometimes it helps — a lot — to get professional advice.

If you prepare your taxes yourself and they end up incorrect, you and the Internal Revenue Service may end up working things out. If you decide to do your estate planning by yourself,” however, you may never know the results of your work, but your loved ones will.  

There are lots of DIY options for completing your own estate plan, and they have been available almost as long as we have had the internet. (Longer, if you count all the software packages you could buy off the shelf.) With the ease and availability of these programs, and their low price, you might think more of us would have an up-to-date estate plan.

Yet according to the AARP article, Haven’t Done a Will Yet?, “only 4 in 10 American adults have a will or living trust.”

What Good Estate Planning Is All About

Our power to express our preferences is what good estate planning (or life planning), is all about. In my work as a trustee and executor, I’ve learned that the documents which provide me with detailed instructions are critical to avoid court involvement, to reduce administrative confusion and to know when our job is done.

The four basic estate planning documents: a will, a trust, power of attorney for financial matters and an advance health care directive. If you plan to use any or all of them through a DIY site, expect to be offered a fill-in-the-blank approach. Keep in mind that each state has its own probate code (the body of law governing estate planning and implementation). The software package you use may have different names for the same documents I have listed above.

Some of the DIY sites I visited have all of these documents for you, but only if you purchase their higher-end packages. Some offer limited attorney consultation; on one site, it was really a drop-down of questions with pre-written responses, not an actual conversation with an attorney.

Pros and Cons of DIY Estate Planning

The advantage of using a DIY service is that you will have a plan, as quickly and cheaply as possible, and that may be better than having no plan at all. This is especially true regarding getting a will, power of attorney and advance health care directive. Those handle most emergencies for people who don’t own real estate or much else.

The range of DIY services also has a range of prices — like $69 for just a will, to several hundreds of dollars for what may be described as a “complete plan.” Some sites have more information than others about their options.

Most presume that you already know what you want. But the reality is that many people have no idea what they want or need. Once you get into the complexities of family dynamics and perhaps trust language specific to your state and situation, DIY estate planning can cause more challenges than working with a team of professionals.

My Caution About DIY Online Wills

Here is my caution, based on my experience: You don’t know what you don’t know. You know some things about how you want to dispose of your assets after you die. What you may not know is all the case law and legislation that have evolved into your state’s probate code.

If you do decide to look for an attorney who specializes in estate planning, I recommend interviewing two or more. This way, you will get a feel for how each handles client relationships, payment, follow-up and his or her own succession. You may already have other trusted professionals (a cpa, a financial planner) who can refer you to estate planners in your area.

However you choose to get your plan completed, DIY or with the help of an experienced attorney, please get your estate plan done, and soon. You never know what surprises life will bring that will invoke your estate plan.

By Marguerite C. Lorenz

Marguerite C. Lorenz is a partner in Lorenz Fiduciary Services, Inc. (LFS), and has served as a professional trustee and executor on over 100 cases. Ethics for Trustees, written by Jane and Marguerite Lorenz, gives further understanding to the work of a fiduciary, and its ethical considerations. Lorenz created the EstatePlanning101.org program in San Diego and is a member of PFAC,  president of the Estate Planning Group Network and vice chair of the board for the Independent Trustee Alliance. Follow her on Twitter @SanDiegoTrustee

Is 75 the New 65? How the Definition of Aging Is Changing

May 24, 2019

Chronological age doesn't mean what it used to, and why that matters
By Andrew Scott

Aging and mortality are intrinsic to the human condition. Accepting our mortality as humans underpins our search for meaning in life and our quest for wisdom and maturity. But when the average age of The Rolling Stones exceeds that of the U.S. Supreme Court, it is clear that an adjustment to our concept of aging is warranted.

At least measured chronologically, everyone is aging and at the same rate — one year every year. But aging is so closely connected with our sense of impending mortality that it usually refers to end of life. This is evident in the widespread concern about an “aging society” defined in terms of a rising proportion of older people.

What Defines Being Old?

If aging is about being old what defines being old?

Two aspects tend to feature predominantly in our social discussions of age.

The first is biological and connected to declines in the physical and mental capabilities that circumscribe our daily lives.

The second is psychological and revealed in Cicero’s remark that “old age is the final scene…in life’s drama.” Stanford Center on Longevity’s Laura Carstensen’s Socioemotional Selectivity Theory posits, for example, that as we approach the end of life, our time horizons narrow. We focus on our most emotionally meaningful relations and activities.

