Home Care CareGivers

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CareGivers providing in home care often are faced with various levels of Alzheimer’s disease. The memory loss found during home care varies in degree and thus requires flexible and sometimes creative caregiving techniques.  The follow is a recap of President Ronald Regan’s battle with Alzheimer’s.  Care-To-Go CareGivers in the Phoenix, Scottsdale, Chandler and Gilbert areas salute his contribution to America.

When Alzheimer’s Waited Outside the Oval Office

By LAWRENCE K. ALTMAN, M.D.

WASHINGTON — Ron Reagan’s new memoir, “My Father at 100,” has touched off sensational headlines with its suggestion that President Ronald Reagan might have begun showing hints of Alzheimer’s disease while still in the White House.

But in two interviews this month, the younger Mr. Reagan said he never meant to suggest that his father had dementia before leaving office in 1989. And he graciously took the blame for not being more explicit in a passage that described a few personal observations along with comments from the former president’s doctors.

A “rather small section of the book has attracted outsize attention,” he said in a telephone interview from Seattle, where he lives.

All he meant, he continued, was that the amyloid plaque characteristic of Alzheimer’s can start forming years before it leads to dementia. The former president’s diagnosis was made in 1993, four years after he left office.

“Given what we know about the disease,” his son told me, “I don’t know how you could say that the disease wasn’t likely present in him during the presidency.”

Had it been stated that way, the assertion about Alzheimer’s would have stirred little if any debate. Still, the issue is important for anyone — including candidates for office — because of the difficulty of distinguishing the initial symptoms of Alzheimer’s from, say, simple forgetfulness.

The disease occurs most frequently after 70, but it can strike younger people. Dr. Alois Alzheimer, a German psychiatrist, diagnosed the first case in a 51-year-old woman. It is now recognized as one of a number of types of dementia. And diagnosing it with certainty requires a brain biopsy, rarely done while a patient is still alive.

Mr. Reagan’s mental state was an issue even before he became the oldest man elected president, at 69, in 1980. Adversaries were fond of attributing his penchant for contradictory statements, forgetting names and general absent-mindedness to Alzheimer’s.

I reported on Mr. Reagan’s health, and he told me that his mother, Nelle, had died of senility — and that if he were to develop it in office he would resign.

As a follow-up to questions about Alzheimer’s, my extensive interviews with his White House doctors, key aides and others, I found no evidence that Mr. Reagan exhibited signs of dementia as president. The interviews did not include family members.

Moreover, until Ron Reagan’s memoir appeared, no other family member — and not Edmund Morris, the official biographer who spent seven years with Mr. Reagan in the White House — publicly hinted that he showed evidence of Alzheimer’s as president.

“My Father at 100” (Viking) is an affectionate, often lighthearted account of a son’s attempt to uncover his father’s character by going back to his early days. It is generally well written, except for portions of the closing chapter about Alzheimer’s — which Ron Reagan acknowledged were flawed because he “relied on memory” without checking facts about when and where the suspicion of his father’s Alzheimer’s was first raised.

He writes, for example, that after the former president fell from a bucking horse in Mexico in 1989, his doctors detected probable signs of Alzheimer’s in removing a blood clot that formed between his skull and brain. But such a procedure does not involve a brain biopsy that doctors would need to diagnose dementia.

Moreover, Mr. Reagan was flown to a military hospital near Tucson — not taken to San Diego, as his son writes — and the blood clot, a subdural hematoma, was removed weeks later at the Mayo Clinic in Rochester, Minn.

In the interviews, Ron Reagan genially acknowledged the errors and said that if he had anticipated the controversy he created, he “would have done more due diligence in terms of pinning down dates.”

When his father was president, Mr. Reagan, then a professional dancer with the Joffrey Ballet, visited him two or three times a year. Now 52, the younger Reagan has been a radio and television talk show host, commentator and magazine writer. In the book, he writes that he did not want his father to run for a second term, partly because of political differences (Ron has long been liberal) and partly because of his concern about Mr. Reagan’s health — not the possibility of Alzheimer’s, but the near-fatal gunshot wound he sustained in a 1981 assassination attempt.

Understandably, the son’s memories about his father’s Alzheimer’s focused on when it first produced symptoms. The anecdotes that he cites are either well known or lack convincing evidence for Alzheimer’s.

For example, he recounts the 1984 re-election campaign, when his father performed dismally as he floundered through his responses and was lost for words in his first debate with his opponent, Walter F. Mondale. But Mr. Reagan performed well in the second debate, 11 days later.

