Halloween, we painted and decorated pumpkins

Pictures of my facility

Good Day All! I wanted to post some of my pictures of party time in my facility. It shows my patients enjoying music and singing. Enjoy!

Scientists Have Found Clues in the Search for Dementia Medications

Out of London - Scientists have found and identified changes in the brains of mice that impairs their learning, they believe the findings may mean that some drugs being developed for certain cancers may also help in the fight of diseases of the age related types such as Alzheimer's and Dementia

German researchers that studied  mice at different stages in life found that the older mice had some changes in the proteins regulating the genes in their brains, more specifically in a process called histone H4K12 acetylation, which showed that it slowed their ability to learn.
The discovery suggests that, changesover time in the way our genes are expressed may lead to impaired learning & memory. That sudden deregulation of H4K12 acetylation could be the early warning sign of a brain that is starting to decline.
Medicines that are known to help regulate such changes in the brain, known as histone deacetylase (HDAC) inhibitors, are at this time being developed by drug makers such as Merck & Co for the treatment of some cancers.
Andre Fischer of the European Neuroscience Institute in Goettingen, who has been involved in the mouse study, said he believes more targeted versions of these types of  medicines can be developed to treat dementia or Alzheimer's patients.
He told Reuters in a telephone interview,"We have finished the first phase, the pre-clinical phase, now it's time for the pharmaceutical industry to really try and drive it into application,"
Dementia affects some 35 million people around the globe and the number is expected to skyrocket as our populations continue to age. Experts have commented that this study and said it could have enormous implications.
Despite decades of research, doctors still only have very few weapons that are effective against Alzheimer's and Dementia, which are the most common forms of the brain-killing disease.
Alzheimer's International predicts that the number of sufferers of all types of Dementia will almost double every 20 years -- to 66 million in 2030 and more than 115 million in 2050, globally.
This drug has been found to restore the ability to learn in mice.
In this study, Fischer and his colleagues gave various learning tasks to groups of mice that were aged 3 months, 8 months and 16 months so they could see when age started to hamper their mental ability.
After they identified that the 16-month-old mice were the slowest learners, the studied the mice brains and found that their H4K12 acetylation function had completely failed.
The result is that the 16-month-old mice were unable to properly regulate levels of genes associated with memory and learning, the scientists found, the 16 month old mice were unable to use the same key brain functions as the younger mice did to learn things.
When scientists gave the mice a medication which restored their H4K12 acetylation which enabled the learning genes to be turned on again, the 16 month-old mice were able to learn and store memories again.
David Sweatt of the neurobiology department at the University of Alabama, Birmingham, in the U.S., said scientists "may now be one step closer to understanding age-related memory loss, and to developing a medication that might help boost memory".Studies in our lab and elsewhere strongly suggested that these drugs could potentially reverse aging-associated memory dysfunction."

Music as Therapy

Good Day Caregivers & Seniors,
Music is an extremely important part of our lives. It brings back memories, lifts our spirits and can create a mood or atmosphere that can be beneficial to our well being.
Many times in my facility I would hire musicians to come play for my patients. I noticed that not only would this music elevate the moods of my patients during the time the music is being played, but also for several days after the music. I would find musicians that played old time music from the generation of my patients.
When the music would play the patients would clap their hands, tap their feet and sing along. Smiles covered their faces and they would talk and reminisce for days. Reminiscing is good for elderly patients because it makes them feel a part of something, family, friends and social groups they have been involved with. It lifts their spirits and gives them something to look forward to.
Gathering a few family and friends together and playing old time music can generate many good days ahead for the patient. If it's just you & the patient, you can get some old time CD's and play it for them.
I would plug in the old karaoke machine and let my patients sing along. This made them feel important and special.
I have a few sites posted below that you can get get old music from. Also you can go online and find sites that have the words to these songs. Print out the words and give them to your elderly loved one so they can sing along.
I promise, not only will the patient be smiling, but so will you. Enjoy!
Old Time Music
Old Victrola Music
Old Time Music Lyrics
Old Military Songs 

If you know of any other resources for music, please post as comment or email me at sherbraill@yahoo.com

Hospice Care Information

Hospice care, what is it?

Hospice care is for patients who no longer benefit from regular medical treatments and are in their final months of life. The hospice goal is to keep pain and suffering to a at a minimal level, hospice care is not to cure the illness. For you and the patient in your care, this requires a change in mindset from searching for a treatment  to accepting that comfort, dignity, pain relief, and privacy are the main concerns near the end of life.

How does Hospice work?