These biological and psychological aspects of ageing are deeply embedded. In practice, however, governments rely on more simplistic chronological measures such as the “Old Age Dependency Ratio.” This is a ratio of the number of old people relative to those of working age, where “old” begins at 65. That’s often mentioned in discussions of the solvency of Social Security.

When We Started Relying on Chronological Age

This reliance on chronological age is actually quite recent, though. Starting around 200 years ago, governments began to accurately record birth dates and then started to use chronological age to segregate society. Schooling became defined by age cohorts.

The apotheosis of this approach was the creation of a “retirement age,” broadly defined as 70 in 1908 and then as 65 in 1925. In response, individuals began to base their sense of age on their birth dates. Today, we think about age in terms of the number of candles needed for a birthday cake. (Did you know the Happy Birthday song didn’t start becoming popular until 1935?)

A focus on chronological age would be fine if its relationship with biological age were constant. But sustained improvements in life expectancy mean this isn’t the case.

What’s Wrong With Focusing on Chronological Age?

Over the course of the 20th century, life expectancy increased around 10 years for each generation. What this means in practice is that a 75-year-old today has the same mortality rate as a 65-year-old in 1950. So perhaps 75 really is the new 65.

Over the same period, the average age of the U.S. population has increased from around 32 to 38, while the average mortality rate has fallen by 13 percent. As a result, the average U.S. citizen has never been older, but also has never had so long left to live.

This decline in mortality rates has implications for the understanding of old age. If we are, on average, healthier at each chronological age, then biological aging is occurring more slowly. We are, in effect, younger for longer.

This increase in life expectancy has already changed the way we experience the earlier phases of the lifecycle. Adolescence now extends well into one’s 20s. Young adulthood these days is characterized by a period of exploration and discovery, free from traditional grown-up responsibilities such as marriage and parenthood.

New Thinking on Lifestages

Following on this logic, should our 40s and 50s also become a time of reinvention and rediscovery in anticipation of a longer second half of life?

If we are healthy in our 70s and 80s, should this be a time of more work, deepening engagement in civil society and/or greater leisure and play?

In this era of a “new old age,” we will have a longer time to recreate our own identities, avail ourselves of a wider set of opportunities and come to terms with past mistakes and misfortunes.

There is a further reason why we need to move away from the dominant chronological concept of age.

The real truth about aging is diversity. You may be like the Frenchman Robert Marchand, still breaking cycling speed records at 105. Or you may end up in a wheelchair by 50. This diversity of experience in what it means to be old will become all the more apparent as more people live into old age.

How Shifting to Biological Age Helps

A shift from chronological to a biological sense of age undermines lazy, age-based stereotypes and helps us to understand better how our own efforts may influence the aging process. This shift also forces governments and corporations to rethink education, retirement and pension policies, as well as employment practices.

Our relationship with time changes when we have more of it. Lacking role models for how to live such long lives, we are —  all of us — currently engaged in a huge, new and long-lasting social experiment. This moment provides an opportunity to free ourselves from the numerical determinism of chronological age and revisit a more humane concept based on an individual’s physical and mental characteristics.

To return to Cicero, only then we will approach that final stage with a sharper sense of who we are.

By Andrew Scott

Andrew Scott is professor of economics, London Business School and co-author of The 100-Year Life: Living and Working in an Age of Longevity.

The Power of Music

May 22, 2019

May is Older Americans Month! Communities that encourage the contributions of older adults are stronger! By engaging and supporting all community members, we recognize that older adults play a key role in the vitality of our neighborhoods, networks, and lives.

This year’s theme, Connect, Create, Contribute, encourages older adults and their communities to: 

  • Connect with friends, family, and services that support participation.
  • Create by engaging in activities that promote learning, health, and personal enrichment.
  • Contribute time, talent, and life experience to benefit others.

One awesome example of how we "connect" with our residents, is through the use of an iPod Shuffle. It is said that "music holds a special place in the heart and mind that time can’t erase, even when almost everything else is gone." We believe this, which is why we utilize the Music and Memory Program.

Music Enhances the Lives of Individuals Living with Dementia

Gina Iuliucci, MT-BC, CDP, lifestyle engagement coordinator at the Presbyterian SeniorCare Network Washington campus loves music. In fact, she is a music therapist and shares her love of music with our residents living with dementia to enhance their lives with their favorite tunes.

