Friday, March 15, 2019

The Negative Effects of Elderspeak

Talking down to older adults is not only disrespectful, but it can be detrimental

By Julie Pfitzinger
January 9, 2019

Faye Kirtley doesn’t appreciate it when store clerks talk down to her and act as if “I don’t know what I’m doing,” she said.

“It’s embarrassing, and I don’t know why they think it’s okay to treat an older person like that,” added the 88-year old resident of Bardstown, Ky. “Maybe they have people in their family that they talk down to, too.”

Barbara Tack, 76, of Exeter, N.H. cringes at diminutives such as “miss” and “little lady” and has been known to correct a supermarket cashier on the impact of those monikers.

“I told him, ‘I am not young, and I think it’s an insult to call attention to my age at all,’” said Tack. “He did seem chagrined, so I tempered it with something like, ‘It makes me feel bad that all you can see is my age.’ But I hear that kind of condescending comment way too often.”

Tack also shared a story about a friend, a 70-year-old man, who was offended by what he perceived to be very childlike instructions given to him by a nurse in a doctor’s office: “Sorry, you have to remove your sweater for me to take your blood pressure. I know it’s cold outside and you can put it back on right away.”

Elderspeak Reveals Perception
What Kirtley and Tack are describing are signs of what is referred to as “elderspeak.” It occurs when an older adult is spoken to by health care workers, service personnel, neighbors or even family members as if he or she is a child with limited understanding.

In a recent article in The Chicago Tribune, Anna I. Corwin, an anthropologist and professor at St. Mary’s College of California in Moraga, noted that elderspeak “sounds like baby talk or simplified speech” and is, in fact, a symptom of how older adults are often perceived.

“Americans tend to view and treat older adults as no longer productive in society. And that’s how we define personhood, as an adult who is a productive member of society,” Corwin said.

Elderspeak involves talking slowly and at a louder volume, with pronounced enunciation; it also employs the frequent use of words such as “sweetie,” “dear” or the pronoun “we” when referring to the older person (as in, “Do we want to go to dinner now?”).

The Negative Impact of Elderspeak
Not only is this type of speech condescending and disrespectful to older adults, it can be damaging to their mental health and well-being.

According to Becca Levy, a researcher on a study on the effects of elderspeak, by Yale University, the practice “sends a message that the patient is incompetent, and begins a negative downward spiral for older adults who react with decreased self-esteem, depression and withdrawal.”

Further, those living with mild to moderate dementia can be even more negatively impacted by this type of language. These people can become aggressive or uncooperative when elderspeak is used, according to the Yale report.

The Importance of Respect
In an article about the dangers of ageism by LifeCare Advocates, a care management practice based in Newton, Mass., one of the tactics mentioned for reducing the use of elderspeak involves training health care workers not only to refrain from using diminutives, but to ask the older adult how he or she wants to be addressed. For some of them, the automatic use of their first names demonstrates a lack of respect.

Kirtley, who tends not to correct those who speak down to her for fear of “causing an incident,” still decries the practice of elderspeak. She’d be happier to always be treated with the respect she said everyone deserves.

“It’s an issue of dignity,” Kirtley said.

Julie has worked as a writer and editor for more than 20 years; most recently she was a managing editor for the community lifestyle magazine group at Tiger Oak Media in Minneapolis, where she also served as editor of Saint Paul Magazine. Julie can be reached via email at    Follow her on Twitter @juliepfitzinger.

Friday, March 1, 2019

Just Diagnosed - Questions for your doctor

After receiving your diagnosis (Alzheimer's), it's normal to leave your doctor's office unsure of what questions to ask. You just received life-changing news, and you need time to absorb this information and understand what it means for you and your family.

Your doctor is an important member of your care team. Use the opportunity to ask your doctor questions about your diagnosis, all the available options, and the benefits and risks of each choice you make.

You may be asking: "How do I know what to ask my doctor?"

Members of our Alzheimer's Association National Early-Stage Advisory Group have shared their own experiences and questions they wish they had asked their doctors. You may find this information helpful as you develop your own list of questions.

Here are some example questions:

The diagnosis of Alzheimer's disease
  1. What test(s) or tools did you use to determine my diagnosis?
  2. What are you measuring with the tests you performed?

Alzheimer's disease
  1. How will the disease progress?
  2. What can I expect in the future?

  1. What treatment options are available?
  2. Which symptoms are being targeted by each medication?

Clinical trials
  1. What clinical trials are available?
  2. Where can I find published information about clinical treatment studies?