You may think of hospice as care that is  received at home, which usually is the case. But a patient can also receive this end-of-life care in a hospital, nursing home, or private hospice facility. The one that is best depends on the patient's physical condition, whether the home is suited for providing hospice care, and the resources in your community,
Hospice care isn't always continuous, and a patient may use hospice, on & off of it as their medical condition improves or deteriorates. For example, if a patient is in hospice care and goes into remission,  from the symptoms of an illness, the hospice care can be stopped and then resumed again if the symptoms come back or the condition gets worse.
The entree into hospice care usually comes from a diagnosis and realization: To qualify for most hospice care, a doctor must give a diagnose of a  a terminal illness,  a medical condition that may cause death within six months or less.

Ho to get hospice help

You may find that you need to use persistence to get hospice care initiated, both in dealing with attending physicians and in finding a hospice organization available to provide the care.
Hospice workers can't initiate care until they have received a written referral from a physician. In spite of the role hospice plays, it can sometimes take some work on your part for the patient to gain admittance to a hospice facility. For instance, if the facility thinks a patient might be too much of a handful (wanders off, or is combative) they may not want to admit your loved one into the facility.

Your initial meeting with Hospice

During an initial meeting, hospice will meet with you, the patient, and any other interested family members or friends to assess the plan of care. If you're going to be providing care at home, the workers will evaluate whether the place needs to be equipped with any special equipment, such as an hospital bed, a pad to help prevent bedsores, protective coverings for the floor, ramps for a wheelchair, shower chairs, grab bars or pressure mattresses.
During this meeting have everyone involved ask questions that they need answered. Especially the person who will be providing the hands on care. Make sure you understand the services they offer and what you need to do as far as care issues.
Hospice offers daily,bi weekly, and weekly visits or how ever often they assess as necassry. They take vitals, bathe, contact doctors, and assess the patients needs every time they visit, as needs can change rapidly with end of life patients. If you are in need of help with any issues of care, Hospice will help in explaining treatments and show you how to follow through with them.
Hospice is a great service and I have used them several times in my facility. They are very caring, dedicated workers. They have great empathy and are exremely helpful in the end of life issues.
I hope you all found this helpful. If you would like to know more about hospice, I have posted a link for you here.

Some Activity Ideas for your Elderly Loved One

Good Day Caregivers,
Looking around on the net I found these couple activity ideas that I thought were really great. Please note that even people that have lost some or most of their vision can do these activities.
Here are some activities you could have your loved one do. Place several different items in a bag or bucket . Blindfold the resident taking turns, have them pull out one item at a time and try to identify it by touch. Keep track of how many they get right and separate the ones they didn't get, then take the blindfold off and let them see the wrong ones. Add or subtract items for the next person.
Another great activity is to get a couple of bags of cotton balls. Open the bag and place on a table. Using a spaghetti spoon or large spoon, a large bowl or bucket, blindfold the person and see how many cotton balls they can get in the bucket. With these games your loved one doesn't have to be able see or have use of both arms.
 If you have any activity ideas you would like to share, please post a comment here or email me  sherbraill@yahoo.com
Have a wonderful day! Take care of yourself and get some good restorative rest!

Respite

I wanted to bring up the subject of respite for the caregiver. It is so very important that as a caregiver you need breaks from caring for your loved one. It helps to avoid burnout which can lead to negative feelings, resentment and overall less quality in your caregiving. It benefits you and your loved one to get respite during your time caregiving.
I have found a great site with information on where and how to find respite caregivers. At the end of the article there is a link to go directly to the article site for more info and great articles.

“I love him but I just can’t do it anymore. The physical and emotional demands are causing me to lose my own health. Soon, I will be in the same shape that he is in. I need some help.”
Statements like this are common among family members and caregivers caring for loved ones such as the elderly with disabilities, chronic illnesses and other conditions that require around-the-clock care. Even though most families take great joy in providing care to their loved ones so that they can remain at home, the physical, emotional and financial consequences can be overwhelming without some support, such as respite. Respite provides the much needed temporary break from the often exhausting challenges imposed by constant caregiving.
Respite care provides, short-term, temporary relief to those who are caring for family members who might otherwise require permanent placement in a facility outside the home. Research has shown that providing this type of help can have a positive effect on the health of the caregiver.
Without respite, not only can families suffer economically and emotionally, caregivers themselves may face serious health and social risks as a result of stress associated with continuous caregiving. Three fifths of family caregivers age 19-64 surveyed recently by the Commonwealth Fund reported fair or poor health, one or more chronic conditions, or a disability, compared with only one-third of non caregivers.
 
A Commonwealth Fund study of elderly spousal caregivers (aged 66-96) found that caregivers who experience caregiving-related stress have a 63% higher mortality rate than non-caregivers of the same age.
Many caregivers may also find themselves in crisis situations due to job loss, homelessness, substance abuse or their own ill health. A temporary haven to insure the safety of the person for whom they provide constant care becomes an absolute necessity.
Respite has been shown to help sustain family caregiver health and wellbeing, avoid or delay out-of-home placements, and reduce the likelihood of abuse and neglect. According to the ARCH National Respite Network, data from an outcome based evaluation pilot study show that respite may also reduce the likelihood of divorce and help sustain marriages.
Respite is among the most frequently requested services for those providing care at home.