“We utilize Music and Memory, a non-profit organization that provides personalized digital music to older adults,” says Gina. She, as well as 20 certified team members on our Washington campus, use music technology to comfort our residents living with dementia at times when they could benefit from this type of engagement.  

“We have a resident who has aphasia. It is heartbreaking to watch the emotions on her face as she tries to verbalize what she is feeling. To help relieve some of her nervousness, we’ve used Music and Memory; once she begins listening, her anxiety melts away. She is often more relaxed long after the music stops playing,” says Gina.

Music and Memory Executive Director, Dan Cohen founded Music and Memory with a simple idea: if he needed nursing care, he wanted to be able to listen to his favorite ‘60s music. With the popularity of iPods, he brought music into nursing communities. Music and Memory also offers certification for organizations to incorporate therapeutic music as a standard of care; Presbyterian SeniorCare Network is a certified organization.

iPods are provided through Music and Memory, as well as through donations from community members. “Our iPods are programmed to include personalized playlists for each of our residents,” says Gina. To get an idea of the music preferences of each resident, Gina and team will inquire with family members, as well as residents. “Often, a resident may not remember the name of an artist, but can tell you if they like country or big band music. That helps us to narrow the genre and program a list that includes their preferred music,” says Gina.  

Music and Memory is offered in the dementia care communities around our Network. Through the program, we are able to give pleasure to persons living with advanced dementia, reduce frustration and late-day confusion, as well as offer an alternative or a reduction to the use of anti-psychotic medications.

When asked if she sees a benefit to Music and Memory, Gina instantly answers, “yes!” “It is an honor to be able to provide personalized music to our residents. When a resident is feeling anxious, as soon as the headphones are placed on their ears, you can see a change in their demeanor. When they are happy, I am happy. It gives me the chills to know that music has made their worries melt away.”

To learn more about the living and care options around Presbyterian SeniorCare Network, visit SrCare.org. 

Pictured above, Aggie, enjoying the Music and Memory Program.

Sue Mazur, Aggie’s daughter, says "The special songs from Aggie's past make an immediate connection and allow my mom to connect with family and friends in a way that she wouldn't be able to otherwise." Aggie is a resident in the Woodside Neighborhood at Southminster Place of Presbyterian SeniorCare Network. The Woodside Neighborhood specializes in dementia-specific personal care. 

The Transformative Joy of Dance at Any Age

May 21, 2019

The Quicksilver dance company takes an intergenerational spin
By Rebecca Theim

Lifelong dancer and choreographer Nancy Havlik wants the world to know that regardless of age, physical condition or experience, “people transform through the joy that dance offers them. You can see them light up and become more alive.”

Havlik, 78, has 25 years of experience teaching interactive creative movement and dance workshops for older adults through Arts for the Aging (AFTA), aa nationally recognized, Rockville, Md.-based organization that brings free artistic programs to older adults in the Washington, D.C. area.

Credit: Denaise Seals

Invited artist Shanna Lim (center) leads participants in an interpretative dance performance during the Washington, D.C., production of Quicksilver’s “Imaginary Gardens”

Earlier this month, Havlik’s AFTA-sponsored Quicksilver, an improvisational dance company for older adults, staged “Imaginary Gardens,” in partnership with the Dance Performance Group, a small company of professional dancers and musicians of which Havlik is artistic director and choreographer. The interactive, interpretative dance production featured dancer Shanna Lim, who got most of the audience involved in the performance.

“We had all ranges of people,” said Lim, 41. “I didn’t know who the audience would be. I opened before it started, and basically warmed up the audience. I coaxed as many as I could down to the stage, and then more came as we started the show.”

Lim, whose work spans hip-hop, and installation and body art, is one of the more unconventional dancers Quicksilver participants have encountered.

“I came out in full body paint, that real-interesting-piece-of-art-weirdo, and everyone was completely cool,” she recalled. “I got huge satisfaction —not a huge surprise, but more like ‘cool!’ — seeing that generation, and having them all behind me, and seeing them learning. I turned around and I felt accepted.”

Quicksilver and other AFTA programs (which include drawing, painting, poetry and music) engage 1,000 older residents in more than 800 programs annually held at 33 community and residential care centers in the Washington, D.C.-area, in partnership with area museums and cultural institutions. The goal is to engage older adults and their caregivers through regular participation in arts activities that improve physical fitness and cognition, and combat isolation.