Care team
  1. How familiar are you with Alzheimer's disease? Will you be managing my care going forward?
  2. If I need to be hospitalized, will you be able to provide care in this setting?

Care and support
  1. What resources are available to help me learn more about my diagnosis? My family?
  2. What support services are available to help me live well with the disease, for as long as possible?

Friday, February 15, 2019

Study Offers Hint of Hope for Staving Off Dementia in Some People

Republished from:

By Pam Belluck

People who received intensive treatment for hypertension were less likely to develop minor cognitive problems than those receiving standard treatment.

In dementia research, so many paths have led nowhere that any glimmer of optimism is noteworthy.
So some experts are heralding the results of a large new study, which found that people with hypertension who received intensive treatment to lower their blood pressure were less likely than those receiving standard blood pressure treatment to develop minor memory and thinking problems that often progress to dementia.

The study, published Monday in JAMA, is the first large, randomized clinical trial to find something that can help many older people reduce their risk of mild cognitive impairment — an early stage of faltering function and memory that is a frequent precursor to Alzheimer’s disease and other dementias.

The results apply only to those age 50 or older who have elevated blood pressure and who do not have diabetes or a history of stroke. But that’s a condition affecting a lot of people — more than 75 percent of people over 65 have hypertension, the study said. So millions might eventually benefit by reducing not only their risk of heart problems but of cognitive decline, too.

“It’s kind of remarkable that they found something,” said Dr. Kristine Yaffe, a professor of psychiatry and neurology at University of California San Francisco, who was not involved in the research. “I think it actually is very exciting because it tells us that by improving vascular health in a comprehensive way, we could actually have an effect on brain health.”

The research was part of a large cardiovascular study called Sprint, begun in 2010 and involving more than 9,000 racially and ethnically diverse people at 102 sites in the United States. The participants had hypertension, defined as a systolic blood pressure (the top number) from 130 to 180, without diabetes or a history of stroke.

These were people who could care for themselves, were able to walk and get themselves to doctors’ appointments, said the principal investigator, Dr. Jeff D. Williamson, chief of geriatric medicine and gerontology at Wake Forest School of Medicine.

The primary goal of the Sprint study was to see if people treated intensively enough that their blood pressure dropped below 120 would do better than people receiving standard treatment which brought their blood pressure just under 140. They did — so much so that in 2015, the trial was stopped because the intensively treated participants had significantly lower risk of cardiovascular events and death that it would have been unethical not to inform the standard group of the benefit of further lowering their blood pressure.
But the cognitive arm of the study, called Sprint Mind, continued to follow the participants for three more years even though they were no longer monitored for whether they continued with intensive blood pressure treatment. About 8,500 participants received at least one cognitive assessment.

The primary outcome researchers measured was whether patients developed “probable dementia.” Fewer patients did so in the group whose blood pressure was lowered to 120. But the difference — 149 people in the intensive-treatment group versus 176 people in the standard-treatment group — was not enough to be statistically significant.

But in the secondary outcome — developing mild cognitive impairment or MCI — results did show a statistically significant difference. In the intensive group, 287 people developed it, compared to 353 people in the standard group, giving the intensive treatment group a 19 percent lower risk of mild cognitive impairment, Dr. Williamson said.

Because dementia often develops over many years, Dr. Williamson said he believes that following the patients for longer would yield enough cases to definitively show whether intensive blood pressure treatment helps prevent dementia too. To find out, the Alzheimer’s Association said Monday it would fund two more years of the study.

“Sprint Mind 2.0 and the work leading up to it offers genuine, concrete hope,” Maria C. Carrillo, the association’s chief science officer, said in a statement. “MCI is a known risk factor for dementia, and everyone who experiences dementia passes through MCI. When you prevent new cases of MCI, you are preventing new cases of dementia.

Dr. Yaffe said the study had several limitations and left many questions unanswered. It’s unclear how it applies to people with diabetes or other conditions that often accompany high blood pressure. And she said she would like to see data on the participants older than 80, since some studies have suggested that in people that age, hypertension might protect against dementia.

The researchers did not specify which type of medication people took, although Dr. Williamson said they plan to analyze by type to see if any of the drugs produced a stronger cognitive benefit. Side effects of the intensive treatment stopped being monitored after the main trial ended, but Dr. Williamson said the biggest negative effect was dehydration.

Dr. Williamson said the trial has changed how he treats patients, offering those with blood pressure over 130 the intensive treatment. “I’ll tell them it will give you a 19 percent lower chance of developing early memory loss,” he said.