Part 1 of 3

CONTINUE »
Models for Respite

Take care all and have a great day! 

Vaccines & the Elderly

Hi all! Sorry I haven't posted the past couple of days as I was in the San Juan Islands spending time with my oldest son. Then back home and Mothers Day I spent most of the day with my youngest son. It was a great Mothers Day and I hope you all had a great Mothers Day also!
I wanted to share this article with you about vaccines and the elderly. Its very informative and contains a lot of info so I will put a link to the site at the end of the article so you can go to the article site and read more.

Vaccinations and the Elderly

Looking for regular updates as to where influenza is circulating including the latest information on the swine flu? Check www.cdc.gov/flu/weekly
(5/7/10)- According to Andrin Oswald, a spokesman for Novartis AG's vaccine division, about half of the 15 governments that ordered H1N1 swine-flu vaccine ended up canceling part of their orders, and some are still negotiating with the company in connection with the purchase price that they paid for the vaccine.
At the height of the panic in October, the governments of multiple countries were inundating the company with calls requesting immediate delivery of the vaccine. When it became apparent that the epidemic was not as virulent as was originally feared it would be, many of these same countries called to cancel the orders.
France canceled part of its original order from Novartis, and said it would pay the company only 16% of the agreed upon price for the vaccine. The United States purchased the equivalent of 229 million doses from 5 different manufacturers, and so far it is estimated that only about 91 doses of the vaccine were administered to patients in this country.
(3/31/10)- The following data is extracted from the above site:
Influenza Season Week 11 ending March 20, 2010. All data are preliminary and may change as more reports are received
During week 11 (March 14-20, 2010), influenza activity remained at approximately the same levels as last week in the U.S139 (4.6%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza
Approximately 99% of all subtyped influenza A viruses reported to CDC were 2009 influenza A (H1N1) viruses. The proportion of deaths attributed to pneumonia and influenza (P&I) was below the epidemic threshold
One influenza-associated pediatric death was reported and was associated with an influenza A virus for which the subtype was undetermined. The proportion of outpatient visits for influenza-like illness (ILI) was 1.8%, which is below the national baseline of 2.3%.
Three of 10 regions (Regions 4, 7, and 9) reported ILI at or above region-specific baseline levels. No states reported widespread influenza activity. Three states reported regional influenza activity. Puerto Rico and eight states reported local influenza activity. The District of Columbia, Guam and 31 states reported sporadic influenza activity. Eight states reported no influenza activity, and the U.S. Virgin Islands did not report.
(3/18/10)- Now that we are well into March, it does not look like the normal third wave of the flu season is going to hit this year. Seasonal flu activity has been unusually low this winter, suggesting that the H1N1 swine flu strain '"crowded out" the usual seasonal H1N1 and H2N2 strains.
There has been very little reported numbesr of the influenza B strain seen in the U.S this year.
The CDC estimated that between 42 million to 86 million people were infected with the swine flu since its emergence in April 2009. Please keep in mind that even if we use the 86 million number, it will mean that more than half of the vaccine that has been produced and paid for by the government will have to be thrown away at the end of the flu season.
(3/12/10)- Flu activity in Week 8 (week-ending February 27^th) decreased significantly year-over-year but increased versus last week. Positive reports of the influenza virus in Week 8 were 6.4% down from 21.2% during the same week ending date last year, and up 200 basis points versus last week.
No states reported widespread flu activity, four states reported regional flu activity, four states reported local flu activity, 34 states reported sporadic flu activity, and four states reported no flu activity.
(2/18/10)- The Centers for Disease Control and Prevention (CDC) latest estimate is that about 11,700 Americans have died from the swine flu since its emergence in April until mid-January.
It also estimated that about 257,000 people have been hospitalized, at a countless cost to the medical system. It went on to further estimate that about 70 million Americans were vaccinated, leaving over 100 million doses of the vaccine as having not been used.
Most of the hospitalizations and deaths have been among those aged 18 to 64.
Luckily enough, the outbreak of seasonal flu has been relatively mild this flu season.
(1/21/10)- According to the latest count from the Centers for Disease Control and Prevention (CDC) about 11,000 Americans have died of swine flu in this recent epidemic.
Because the second wave peaked in late October, the number is unlikely to rise much unless there is a third wave later this winter.
The World Health Organization estimated that as of January 3 there were 12,799 deaths worldwide. WHO counts only lab-confirmed swine flu cases in its estimate, which is different than the estimate from the CDC. Thus the number of deaths worldwide is likely to be much higher than the number given by WHO.