“Quicksilver is unique among the programs we offer because dance is accessible to everyone,” said AFTA program director Brandi Rose. “It’s something everyone can tap into, no matter what their cognitive level or physical ability. It’s such a great combination that we’ve thought about how we can bring it into other art disciplines.”

Science Backs the Benefits of Dancing

In addition to the joy Havlik and Lim say dancing brings to participants young and old, there’s science supporting the benefits it offers older adults. Numerous U.S. and Europeans studies have shown that regular dance improves balance and enhances cardiovascular health, stems or slows the advancement of dementia and boosts emotional health.

Nancy Havlik, co-director of Quicksilver, a dance program for participants 65 and older sponsored by Bethesda, Md.-based Arts for the Aging

Patients with Parkinson’s Disease who took part in regular tango lessons experienced improved motor skills and balance, reduced non-motor symptom severity and were able to better perform daily activities, researchers found.

A two decade study by the Albert Einstein College of Medicine found that dancing was the only physical activity that resulted in lower reported rates of dementia among older people who danced frequently. A more recent study of older women in Japan found that those who danced often had a 73 percent lower chance of becoming disabled during the study period, contrasted with women who didn’t dance. Again, no other physical activity — including walking or yoga — produced such significant results, researchers found.

Why is dancing so powerful? Researchers theorize it’s because it demands both mental and physical effort. “Dancing requires not only balance, strength, and endurance ability, but also cognitive ability: adaptability and concentration to move according to the music and partner, artistry for graceful and fluid motion, and memory for choreography,” a study by Chinese researchers concluded.

Quicksilver Participants Dance Around

Quicksilver dancers, who range in age from 65 to 88, are involved in weekly programs within the group, Rose said. Twice a month, they take their performances to the community and senior centers and residential facilities AFTA serves.

“We go out in the community and work with people, some who have never danced before,” Havlik said. “People always say they can’t dance. People get that in their heads, that ‘I’m no good at that.’ I’m really good at getting people dancing; that’s one of my strengths.”

Because of Washington, D.C.’s global draw, participants are often multicultural. Havlik and her Quicksilver co-director Anthony Hyatt, who provides music for the programs, have a trick to engage international participants.

“They may not have the same language, but you don’t need a common spoken language to dance,” Havlik said. “They respond to different music. Anthony knows almost all national anthems of the world, so when we have someone new, he’ll play their national anthem.”

Professional dancers in Havlik’s Dance Performance Group relish working with Quicksilver participants. “These younger dancers are in very competitive fields,” Havlik said. “It’s very tough to be a dancer these days; there’s no money in it. But there’s a warmth and generosity that comes with age, and my young dancers love dancing with the older dancers.”

Lim said her “Imaginary Gardens” experience, her first time working with Havlik, confirmed that observation. “I just liked being part of the energy and the presence of elders who have been there, done that, and getting the chance to work with people who have a full level of knowledge in areas I don’t,” she said.

Quicksilver members also benefit as they begin to grapple with the possibility of their own physical and cognitive limitations. Working with other older adults “allows them to confront some of the fears they may have about aging, and recognize that when those physical or cognitive declines come, there’s still life and there’s still joy,” Rose said.

By Rebecca Theim

Rebecca Theim is a former daily news reporter and periodic freelance writer.@rebeccatheim

Dementia Care Reimagined: A Q&A With Dr. Tia Powell

May 21, 2019

The author calls for more research on developing compassionate care model
By Edie Grossfield

As so many medical professionals, policymakers and nonprofits continue to sound the alarm about the impending tsunami of Americans with Alzheimer’s disease and other dementias, the U.S. still has no affordable long-term care system to handle the situation.

In her new book Dementia Reimagined: Building a Life of Joy and Dignity from Beginning to End, Dr. Tia Powell joins those sounding the alarm, but she calls for a much greater focus on developing care programs and facilities for people with dementia that preserve their dignity and ability to experience joy in life.

The professor of psychiatry and bioethics at the Albert Einstein College of Medicine in New York says it’s time to stop focusing only on finding a cure for dementia, as if that will save us from having to pay for care. It’s too late for that, she says. No magic pill or other preventative intervention is anywhere on the horizon that would be available in time to make a difference for the 10,000 boomers turning 65 every day.