Dr. Yaffe is more cautious about changing her approach. “I don’t think we’re ready to roll it out,” she said. “It’s not like I’m going to see a patient and say ‘Oh my gosh your blood pressure is 140; we need to go to 120.’ We really need to understand much more about how this might differ by your age, by the side effects, by maybe what else you have.”

Still, she said, “I do think the take-home message is that blood pressure and other measures of vascular health have a role in cognitive health,” she said. “And nothing else has worked.”

Pam Belluck is a health and science writer. She was one of seven Times staffers awarded the 2015 Pulitzer Prize for International Reporting for coverage of the Ebola epidemic. She is the author of “Island Practice,” about a colorful and contrarian doctor on Nantucket. @PamBelluck

Friday, February 1, 2019

There’s Still Time to Go Back to Traditional Medicare or Change MA Plans

Republished from:

Annual Enrollment has ended, but the Medicare Advantage Open Enrollment Period, allowing plan changes or a return to traditional Medicare continues through March 31 – Make sure you are fully informed about the Medicare that is right for you.

January 1–March 31

What Can I Do?
If you’re in a Medicare Advantage Plan (with or without drug coverage), you can switch to another Medicare Advantage Plan (with or without drug coverage).

You can disenroll from your Medicare Advantage Plan and return to Original Medicare. If you choose to do so, you’ll be able to join a Medicare Prescription Drug Plan.

If you enrolled in a Medicare Advantage Plan during your Initial Enrollment Period, you can change to another Medicare Advantage Plan (with or without drug coverage) or go back to Original Medicare (with or without drug coverage) within the first 3 months you have Medicare.

What Can't I Do?
1.       Switch from Original Medicare to a Medicare Advantage Plan.
2.       Join a Medicare Prescription Drug Plan if you're in Original Medicare.
3.       Switch from one Medicare Prescription Drug Plan to another if you're in Original Medicare.

10 Ways to Love Your Brain

Growing evidence indicates that people can reduce their risk of cognitive decline by adopting key lifestyle habits. When possible, combine these habits to achieve maximum benefit for the brain and body. Start now. It’s never too late or too early to incorporate healthy habits.

Break a sweat
Engage in regular cardiovascular exercise that elevates your heart rate and increases blood flow to the brain and body. Several studies have found an association between physical activity and reduced risk of cognitive decline.

Hit the books
Formal education in any stage of life will help reduce your risk of cognitive decline and dementia. For example, take a class at a local college, community center or online.

Butt out
Evidence shows that smoking increases risk of cognitive decline. Quitting smoking can reduce that risk to levels comparable to those who have not smoked.

Follow your heart
Evidence shows that risk factors for cardiovascular disease and stroke — obesity, high blood pressure and diabetes — negatively impact your cognitive health. Take care of your heart, and your brain just might follow.

Heads up!
Brain injury can raise your risk of cognitive decline and dementia. Wear a seat belt, use a helmet when playing contact sports or riding a bike, and take steps to prevent falls.

Fuel up right
Eat a healthy and balanced diet that is lower in fat and higher in vegetables and fruit to help reduce the risk of cognitive decline. Although research on diet and cognitive function is limited, certain diets, including Mediterranean and Mediterranean-DASH (Dietary Approaches to Stop Hypertension), may contribute to risk reduction.

Catch some Zzz's
Not getting enough sleep due to conditions like insomnia or sleep apnea may result in problems with memory and thinking.

Take care of your mental health
Some studies link a history of depression with increased risk of cognitive decline, so seek medical treatment if you have symptoms of depression, anxiety or other mental health concerns. Also, try to manage stress.

Buddy up
Staying socially engaged may support brain health. Pursue social activities that are meaningful to you. Find ways to be part of your local community — if you love animals, consider volunteering at a local shelter. If you enjoy singing, join a local choir or help at an after-school program. Or, just share activities with friends and family.

Stump yourself.
Challenge and activate your mind. Build a piece of furniture. Complete a jigsaw puzzle. Do something artistic. Play games, such as bridge, that make you think strategically. Challenging your mind may have short and long-term benefits for your brain.

Tuesday, January 15, 2019

Just 6 Months of Walking May Boost Aging Brains

Republished from:

By Amy Norton
HealthDay Reporter
THURSDAY, Dec. 20, 2018 (HealthDay News)

Walking and other types of moderate exercise may help turn back the clock for older adults who are losing their mental sharpness, a new clinical trial finds.