While spending a day in the Oval Office in 1987, the younger Reagan noticed that aides were providing his father with scripted index cards — a technique he often used when giving speeches — for phone calls lasting five minutes at most, implying signs of a failing memory. But in an interview, Mr. Reagan said it was “hard to know what to make of that” — and laughed as he said he was using similar notes in our conversation.

The son noted little things that he could not explain and to which he did not attach a name at the time. Based on knowing his father’s demeanor and cognition over a lifetime, the observations created an impression “that something was amiss.” But, he wrote, he did not want to leave an impression that his “father was catatonic or mumbling incoherently” at any period in the White House.

In his last months, Mr. Reagan held court from a hospital bed in his den, uncomplaining and gently agreeable. By this time he looked younger; his face had lost many of its worry lines and wrinkles. But as he stopped eating and drinking and his kidneys failed, Mr. Reagan lost the decade-long battle with Alzheimer’s and died on June 5, 2004.

Alzheimer’s hereditary patterns are not precisely known. Ron Reagan said he is aware that he is at risk for the disease. But he has not had genetic tests for it, and has not been asked or volunteered to take part in any study of the family history of Alzheimer’s.

Care-To-Go provides home care and caregivers in the Phoenix, Scottsdale, Chandler and Gilbert areas.

By David Lowell, MD

The holidays can be a time of renewal – renewal of friendships through visits and cards, renewal of family relationships through gatherings and shared meals, and renewal of one’s faith. But the holidays also are a time that can be particularly challenging for a family caregiver. It is a time during which the changes in one’s life are highlighted and there are additional demands placed upon on an already stressed life.
The holidays are always a whirlwind and this is especially true for caregivers. During the holidays it is important for caregivers to seek a balance – between caring for someone else and caring for oneself; between celebrating good memories of past holidays while not dwelling on what might have been lost. Here are ideas to keep in mind for both the caregiver and the care receiver as the holiday season arrives:
Ideas for the Caregiver:
1. Don’t try to do it all. In the past you may have prepared Christmas dinner for 20 and created hand-made gifts for all of your relatives. Ask other members of the family to carry on specific family traditions. Dividing the responsibility will help you manage your stress level. 
2. Don’t attempt to travel long distances by car if your loved one is not used to it and tires easily. You will both be exhausted by the time you reach your destination, and you will have a difficult time enjoying yourself. 
3. Ask family or friends to provide respite care. Make time to enjoy holiday decorations or window shopping. Just a few hours of time by yourself or with a friend can be renewing and help combat a sense of isolation. 
4. Avoid comparisons with past holidays. It is often emotionally draining to look upon change as loss. “Life is change” can be a helpful concept to hold onto. 
5. Create new traditions that can be carried on year to year, rather than dwelling on old traditions that your loved one can no longer participate in.
Ideas for Your Loved One:
1. Find a way to have your loved one participate in the holidays, whether its making decorations or counting the days on an Advent calendar
2. Decorate your loved one’s room or living area for the holidays. Incorporate symbols and decorations that are meaningful. 
3. Stimulate all of your loved one’s senses with the sounds, sights, smells and tastes of the holidays. Ideas include holiday music and decorations, a favorite dessert and familiar scents.
4. Familiar holiday foods are a nice way to evoke positive memories.
5. If your loved one is in a care facility, extend traditions to other people in the facility. For example, pass out holiday cards or make a traditional dessert to share.

For families caring for elder loved ones at home, respite care can be a great relief during the holidays. It can be a great relief for the family caregiver as well as the senior. There are two options. First the caregiver can stay with the senior at home while the family members take a break. The other option is to take the senior out for an outing.

For Home Care in the Phoenix area contact Care-To-Go (480) 284-8611 Care-To-Go.com

Caregiver Explains How To Prevent Falls With Better Balance

By John Hanc New York Times

Unintentional falls among those 65 and older are responsible for more than 18,000 deaths and nearly 450,000 hospitalizations annually in the United States, according to the Centers in Atlanta. Most of these falls are caused by a decline in that complex and multidimensional human skill known as balance.

Balance is a critical issue to older people. And more and more, at one-on-one training facilities like Mr. Morea’s or at larger health clubs, whether in yoga and Pilates studios or adult-education exercise classes for older adults, balance training is becoming a priority.

To remain upright and sure-footed, explained Dr. David Thurman, a neurologist with the center and a spokesman for the American Academy of Neurology, “there are several components of the nervous system, as well as motor or movement functions, that need to be intact.” These include the vestibular system of the inner ear, vision and proprioception, the ability to sense where one’s arms, legs or other parts of the body are without looking at them, as well as the strength and flexibility of bones and soft tissue.