Powell’s book, released this month, blends a fascinating history of how dementia has been viewed in the U.S. with her thoughts on what compassionate care for people with dementia might look like. She also includes her own experience helping to care for her mother who had dementia and died a few years ago.

In a recent interview with Next Avenue, Powell talked about what she learned from researching and writing her book:

Edie Grossfield: You wrote that you expect some people will take issue with your suggestion that we need to shift more research funding from finding a cure for dementia to developing compassionate care for people with the disease. Can you elaborate?

Dr. Tia Powell: I don’t want people to stop looking for a cure. Dementia is a serious illness, it is a fatal illness and we don’t have a cure, so I’m all for finding a cure. But that has been the overwhelming majority of the research we’ve done.

If we find a cure, it’s not going to be in time for the baby boomer generation. We will have millions and millions of people who need care. And although I think there are good people working on that, there has been pretty modest funding for thinking about what would good care look like? How can we pay for that? How can we make it accessible to people all across the country? What are the things that people with dementia and their caregivers really say they need and want?

You also expressed concern about some researchers and pharmaceutical companies focused on a preventative drug for people who have high levels of amyloid plaque in their brains — that being one theory about the cause of Alzheimer’s. You said that since research has shown high levels of amyloid doesn’t mean a person will get Alzheimer’s, such a drug would mean big bucks for ‘Big Pharma’ with little benefit for most of the people who take it. What are your thoughts on this research today?

I hope that particular dream is fading. We just had in the last couple of weeks another major failure of a big, hundreds-of-millions-of-dollars clinical trial trying to decrease amyloid as a way of preventing and treating dementia, and it failed again, just like the ones I’ve described in the book. I’m hoping it’s going to be the nail in the coffin for looking just at amyloid. It’s not that amyloid is good for you, but there’s something really important that we don’t understand, and it really looks like just decreasing amyloid or even preventing its buildup — I don’t think that’s going to be the ticket.

What are your hopes for developing care for people with Alzheimer’s and other dementias?

A lot of people who don’t even have dementia yet are absolutely terrified. They think that this is more frightening than cancer, than AIDS. And that’s partly because we haven’t done enough to reassure them. I think we can reassure people. I think you can have a life with dementia that has joy in it, and we need to make sure that’s not an empty promise, but an actual one. I think it can be. And since a lot of us are going to have dementia, and probably me, too … I think we should do more to make sure that people with dementia don’t have to be so terrified of it.

What is one example of the kind of care you hope we’ll see more of?

A lot of older buildings that are nursing homes had no easy access to the outdoors. In some cases, people might go literally years without ever feeling the outside air. And now, there are places that think we can do better than that. They’ve said even if somebody is in a wheelchair, why don’t we get one that they can operate by themselves? Why don’t we set up our facility so that the access is easy so the person can just present themselves at the door, the door will open automatically and they will be in, basically, a kind of walled garden? They can walk or roll about as much as they want, and end up back at the door. You can’t get lost. So, it’s that simple freedom that can make an enormous difference in somebody’s life.

Toward the end of the book, you wrote that you think you have a good chance of getting dementia when you’re older because both your mother and grandmother had it. Is that one of the reasons why you wanted to write the book?

The book is, in a sense, an enormous thought experiment for me to figure out: Can I make my peace with that? And if I’m going to have dementia, I’d like to have some joy in that life. I would like to be happy, because that’s really the point of life. So, I better think about how to be happy with dementia — and what would that look like and how would I do that.

What was it like for you to do that exercise?

I think it was very useful. It was very comforting to try and think about that. So, I thought that I would offer it as a suggestion (to readers of the book) because, as we know, a lot of people in middle age and up are really worried about ‘Oh man, what if I get dementia? It’s just the most horrible thing in the world.’

I’d like to at least tease them with the idea that maybe it doesn’t have to be so horrible. What could you think about, what could you bring with you into the stage of dementia that might make you happy? How could you remodel the world around you? So, if you wish there was a community garden where little kids come and plant bulbs, it may be great for older people with dementia to maybe sit and watch the little kids putting in the bulbs. Maybe you could work on that. It would be a great thing to do.

Hope for Simple Joy

In the last paragraph of her book, Powell described what she hopes she could still enjoy as a person with dementia.