(1/5/10)- Cases of H1N1 flu confirmed by laboratory testing have been reported in more than 208 countries and overseas territories, according to the latest report from the World Health Organization, and at least 12,200 people have died from the disease.
Positive reports of the flu virus in Week 50 (week ending December 19^th) were 6.9%, up +340 bps from 3.5% during the same week last year, and flat versus Week 49.
Seven states reported widespread flu activity during the week, 18 states reported regional flu activity, 13 states reported local flu activity, 11 states reported sporadic flu activity, and one state reported no flu activity.
(12/23/09)- Federal officials now estimate that there are about 100 million doses of swine flu vaccine available. Most cities are releasing the vaccine to medical professionals, while telling them to vaccinate anyone who wants to get the shot.
Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said that the second wave of the flu was ebbing, and that there was "no way to know if there will be a third."
If a third wave hits, it is expected to rear its ugly head in January.
(12/16/09)- Federal health officials claimed that almost 10,000 people had died of swine flu since April, and that 213,000 people had been sick enough to be hospitalized because of it.
Although we are coming through a quiet period now in connection with the epidemic, health officials anticipate that the third wave of the pandemic will take place in January, as happened in the 1917 and 1957 pandemics.
Dr. Thomas R. Frieden, director of the CDC, said about 85 million doses of swine flu vaccine were now available, with some states now reporting an oversupply of the vaccine, so that everyone, not only high-risk individuals are eligible to receive the shot.
(12/2/09)- The latest report on flu activity indicated that only 32 states, mostly in the Northeast and the West, had "widespread" flu activity, down from the peak of 48 in late October.
Doctors' visits for flu declined for the fourth week in a row. Hospitalizations dropped for the third straight week, and for the first time, there appeared to be a clear drop in weekly deaths. Campus flu activity continues to decline also.
Health experts at the CDC have tentatively predicted that a new but smaller January wave could emerge.
(11/15/09)- The Centers for Disease Control and Prevention (CDC) announced last Thursday that an estimated 22 million Americans have been sickened with swine flu since April and that about 3,900 had died from it. Most cases have been mild with only 98,000 having been hospitalized by it.
Flu season in the U.S. usually lasts through May. About 43 million doses of the vaccine have been made available to the states since October.
In a typical regular flu season, there are about 200,000 hospitalizations, and 36,000 deaths. The elderly are the most prone age group for fatalities from the regular flu.
The elderly have however only accounted for 440 deaths, out of two million illnesses, and about 9,000 hospitalizations from the swine flu.
Most of the deaths, about 2,900, have been among people between the ages of 19 and 64 years of age. According to the CDC figures, there have been 12 million cases of swine flu in this age group, and 53,000 hospitalizations
The latest CDC figures show that 540 have occurred in children younger than 18, while about 8 million of them have come down with the disease, and 36,000 have been hospitalized as a result of the swine flu.
A total of 250 million doses of swine flu vaccine have been ordered by the U. S. government and this includes doses that will be shipped to third world countries too poor to pay for the vaccine themselves.
(11/6/09)- According to David Daigle, a spokesman for the Centers for Disease Control and Prevention (CDC) there have been 85 million Americans who have received the seasonal flu shot so far this year, compared to the 61 million who had received their shot last year.
Last year 113 million doses of the seasonal flu vaccine were produced, and about 103 million Americans took the shot, which was a record in both categories. About 10 million doses of the vaccine had to be thrown away, since the vaccine can not be saved and carried over to the next year.
About 90 million doses of the seasonal flu shot have been shipped out, with total production expected to come to about 114 million doses.
In New York, children and teenagers have gotten 258,000 doses, twice the number given at this same time as last year. New York City's public health clinics have already vaccinated more people this year than they did all of last year.
The FDA has approved the vaccines made by Sanofi-Pasteur, a unit of Sanofi-Aventis SA, Novartis AG, CSL Ltd and AstraZeneca PLC's Medimune unit (nasal spray). GlaxoSmithKline, PLC is still awaiting approval for its "swine flu" vaccine batches. Sanofi is the only one of these companies that has a plant in the U.S. that manufactures the vaccine.
The U.S. government has paid for all the expected 200 million doses of swine flu vaccines, about 89% of each year's seasonal vaccines made for the private sector.
Because of shortages of the seasonal flu vaccine cropping up all over the country, many health facilities have had to delay administering the shots to the public.
