As Kathy Helgerson slipped the pair of MINDVR goggles over Rita Strauss’ head, the reaction was instant.
“It looks like Midnight!” Strauss, 87, said with glee. “My tomcat.”
It’s moments like this that lead Helgerson, Strauss’ daughter and founder of “Simple Steps to Technology” to say she has “the best job in the world.”
“It is so powerful, I can’t even tell you,” Helgerson said, tears welling in her eyes at the spark of recognition from her mom, who has Alzheimer’s. “It brings up those memories of the past. … If you had asked my mom about (the cat) normally, she would have forgotten about it.”
You’ve turned 65 and exited middle age. What are the chances you’ll develop cognitive impairment or dementia in the years ahead?
New research about “cognitive life expectancy” — how long older adults live with good versus declining brain health — shows that after age 65 men and women spend more than a dozen years in good cognitive health, on average. And, over the past decade, that time span has been expanding.
By contrast, cognitive challenges arise in a more compressed time frame in later life, with mild cognitive impairment (problems with memory, decision-making or thinking skills) lasting about four years, on average, and dementia (Alzheimer’s disease or other related conditions) occurring over 1½ to two years.
I had hoped that by now most adults in this country would have completed an advance directive for medical care and assigned someone they trusted to represent their wishes if and when they are unable to speak for themselves. Alas, at last count, barely more than one-third have done so, with the rest of Americans leaving it up to the medical profession and ill-prepared family members to decide when and how to provide life-prolonging treatments.
But even the many who, like me, have done due diligence — completed the appropriate forms, selected a health care agent and expressed their wishes to whoever may have to make medical decisions for them — may not realize that the documents typically do not cover a likely scenario for one of the leading causes of death in this country: dementia. Missing in standard documents, for example, are specific instructions about providing food and drink by hand as opposed to through a tube.
Advanced dementia, including Alzheimer’s disease, is the sixth leading cause of death overall in the United States. It is the fifth leading cause for people over 65, and the third for those over 85. Yet once the disease approaches its terminal stages, patients are unable to communicate their desires for or against life-prolonging therapies, some of which can actually make their last days more painful and hasten their demise.
Two new resources are available for community-based organizations to help with business planning and contracting with health care organizations and payers.
“Fundamentals of Community-Based Managed Care: A Field Guide” from the American Society on Aging is the second in a series of three issues of the publication Generations to focus on how best to build and preserve community-based organization (CBO) partnerships with the healthcare sector, in the interest of helping CBOs survive in the new financial climate, and for addressing the Triple Aim of improving care, improving population health, and reducing costs. This issue also addresses the social determinants of health and the role they play in aging in the community.
A resource guide on pricing from the Aging and Disability Business Institute explores financial contracting and provides guidance to community-based organizations on how to build competitive pricing models for contracting with health care payers. The pricing guide also explains the differences between common types of payment arrangements such as Per Member Per-month (PMPM), per episode, and capitation.
Alzheimer’s disease is among the most expensive illnesses in the U.S. There’s no cure, no effective treatment and no easy fix for the skyrocketing financial cost of caring for an aging population.
Spending on care for people alive in the U.S. right now who will develop the affliction is projected to cost $47 trillion over the course of their lives, a report issued Tuesday by the Alzheimer’s Association found. The U.S. is projected to spend $277 billion on Alzheimer’s or other dementia care in 2018 alone, with an aging cohort of baby boomers pushing that number to $1.1 trillion by 2050.
Research so far has been stymied by clinical failures. By one count, at least 190 human trials of Alzheimer’s drugs have ended in failure. No company has successfully marketed a drug to treat it, though many big pharmaceutical companies, including Merck & Co. and Pfizer Inc., have tried. Biogen Inc., a company based in Cambridge, Massachusetts, saw its shares dive last month after it said it was expanding the number of participants in its trial for the drug aducanumab.
Nursing homes in the U.S. are administering antipsychotic drugs to tens of thousands of elderly residents each week who do not have the diagnoses for which the drugs are prescribed and who are not giving their “free and informed consent,” according to a new Human Rights Watch report.
In a report released Monday titled, “They Want Docile,” the group states that some 179,000 residents of long-term nursing homes across the country are given antipsychotic drugs each week that are not appropriate for their condition. The report says the drugs are used for their sedating side effects, which make patients with dementia and Alzheimer’s disease easier to manage.
“People with dementia are often sedated to make life easier for overworked nursing home staff, and the government does little to protect vulnerable residents from such abuse,” Hannah Flamm, a New York University law school fellow at Human Rights Watch told The Guardian.
A paper published today in the New England Journal of Medicine reports that solanezumab, a monoclonal antibody-based treatment for Alzheimer’s disease developed by Eli Lilly that targets amyloid plaques, did not significantly slow cognitive decline.
Columbia University Irving Medical Center (CUIMC) led the multicenter study.
Researchers have proposed that Alzheimer’s disease is caused by the buildup of a sticky protein called beta-amyloid. According to this ‘amyloid hypothesis,’ the protein forms plaques in the brain that damage and eventually destroy brain cells. Solanezumab was designed to reduce the level of soluble amyloid molecules before they aggregate.
At 90, Beverly Herzog is writing songs for the first time.
Once a week, a music therapist helps Mrs. Herzog transform her thoughts into lyrics, then sings them back to her mellifluously over the strums of her guitar. The result can be transformative. When Mrs. Herzog listened during a session in December, she marveled at how magically the music reflected her views on love and life.
“I can’t believe it,” Mrs. Herzog said in her room at the Hebrew Home at Riverdale in the Bronx. “So I sit with my mouth open, I do. And I’m starting to get an appreciation, not just swallowing it,” she added. “Not because it’s a song that we wrote together, but because it feels, like, complete, for all of us.”
Dementia with Lewy bodies has a unique genetic profile, distinct from those of Alzheimer’s disease or Parkinson’s disease, according to the first large-scale genetic study of this common type of dementia.
The genome-wide association study, conducted by a UCL-led collaboration of 65 academics in 11 countries and funded by Alzheimer’s Society and the Lewy Body Society, is published in The Lancet Neurology.
“Dementia with Lewy bodies accounts for 10-15% of dementia cases, yet our understanding of it lags beyond the more well-known Alzheimer’s disease, partly because it’s commonly misdiagnosed. Our findings clarify the disease’s distinctive genetic signature, which should, in the future, help improve clinical trials, and lead to more targeted treatments,” said the study’s lead author, Dr Jose Bras (UCL Institute of Neurology and Alzheimer’s Society senior research fellow).
About 15 million Americans will have either Alzheimer’s dementia or mild cognitive impairment by 2060, up from approximately 6.08 million this year, according to a new study by researchers at the UCLA Fielding School of Public Health.
The findings highlight the need to develop measures that could slow the progression of the disease in people who have indications of neuropathological changes that could eventually lead to Alzheimer’s dementia, said Ron Brookmeyer, professor of biostatistics at the UCLA Fielding School of Public Health and the study’s lead author. The country’s population is aging and with it comes a growing number of people with Alzheimer’s disease.
The study was published in the peer-reviewed Alzheimer’s and Dementia: The Journal of the Alzheimer’s Association. The study is the first of its kind that has estimated the numbers of Americans with preclinical Alzheimer’s disease or mild cognitive impairment.