She wrote: Even toward the end, I hope still to have some joy. I may not get there, but I’d like to see again one of my familiar places: the dancing world of Central Park on a perfect day. Leaves shimmer overhead in a light breeze. Midair Frisbees fly while dogs and people arc gracefully up to seize them for the ether. On the ground, a young couple on a picnic blanket, Motown on their boombox. Their wobbly first child stands, resplendent in a dinosaur-print onesie, his small hands in the large ones of his seated father. He cannot walk yet, but he dances, bobbing his padded bottom up and down. His face is the portrait of happiness, with the sun, his parents’ love, the breeze, the music all radiating through him. If I could be there again, trees, breeze, flying dogs and dancing babies, that would be enough. I’ll be seeing you.

The last paragraph of your book is beautiful, but also sad, as you talk about what you hope to be able to still enjoy if you have dementia.

It is a little sad, but it’s also about gratitude and feeling happy for the things that you have loved in life, and really hoping to find at least some of those things that you can still be happy about as you go forward and step into the future. What could you take with you that would still be a happy thing?

By Edie Grossfield

Edie has been a journalist for more than 20 years, reporting and editing for newspapers and magazines. She also worked in communications for a large health care organization. She holds a bachelor’s degree in communications and media and a master’s degree in journalism, both from the University of Wisconsin in Madison. Reach her by email at egrossfield@nextavenue.org.

Should All People 65+ Get Cognitive Assessments?

May 20, 2019

Experts agree it's crucial for early detection of dementia, but some have concerns
By Edie Grossfield

A special section in the recently released Alzheimer’s Association’s 2019 Alzheimer’s Disease Facts and Figures report focuses on the role primary care physicians can play in early detection of the disease. The association says all people 65 and older should receive some kind of assessment of their thinking and memory functions and that the primary care setting is the best place to do it. It should be a part of routine exams, said Joanne Pike, the association’s chief program officer.

“We hope the report will encourage seniors and physicians both to be more proactive in discussing cognitive health during the Medicare Annual Wellness Visit and other routine exams,” she said in the press release about the new report.

According to the report’s survey of 1,954 health care consumers age 65 and older, only half have received a cognitive assessment, and even fewer receive routine cognitive assessments.

Experts say early detection of mild cognitive impairment, which can lead to dementia and Alzheimer’s disease, is important in terms of treatment and other factors. But some see problems with assessing all people who are asymptomatic — that is, showing no signs of impairment and not complaining of thinking and memory problems.

The main concern is the lack of information regarding the accuracy of the tools commonly used to detect cognitive impairment. Those are structured tests such as the “Mini-Cog,” the “Mini-Mental State Examination” and the “General Practitioner Assessment of Cognition,” or GPCOG.

The Alzheimer’s Association’s survey of 1,000 primary care physicians found that nine out of 10 sometimes use one or more of these types of tests, along with their own observations, during office visits. If some indication of impairment is found, most of these doctors refer their patients to a specialist, according to the survey.

Concerns About ‘Mini’ Cognitive Assessments

Dr. Terry Quinn, a geriatrician, researcher at the University of Glasgow and editor with the Cochrane Dementia and Cognitive Improvement Group, has written and been involved in articles investigating the accuracy of several brief cognitive assessments. Quinn is concerned about cognitive screening for all asymptomatic people 65 and older, not only because there’s lack of evidence to show the tests are accurate, but because there’s lack of information about the emotional and practical impacts they can have on people when the tests miss problems or falsely find problems.

“For example, we don’t know whether asymptomatic older adults want screening, we don’t know the effects of an erroneous label of cognitive impairment, we don’t know if screening tests predict future cognitive change, we don’t know the health economics of screening, we don’t even know what to do with a positive screening result,” Quinn says. “There are many examples of screening tests that do more harm than good. I am not against cognitive screening per se, but I would, at least, like to see small-scale pilots before we introduce it at scale.”

One of the most commonly used brief cognitive assessments is the Mini-Cog, a three-minute test in which the patient is asked to remember three words, then draw a clock with the hands set to a certain time. After the patient completes the clock, he or she is asked to recall the three words given at the beginning of the test.

A Cochrane review of studies measuring the accuracy of the Mini-Cog to detect dementia stated that the highest-quality study found the Mini-Cog “failed to detect up to 24 percent of individuals who have dementia,” according to Cochrane. In addition, the same study found that “up to 27 percent of individuals may be incorrectly identified as having dementia.”