President Barack Obama has declared the swine flu a national emergency. In doing so, the administration can waive or modify certain federal requirements involving Medicare, Medicaid and health-privacy rules to speed treatment.
There were 1.8 million to 5.7 million cases of swine flu in the country during the swine flu's early spring wave in this country, which resulted in 9,000 to 21,000 people being hospitalized, and up to 800 died as a result from April to July, when it largely faded out, according to estimates from the CDC and the Harvard School of Public Health and published online in the journal Emerging Infectious Diseases.
(10/27/09)- The Centers for Disease Control and Prevention (CDC) announced that it now expects that only 28 million to 30 million doses of the H1N1 swine flu vaccine will be delivered by the end of October, instead of the 40 million doses that it had expected to be available by the end of the month.
The delay in the delivery has been caused by the fact that the vaccine is taking longer to produce than had been originally projected. This delay in delivery is of course making it much more difficult for health-care providers to schedule appointments for these shots.
Of the 11.4 million doses of the swine flu available as of the middle of the month, state health officials had placed orders for 8 million dosages
One of the concerns of opponents of the swine flu vaccine is that it contains thimerosal, a mercury-containing preservative that in turn leads to autism. All H1N1 nasal spray vaccines are free of thimerosal. The federal government has ordered a total of 251 million doses of the swine flu vaccine, from 5 different vaccine manufacturers.
75.3 million doses have been ordered from Sanofi-Aventis SA, but it has not yet told the company how many doses it wants of the vaccine to be multi-dose, which must contain a preservative. A spokesman for the company said that all the pediatric doses that the company is making are packaged in syringes and are thimerosal-free.
AstraZeneca PLC has received orders for about 40 million doses of its nasal spray vaccine, which is licensed for people from 2 years of age to 49 years of age, and those dosages are all thimerosal free.
While adjuvants will be used in many H1N1 shots given throughout the world, they will not be used in dosage administered in the U.S.
(10/24/09)- A CBS news poll indicated that only 46% of the U.S. population was willing to take the flu shot. On the other hand about 60% indicated that they were going to have their children get the shot.
About 82 million of the expected 114 million doses of the seasonal flu vaccine has been distributed so far.
Forty-three children have died from swine flu since August 30^th. Nineteen of the 43 were teenagers, 16 were ages 5 to 11 years, and the rest were under the age of 5
Flu caused by the H1N1 virus is now widespread in 46 states, and flu like symptoms account for 6.1% of all doctor visits.
(10/17/09)- According to the latest figures from the Centers for Disease Control and Prevention (CDC) 76 children have died from the H1N1 swine flu since the virus was discovered in April.
This is a higher rate than pediatric deaths caused by the seasonal flu.
Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases at the CDC, said that by comparison, 46 to 88 children died each year during the past three influenza seasons.
While most of the children had underlying medical conditions, Ms Schuchat said 20% to 30% did not.
(10/11/09)- Only about 21% of children ages 5 to 17 received the regular flu shots last year, according to the Centers for Disease Control and Prevention, compared with 41% of infants, 32% of adults at risk of complications and67% of the elderly.
The data came from a telephone survey of 414,000 households.
Last year was the first in which federal officials had recommended that everyone ages 5 to 17 receive the flu shots, and that recommendation was made only after doctors had ordered their fall shipments, so the vaccine ran short.
This year however, data compiled by the CDC indicated that as many people had received their shot by the end of September as would have received it by the 3^rd week of October in a normal year.
Tamiflu, the nasal spray vaccine has been the first of the vaccination dosages received by most health professionals who are administering the shots. Studies have shown that Tamiflu is not as effective as the injectible versions of the shot.
The National Institute of Health has awarded $60 million in grants to discover new adjuvants, immune boosters that can be added to vaccines to make then more effective.
The only adjuvant approved for use in the United States is alum, an aluminum salt. Adjuvant usage however has resulted in more negative side effects such as sore arms and higher fevers.
(10/8/09)- Consumer Reports released poll showing that half of all parents surveyed said they were worried about the flu, but only 35% would definitely have their children vaccinated. About half were undecided, and of those, many said they feared that the vaccine was new and untested.
Sixty-nine percent of the parents who were undecided or opposed to shots said they "wanted their children to build up their natural immunity."
(9/30/09)- Dr. Thomas R. Frieden, the director of the Centers for Disease Control and Prevention said that the first doses of the swine flu vaccine should reach doctors by October 6^th. Initially, about 6 million doses will be available by that date, and by mid-October there should be about 40 million doses available.