The study focused on older adults who had milder problems with memory and thinking skills. The researchers found that six months of moderate exercise -- walking or pedaling a stationary bike -- turned some of those issues around.

Specifically, exercisers saw improvements in their executive function -- the brain's ability to pay attention, regulate behavior, get organized and achieve goals. And those who also made some healthy diet changes, including eating more fruits and vegetables, showed somewhat bigger gains.

The effect was equivalent to shaving about nine years from their brain age, said lead researcher James Blumenthal, a professor at Duke University School of Medicine, in Durham, N.C.

In contrast, those same mental abilities kept declining among study participants who received health education only.

Experts said the findings support the general concept that a healthy lifestyle can help protect the brain as you age.

"And it's never too late to start," said Keith Fargo, director of scientific programs and outreach for the Alzheimer's Association. "The people in this study were older, already had cognitive [mental] impairments and cardiovascular risk factors, and they were sedentary."

Fargo, who was not involved in the research, described the findings as "great news."

He said that's in large part because this was a clinical trial that actually put exercise to the test. Many past studies have found that physically active people tend to be in better mental shape as they age. But those studies don't prove cause and effect, Fargo noted. Clinical trials do.

Blumenthal echoed the "never too late" message, and also said the exercise routine used in the trial was very accessible. People walked or rode a stationary bike three times a week, for 35 minutes with a 10-minute warmup.

"They weren't training for a marathon," he added.

Blumenthal said the same of the diet changes some study participants made. They followed the so-called DASH diet, which is routinely recommended for people with high blood pressure. It is rich in fruits, vegetables, whole grains and healthy unsaturated fats, and low in sodium, sugar, and meat and dairy high in saturated fat.

Fargo agreed that those changes are within reach for most older adults. "Almost everyone can get up and sweat a few times a week," he said. "Almost everyone can eat more fruits and vegetables than they already do."

For the study, Blumenthal's team recruited 160 adults, aged 55 and older, who had complaints about their memory and thinking abilities. Objective tests confirmed that they had signs of impairment.
None had full-blown dementia, such as Alzheimer's disease. But at the outset, the group's performance on tests of executive function was similar to that of people in their early 90s -- even though their real average age was about 65.

Participants were randomly assigned to one of four groups: one that exercised; one that followed the DASH diet; one that exercised and made the diet switch; and another that received health education only.

After six months, both exercise groups showed improvements in tests of executive function, while the health-education group continued to decline. People who exercised and followed the DASH diet seemed to fare best -- but the diet alone did not make a statistically significant difference.

Blumenthal stressed that the study group was small, which makes it more difficult to tease out the effects of each intervention. He said larger studies are still needed.

It's also unclear whether exercise and diet can ultimately delay or prevent full-blown dementia in some people.

Why would exercise and a healthy diet help with thinking skills?
It's not clear, Blumenthal said. But in this study, there was a correlation between improvements in physical fitness and people's test performance. Similarly, if their heart disease risk factors improved -- a drop in blood pressure, for example -- their test scores rose, too.

According to Fargo, that's consistent with the theory that a healthier flow of blood and oxygen to the brain may boost older adults' mental acuity.

He noted that the Alzheimer's Association is launching a trial that will test a combination of lifestyle changes -- exercise and diet, plus social engagement and mentally stimulating activities such as puzzles and crosswords.

It will look at whether those measures can protect mental function in older adults at increased risk of decline.

The study was published online Dec. 19 in the journal Neurology.
SOURCES: James Blumenthal, Ph.D., professor, psychiatry and behavioral sciences, and psychology and neuroscience, Duke University School of Medicine, Durham, N.C.; Keith Fargo, Ph.D., director, scientific programs and outreach, Alzheimer's Association, Chicago; Dec. 19, 2018, Neurology, online

Tuesday, January 1, 2019

After marijuana edibles helped dying Holocaust survivor battle Alzheimer's, his family's foundation pushes for more research

Republished from:

By FORD VOX Dec 9, 2018, 1:50 PM ET

A Massachusetts family’s experience giving marijuana edibles to their dying patriarch is set to kick off a desperately needed investigation into how cannabis might treat some of the more troubling symptoms of Alzheimer’s disease, a condition that affects 5.7 million Americans.

Alexander Spier spent three years during the Holocaust in Auschwitz and other concentration camps as punishment not only for his heritage but also because he had fought against the Nazis with the Dutch Underground. Spier was eventually able to emigrate to the U.S. from Holland in 1945, where he began working as a watchmaker and jeweler before moving into real estate and construction.