Most of the primary care physicians surveyed by the Alzheimer’s Association (94 percent) said it’s important to screen all people 65 and older for cognitive impairment, and 82 percent of the consumers surveyed said it’s important to have their thinking and memory functions checked.

However, the report also found a significant minority of consumer respondents who are concerned about assessment and testing. About one-third believe the tests are unreliable, and 24 percent agreed that “the idea of all seniors being tested for thinking or memory problems is insulting,” according to the report. Also, 19 percent believe that since there’s no cure or treatment for thinking or memory problems, “why bother testing for them.”

‘Is Something Better Than Nothing?’

Neurologist Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer’s Disease Research Center in Rochester, Minn., agrees that there are significant problems with brief cognitive tests, like the Mini-Cog, but still believes regular cognitive assessments should begin at age 65.

“I’m a neurologist, so I’m a specialist, and I sometimes cringe at those very, very coarse assessments of a complicated operation — namely cognitive function,” Petersen says. “But on the other hand, is something better than nothing?”

He says there’s plenty of debate about which brief assessments are better than others, “and studies show that ones that are a little more detailed and take a little longer to do, in fact, give you more information about the future outcome.”

But even at the simplest level, Petersen says, some kind of discussion of thinking and memory should happen during an annual physical exam for people 65 and older because early detection is important. So is having a baseline from which to compare future assessments, he adds.

“It could even be, ‘I asked Bill how his memory was and he said it was OK,’ and put that in the medical record. As incomplete as that might be, at least it shows that some attention has been paid to that issue. And I think that’s an important first step,” Petersen says.

The Alzheimer’s Association website lists these advantages to early detection of dementia:

  • Treatment that can lessen symptoms, such as memory loss and confusion, for a limited time
  • Opportunities to participate in clinical trials
  • A chance to prioritize other health issues, such as high blood pressure, smoking and fitness, which can help preserve cognitive function
  • Receiving emotional and social support as soon as possible
  • Planning for the future, including finances and care services

Petersen recommends that people 65 and older bring up the topic of cognitive function with their doctors. Not only can it lead to early detection of possible problems, he says, but peace of mind for those patients. He says studies by AARP and other organizations have found that Alzheimer’s disease is what most scares older people when it comes to medical issues.

“They’ve done surveys asking people, ‘What are you most concerned about?’ and you’d think [things like] heart disease or cancer, but it’s Alzheimer’s disease,” Petersen says. “They’re most concerned about losing their cognitive function, interactions with their family, losing their memory and things like that. So, if that’s the case, shouldn’t we at least open the door on this issue rather than waiting until something develops?”

By Edie Grossfield

Edie has been a journalist for more than 20 years, reporting and editing for newspapers and magazines. She also worked in communications for a large health care organization. She holds a bachelor’s degree in communications and media and a master’s degree in journalism, both from the University of Wisconsin in Madison. Reach her by email at egrossfield@nextavenue.org.

Plugging In

May 17, 2019

May is Older Americans Month! Communities that encourage the contributions of older adults are stronger! By engaging and supporting all community members, we recognize that older adults play a key role in the vitality of our neighborhoods, networks, and lives.

This year’s theme, Connect, Create, Contribute, encourages older adults and their communities to: 

  • Connect with friends, family, and services that support participation.
  • Create by engaging in activities that promote learning, health, and personal enrichment.
  • Contribute time, talent, and life experience to benefit others.

There is no greater example of this theme than our Longwood at Oakmont Technology Committee, led by Janis Ramey. Read on to learn more about how Janis connects Longwood residents, creates engaging and meaningful activities to help our residents use and understand technology, and contributes her technology expertise to benefit the lives of her fellow residents.

How Technology Enhances Connections at Longwood at Oakmont

I like to be involved wherever I live or in whatever I’m doing, and technology is one way for me to be a part of the community and to be able to not only contribute something, but meet people and create a network,” said Janis Ramey, a resident at Longwood at Oakmont. “I wouldn’t want to sit in my apartment and stare out the window.”

Janis brought her skills as a technical writer and teacher to Longwood about two years ago, and shared her knowledge with others after joining the Technology Interest Committee, helping to launch an app that Longwood residents fondly call the MyLAO app (LAO = Longwood at Oakmont).

The MyLAO app serves as a one-stop shop for the residents and team at Longwood at Oakmont. Users can look up names in the directory, read the resident handbook, view photos from events, see the daily activities and dining menus, play games, look at the weather forecasts and news, put in work requests and so much more.