Almost all of the first doses that will be available will be the FluMist nasal spray version, which has some limits on who may use it. FluMist is not recommended for infants under 2, adults over 49, pregnant women or anyone with underlying health problems.
All swine flu vaccine has been paid for by the federal government, which is also paying for its distribution and providing syringes and other items with it. This should help to keep the cost of getting the shot to a minimal level.
A study of the effectiveness of the rapid flu tests used in many doctor's offices found that they missed many of the cases of swine flu by giving false-negative readings.
One dose of the H1N1 vaccine should offer protection against the new virus in children ages 10 to 17, while younger children, especially those getting the flu shot for the first time, will need to get two dosages of the shot at least 21 days apart. This is the same timetable for receiving the regular flu shot also.
In a study conducted at the University of Michigan school of public health, the injectible version of the flu shot was found to be more effective than was the nasal spray version of the vaccine.
(9/22/09)- Further results from the clinical trials of the swine flu vaccine are showing that only one dose of the vaccine, not two will be needed to provide adequate protection against the disease.
The first vaccine dose is intended to "prime" a person's immune system so that it can recognize a new type of virus, while the second dose helps the immune system produce enough antibodies to fight against the virus.
The FDA has approved the vaccines made by a unit of Sanofi-Aventis SA, Novartis AG, CSL Ltd and AstraZeneca PLC's Medimune unit (nasal spray). GlaxoSmithKline, PLC is still awaiting approval for its "swine flu" vaccine batches.
The nasal spray vaccine made by Medimune contains a weakened live virus, while injections contain killed and fragmented virus. About 3.4 million doses of swine flu vaccine are expected to be available by early October.
There are an estimated 159 million Americans who are in what the Centers for Disease Control and Prevention calls the "high risk" group. This group consists of pregnant women, people less than 24 years of age, people with high-risk medical conditions and health-care workers.
The 195 million swine flu vaccine doses that have been purchased by the U.S. government will flow into 90,000 distribution centers throughout the country starting sometime in the middle of October. The local state health department will allocate the distribution of the vaccine to the individual medical facilities that will administer the vaccine.
There is now widespread flu activity in 21 states, up from 11 a week ago, and virtually all the samples tested are of the swine flu variety. It is estimated that about 54 million regular flu vaccine doses have already been distributed and are available now to be used to help prevent the onslaught of the regular flu.
(9/18/09)- Even though swine flu (H1N1) seems to be garnering the most media attention, the U.S. is now bracing for the traditional flu season as well. According to Dennis Garcia, associate medical director of health and wellness services at Washington State University, "It's (swine flu) mild-the seasonal flu lasts 10 to 14 days, and this (swine flu) is lasting three to five days."
Health officials are also closely monitoring the emergence of a new variant of a long-circulating seasonal flu strain, called H3N2, which is associated with more hospitalizations and deaths among the elderly than other strains.
A single shot of the swine flu vaccine, developed by an Australian drug maker CSL Ltd., and tested in 240 healthy adults in that country has proven to be effective without having the subjects being given a 2^nd shot.
(9/10/09)- Nationwide, there are an estimated 15.9 million college students, at more than 4,000 two-year and four-year institutions. A tracking system has been set up by the American College Health Association, which will post weekly flu case data and cumulative figures on its Web site.
From August 22 to 28, 1,640 cases were reported in 165 colleges. So far, most cases have been relatively mild, with only one student hospitalized.
"The good news is that so far, everything that we've seen, both here and abroad, shows that the virus has not mutated to become more deadly, " said Dr.Thomas Frieden, the director of the U.S. Centers for Disease Control and Prevention. "That means that although it may affect lots of people, most people will not be severely ill."
As of August 8, 36 children (2 months to 17 years old) died in the United States of the swine flu, but 67% of those who died had high-risk medical conditions, predominantly neuro-development disorders, such as epilepsy or cerebral palsy. As of that date the death count among all ages in this country is 477 confirmed swine flu cases.
Worldwide, the swine flu has been confirmed to have infected more than 209,438 people, and at least 2,185 have died, according to the World Health Organization.
The Institute of Medicine recommended that health care workers treating people with swine flu protect themselves from infection by wearing a type of specially fitted mask called an N95 respirator, which is tighter and better able to seal out viruses than the more common types of surgical masks..