Today, Spier’s family runs the multimillion-dollar company that he built, Mayfair Realty & Development Corporation. They’ve also carried on his tradition of philanthropy through the Spier Family Foundation, which has supported a variety of medical research through different hospitals in the past.

Harvard’s McLean Psychiatric Hospital is one of those institutions supported by the Spiers. And now, it’s partnering with the family to research the potential benefits of medical marijuana on Alzheimer’s and other forms of dementia.

Spier died of complications related to Alzheimer’s in 2017. His final two years were characterized by rapid decline, which his son, Greg Spier, described as torturous.

“It was the most difficult time of my life, having to see him deteriorate. My father spoke five languages, and he was speaking Dutch and German, reliving the three concentration camps he survived,” Greg Spier said, recalling how his father often pleaded, “Where is my mother?” in German.

Alex’s story is typical for many of the 50 percent of Alzheimer’s patients who develop so-called neuropsychiatric symptoms of the condition, characterized by agitation, anxiety, depression, psychosis, wandering and pacing.

For Alex Spier, the symptoms became too much to continue with assisted living, where he managed to escape twice. But even after his family moved him to a dedicated memory care program in Florida, where he was given supplementary care and a private attendant, his condition progressed.

Doctors resorted to aggressive medications, including a variety of antipsychotic and antiseizure drugs, but the sedation they caused — side effects of their use — only seemed to worsen his agitation and delirium.

In a decision that at first divided the family, Greg Spier and a niece who lives in Colorado decided to try marijuana edibles. The last-ditch effort involved Greg Spier, along with a private assistant, feeding his dad granola bar marijuana edibles up to four times a day during his final three months.
“The only thing that seemed to give him any reprieve was the marijuana,” Greg Spier said, adding that it allowed his dad to sleep.

According to Dr. Brent Forester, chief of the division of geriatric psychiatry at McLean, the science of medical cannabis for dementia is far behind what families like the Spiers are already doing on their own. Alex Spier wasn’t his patient, but Forester was fascinated to learn about the family’s success with edibles last year.

Forester’s own research involves the synthetic THC drug dronabinol, an FDA-approved medicine for chemotherapy-related nausea and AIDS-associated weight loss, which can cost $400 to $1,500 without insurance coverage.

Forester and his colleagues have published promising study results after giving dronabinol to agitated and distressed dementia patients, and are currently recruiting for a larger multicenter trial funded by the National Institute on Aging.

It’s true that in teens and young adults, frequent marijuana use is associated with a lower IQ and an increased risk of psychiatric disorders. In adults who have been using it since adolescence, it has been found to erode memory and visuospatial skills.

But these negative impacts could be limited to young brains that are exposed to marijuana for extended periods, and they might not be true for people who begin in older age. When a team of German and Israeli researchers gave low doses of THC to old mice, for example, learning and memory improved to a level similar to young mice.

When these scientists examined the brain tissue, they found that the mice given the THC had more complex hippocampal connections. By contrast, THC worsened brain function in young mice.

More promising for Alzheimer’s disease, animal research has also shown that THC may increase the neurotransmitter acetylcholine, just like the FDA-approved dementia drug Aricept. THC also appears to slow the accumulation of amyloid beta plaques, the hallmark characteristic of Alzheimer’s.
Forester and his colleagues theorize that these protective effects — which result from the use of cannabinoid drugs — might reduce the risk of the abnormal behaviors associated with dementia. However, only time and research will tell.

The Spier Family Foundation is eager to support this work and is giving private dollars to fund it. Federal funding is difficult to obtain with marijuana still being classified as a schedule I controlled substance, defined as “having no currently accepted medical use and a high potential for abuse.”

There are currently no FDA-approved drugs that treat the behavioral symptoms of dementia, which can become the most distressing aspect of the condition. Current drugs that are given to Alzheimer’s patients, such as antipsychotics and benzodiazepines, can even make their symptoms worse due to side effects, Forester said.

“We really need to open up opportunities to study medical marijuana for this particular indication. I think there’s enough evidence from the synthetic THC as well as anecdotal reports that it’s certainly worth studying,” Forester said.

The Spier Family Foundation’s willingness to fund this work is extraordinarily important, Forester said, adding that he was hopeful the medical marijuana industry will see the value in supporting such research as well.

Dr. Ford Vox practices rehabilitation medicine at the Shepherd Center in Atlanta and contributes analysis to the ABC News Medical Unit.