To develop the app, Touchtown, an Oakmont-based resident engagement solutions company, teamed up with Janis and the committee in order to tailor the application to the needs and interests of the residents at Longwood. The app is heavily influenced by the Longwood at Oakmont Technology Interest Committee. Therefore, residents like Janis are able to help dictate the content and features included on the app, which enables the residents to make the most of their experience at Longwood.

Sean Porter, project manager at Touchtown, described the app as a way to “make it easier for residents to establish and maintain connections throughout their community, while taking advantage of all of the excellent resident engagement opportunities.”

Since joining the committee and helping to launch the MyLAO app, Janis has noticed how the introduction and integration of technology in the community has changed both her life and the lives of her fellow residents as they convert to a more digital world. “The MyLAO app has given me access to lots of information about what’s going on at Longwood, without the hassle of shuffling through paper announcements – which I consider an affront to our environment,” said Janis.

“We’re helping to save trees!” Sarah Kuhns, lifestyle engagement team leader and staff liaison at Longwood, works behind the scenes on the MyLAO app, uploading documents, information and reorganizing any features to keep them up to date. According to her, this surge of interest in technology from the residents has opened the doors to modern technology like social media and texting, which has allowed them to easily connect with friends and family members and heightening the camaraderie among the Longwood community.

To help residents struggling with the app or any of their devices in general, technical support sessions are held every Friday, where Janis and other residents on the committee help troubleshoot issues. The committee also holds the occasional “fireside chat,” which teaches residents how to perform certain tasks regarding technology, like sending photos from their iPhone.

Thanks to the efforts of Janis and the rest of the Technology Interest Committee, the MyLAO app has enriched its users’ lives and the Longwood community in the process.

My Neighborhood

May 15, 2019

“My time with Presbyterian SeniorCare Network has been ever evolving. I remember the day I interviewed to work here! I sat across from Kathy Hammar, who is now the Administrator here at Westminster Place. I remember how scared I was! She asked me why I wanted to work here, and I thought long and hard about my reasoning. I was inspired by my own mother who has been an RN for over 40 years! Growing up, I lived in a primarily elderly neighborhood. My parents took it upon themselves to give my brother and I exposure to our wonderful aging neighbors. I remember each of them fondly.

Here is where I gave my reasoning: I told her that I loved seniors and found them to be inspirational! My neighbor, Mr. Johnny next door, would have us over to sit on his porch until we were exhausted talking about the “good days” and when times were different. He was the kindest soul, he always called me “sweetheart.” My brother, Jonathan and I, had special permission to go into his garage and get out the extra lawn mower wheels from the shelf and race them down his hilly sidewalk on the side of his house, whenever we wanted! His neighbor, Mrs. Betty, was a lovely woman with white hair who lived alone. She was a joy and delight to talk with. She attended my birthday parties as a child. We didn’t sit too much on her porch, but she did invite me in and played piano for me. We also sat in her kitchen and talked for hours about her grandchildren and her kids. I loved listening to her speak about “the old days.” Across the street lived Mr. and Mrs. Jim and Cres. Two spunky individuals who I remember fondly. They drove a giant purple Cadillac and I don’t think she ever cooked a meal because they would invite us into their house and she always said “Let’s get you something special from the oven.” The oven was full of Lance sandwich crackers. On certain nights of the week they would be dressed in matching outfits to go square dancing! I loved seeing what outfit they would be wearing. These folks taught me a lot about life in general. And finally the last person who was the biggest influence in life, my Grammie. She played the biggest roll in raising me and I know that I wouldn’t be the person I am today without her.

I have stayed at Presbyterian SeniorCare Network for 10 years because of all of the people! Fellow team members, residents and family members have made a huge impact in my life. We have a resident who I care for currently, whose daughters hug me every time they see me! That is heartwarming to me! It makes it easier to get out of bed to come to work. This is my neighborhood and these are my neighbors. I must say my most cherished memory is getting to know all of the residents who I have had the pleasure of knowing and they will meet me again one day.

Like Emily, do you have a story about Presbyterian SeniorCare Network that you would like to share? We would love to hear it! Click here to visit our web page. Once there, please click on the button, Share My Story.

Once you have submitted your story, you will automatically be entered into a random drawing to win a $50 Visa gift card! Winners will be pulled the first Monday of every month.

 
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