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Illusions & Delusions Part 3

Illusions and Delusions-Part III-Medical Condition Delirium

Delirium is a syndrome of disturbed consciousness, cognition and perception that develops over a short period of time and tends to fluctuate during the course of the day and is caused by one or more physical conditions. Delirium results from a disturbance in the neurotransmitters (chemical messengers) in the brain that control consciousness, thinking and behavior.

The hallmarks of delirium are an abrupt onset of depressed level of consciousness, alterations in memory and behavior, and sometimes hallucinations. It is more common in older adults, possibly due to normal age-related changes in the nervous system and brain, diminished eyesight and hearing associated with age, greater use of medications in elderly patients, and diseases that injure the brain and predispose to delirium. For example, it is known that the condition dementia places a person at higher risk for developing delirium than people who are not afflicted with dementia.

Researchers at medical centers have been looking into this phenomenon for years. One POTENTIAL PREVENTATIVE STUDY came from the group at Yale University Medical Center who reported in NEJM. (See: Inouye et al. NEJM. 1999; 340:669-676.). The group found that in a group of hospitalized general medicine patients aged 70 or above who had no delirium at admission, 10-15% of the group went on to develop delirium after admission. They identified the risk factors for delirium as related to visual impairment, severe illness, cognitive impairment and abnormal renal function blood tests.

They attempted an intervention program, Elder Life Program, which they hoped would reduce the risk of delirium. This intervention employed a specialist in geriatrics and trained volunteers who instituted the following activities:
· Activities to stimulate the mind.
· Special efforts to keep patient oriented while in hospital.
· Avoiding excessive bed rest and keeping patient mobile.
· Promoting sleep without the use of hypnotic drugs and ensuring the environment was conducive to sleep.
· Reminders to bring and use communication devices (e.g. hearing aids, eyeglasses etc.).
· Providing aids to promote communication such as magnifying glasses, large print glasses, clearing wax from ear canals.
· A protocol to detect and treat low fluid intake (dehydration).

This intervention reduced the incidence of delirium by 40%, as well as reduced the number of days of delirium and the number of episodes of delirium. Lower risk patients benefited most from this program. Those with marked dementia did not benefit in any appreciable way.

Measures to identify and prevent delirium from occurring have been identified, though it will not be eliminated. More basic clinical and neuroscience investigation are needed to help reduce the incidence of this troubling issue so that many elderly can enhance the quality of their lives, not fearing entering a hospital and undergoing clinical treatment because of potentially aversive effects of hospitalization. Let us hope that the current difficult fiscal times will not interfere with such programs of proven value.
Illusions and Delusions in the Elderly-Part I
Illusions and Delusions-Dementia Delirium-Part II
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "How to Select a Nursing Home"
Harold Rubin, MS, ABD, CRC, Guest Lecturer
April 19, 2003

FREE Stuff!

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Today they posted a free tshirt from a printing company. There is also Purex samples and 2 free energy efficient light bulbs, EmergenC samples. It's a new site so it is just starting up but everyday there is a new freebie so if you start now, you will not miss one freebie.
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Part 2 of Illusions and Delusions