“All of these,” Dr. Thurman said, “tend to degrade with age, particularly as people move into their seventh and eighth decades.”

Yet, unlike many effects of aging, balance can be improved, and the age-related declines can be delayed or minimized with proper training.

“The preponderance of evidence,” Dr. Thurman said, “shows fairly convincingly that strength and balance training can reduce the rate of falls by up to about 50 percent.”

Hence, the Department of Health and Human Services in revising its national physical activity guidelines, issued in 2008, added a recommendation for the elderly to include balance exercises as part of their overall physical activity regimen.

The problem, said Michael Rogers, an exercise scientist at Wichita State University, is that while most major public health agencies recommend 30 minutes a day of cardiovascular exercise for the heart and two or three sessions a week of strength training, “there is no real exercise prescription for balance.” So activities that promote balance tend to become integrated into other activities. Mr. Morea does this with older clients like Ms. Luftig in twice-weekly, 30-minute strength-training sessions.

Of course, while it is good to have supervision by a certified fitness professional, not to mention the benefit of a gym full of balance toys (and there are many these days, including wobble boards, balls and cushions), one does not have to work out with a personal trainer to get the benefits of balance training.

“You can do it anytime, anyplace,” said Mr. Rogers, who is research director at Wichita State’s Center for Physical Activity and Aging and teaches exercise classes to older adults. “You don’t have to be involved in a systematic program.”

He added, “You don’t have to be standing on one foot, which is often too difficult for some older people. You can challenge your balance while brushing your teeth.” Simply put one foot in front of the other while you brush, or stand with your feet closer together.

Balance training is often seen as part of a larger trend called functional fitness exercises, which are geared to helping one handle the physical challenges of day-to-day life. Around holiday time, for example, Mr. Rogers tries to prepare the elderly in his class for crowded shopping malls. He has them walk between narrow gaps, occasionally getting brushed by others. This, he said, “helps give them confidence” to face the holiday throngs.

Trainers like Mr. Morea devise balance training drills for their older clients. For example, a woman was having trouble bending down in her kitchen to reach to the back of a floor-level cupboard and retrieve cooking pots. So he developed “pot squat and reach” — a movement that basically imitated what she was doing, except on an unstable surface, so that she could develop the strength, neural connections and balance to confidently perform that movement at home.

One of the nice things about balance training is that the results can be evident fairly quickly.

“The nervous system has considerably more regenerative capacity well into the senior years than we used to think,” said Dr. Thurman. “The capacity for adjustment, compensation and even developing new skills remains there.”

Which is exactly what Ms. Luftig, who lives in Greenwich Village, has found. “I feel more confident,” she said. “In my neighborhood, you have bicycles whizzing by you all the time. You could lose your balance when they come so close. But when that happens now, I feel more stable. I have this ability that I didn’t used to have.”

For assistance in the Phoenix area contact Care-To-Go at 480-284-8611

Phoenix Care-To-Go CareGiver points to article on Flue Shots

A recent comprehensive review of clinical trials suggests that there has been LITTLE evidence to demonstrate the flu vaccines used in the past 40 years are safe to use to prevent flu effectively in people aged 65 years and over.

Ironically, elderly people are among the most vulnerable and they are in the priority group to receive flu vaccine as the medical industry and government health agencies keep telling them that flu vaccine is the best preventative against flu.

Tom Jefferson of the Cochrane Collaboration in Rome, Italy and colleagues conducted a thorough search of studies based on previous vaccine trials.   Of the 75 studies reviewed, the researchers were able to identify only one recent randomized controlled trial with "real" outcomes.  All the other studies in the review except one were considered of low quality and open to bias, Wiley-Blackwell, the journal publisher says in a press release.

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Contact Care-To-Go for Phoenix Home Care CareGivers and Phoenix Travel Companions for Seniors 800-818-0407

Care-To-Go Travel Companions are always on the lookout for interesting travel deals and ideas.  The following article for travel agents reveals Top 30 Themed Cruises for 2010.  Traveling Caregiver assistance can make a vacation for a senior an enjoyable and safe event.

Tapping into themed cruises that precisely match your client’s interest, hobby or passion is equivalent to adding a “must-have” ingredient to your recipe for sales success.

Themed cruises often include private onboard events or activities not open to regular cruise guests. So, “the cruise isn’t sold based on price, it’s sold on a specific experience,” stresses Susan Schaefer, independent affiliate of America’s Vacation Center, Brentwood, TN. “Your client isn’t looking for the lowest price, so you aren’t competing with pricing when selling a themed cruise.”

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Care-To-Go Travel Companions can be reached at 800-818-0407 or on the web at www.CareToGoTravel.com