Illusions and Delusions- Part II-Dementia and Delirium

Dementia refers to a group of disorders characterized by progressive loss of cognitive functions. It is more than forgetting or age related changes in memory. A cascade of events has to occur in the brain for dementia to be evidenced in behavior.
Some dementia is temporary. Irreversible dementia can be divided into four categories of origin: degenerative diseases; vascular diseases; traumatic dementia and infections. Alzheimer’s disease, Lewy body dementia and vascular dementia account for most cases of dementia (See below for a full list of diseases that may cause dementia.) Progression of the dementia associated with these diseases invariably leads to increasing dependence on others for everyday care as well as increasing health costs. Medicare, except in extraordinary circumstances, does not pay for long term custodial care for dementia.(See Medicare articles). Residents of nursing homes usually have to spend down their savings before being covered by Medicaid.
In its initial stage, dementia is characterized by some degree and quality of change in behavior and cognition, and not by any presence of specific histological changes that are measurable. It is hard to diagnose in this initial phase. To date, there are no biological tests for dementia itself. In many cases, those around the patient are aware of subtle changes in behavior and memory. Sometimes the individual is aware of cognitive changes, but does not attribute it to dementia. At the same time, individuals worry about "forgetting" and have anxious moments filled with thoughts about becoming demented. An individual's anxiety over this issue can be debilitating in of itself. Neuropsychological tests may pick up early signs of possible dementia before they express themselves.
Psychotic features associated with dementia involve altered perceptions, which may include hallucinations, misperceptions and delusions. Hallucinations, when present, are most commonly visual (actually see things that are not there as opposed to thought broadcasting or thought insertion). Typical misperceptions include inability to recognize oneself in a mirror and an inability to distinguish a real person from a TV image. Delusions are most commonly paranoid and relate to the ideas of theft, abandonment or infidelity.
The clinical features of dementia often point to a specific cause. In patients with Alzheimer’s disease, memory loss, language impairment and visuospatial disturbances (distance as well as place is misjudged; also not sure where they are) are typical. Often these patients appear indifferent and experience delusions and agitation especially during advanced stages.
Frontotemporal dementia e.g. Pick’s disease, by contrast, evidences marked personality changes and executive dysfunction (difficulty in higher order capabilities that are called upon in order to formulate new plans of action and to select, schedule and monitor appropriate sequence of action) but a relative preservation of visuospatial skills.
Patients with dementia called Lewy body type display symptoms such as tremors, stiffness, or some signs of Parkinson disease. They may experience visual hallucinations, delusions, fluctuating mental status and evidence a high degree of sensitivity to neuroleptic medications.
The depression symptoms associated with Alzheimer's disease tend to be indirect, taking the form of agitation and insomnia. This contrasts with depression as a primary diagnosis, where the patient exaggerates cognitive deficits and appears poorly motivated. Such patients also emphasize mood complaints, while language and motor skills remain in tact. Here is where diagnosis proves important. Specialists is geriatric medicine should be consulted along with a neuropsychological evaluation to distinguish depression from Alzheimer’s Disease.
VASCULAR DEMENTIA
The main focus of therapy in vascular dementia is prevention. It has been argued that once a patient fulfills the criterion for dementia, it is too late to do anything. Improved control of hypertension and cessation of smoking reduce the risk of developing vascular dementia.
Determining the prevalence of vascular dementia is problematic. Lack of agreement on the definition of this disorder has resulted in widely varying prevalence rates. One problem is that vascular dementia is a syndrome with multiple causes and multiple manifestations. There is a great deal of controversy regarding the relationship between vascular brain injury and dementia. It is unclear what size, type and the number of lesions, and in what location, will cause dementia. Many vascular lesions have been seen using computerized tomography (CT) or magnetic resonance imagery (MRI) in people with normal cognition.
Is vascular dementia primarily a dementia, or a vascular disease, which can be treated? Is it a consequence or a special form of cerebrovascular disease, or do patient’s who are going to develop it need to have some additional degenerative changes in order to become demented? These are things that are not very clear at this time.
The diagnosis of vascular dementia depends on the criteria selected and on the presumed pathophysiology and symptoms that can be detected and recognized in a particular patient. If a patient is demented, and if there are clear signs and symptoms of cerebrovascular disease (stroke), and if the dementia follows shortly after the cerebrovascular events, the diagnosis of vascular dementia is probably clear.
ALZHEIMER’S DISEASE
Alzheimer’s disease causes a devastating loss of cognitive and functional capacities. It is estimated that more than 4 million people in the US currently suffer from AD. At some point in time virtually all persons with AD will require continuous care. The psychological and financial burdens are devastating to everyone involved with an AD patient.
In many ways, taking care of patients with AD is different from assisting patients with only physical ailments. For example, patients with AD have impaired insight, often misjudging or denying the extent of their physical and mental impairment. These patients may perceive the intervention of a caregiver who assists them with performing the activities of daily life (ADL) as an indignity and, mistakenly, as an imposition. Consequently, patients with AD frequently display behaviors that are disturbing to the caregiver and disruptive to the caregiving process. These include resistance, rejection, agitation, negativism, and verbal or physical aggressiveness and abuse. These behavioral changes are, at least in part, accompanied by changes in neuromotor function. With the progression of the disease, the brain is increasingly less capable of selecting and modifying its responses to various incoming stimuli. Consequently, the body of a patient with AD reacts differently to a variety of external stimuli that act upon it compared to the body of a healthy person. These fundamental changes in neuromotor function profoundly complicate patient care because they limit the patient’s physical capability to cooperate with the caregiver.
AD is characterized in the brain by the deposition of amyloid protein outside the neuron, resulting in the formation of plaques and inside the neuron with neurofibrillary tangles, which are cytoskeletal components that affect the way the neuron functions. The number of synapses is decreased in AD. The synapse is the unit of communication between cells. Loss of synapses is reflected in dementia. This loss occurs across a number of different kinds of neurons that make different kinds of neurotransmitters, but not in all areas of the brain or across all neurons. They are most seen in temporal and parietal regions with extension to frontal cortex of the brain. The neurotransmitters, which are most often affected, are those known to be involved in the learning and memory processes. Acetylcholine is eventually diminished in virtually all patients with AD. There is a deficiency in CSF immunoreactivity and somatostatin immunoreactivity. The assumption made is that the cells that make these neuropeptides are dysfunctional and are losing synapses as well.
Diagnosis is generated by a history of progressive deterioration over some period of time in at least two domains of cognition, of which one is usually memory. Apolipoprotein E genotyping is not considered diagnostic for AD. In 5% of all the Alzheimer’s disease cases, a chromosome deficiency has been found. This is called early-onset Alzheimer’s disease and manifests itself before the age of 65. The vast majority of AD appears to be sporadic and involve a process not fully understood to date, with the amyloid precursor protein playing some important role. (See below.)
Non-cognitive symptoms associated with AD, such as agitation, paranoia, uncooperativeness and depression can be treated. This makes for a better quality of life for the patient, though it is not a cure for Alzheimer’s disease. Psychoactive agents with anticholinergic effects and benzodiazepines should not be used because they can worsen cognition. (See our series of articles on AD listed below).
A number of potential therapies are currently under investigation including estrogen replacement, anti-inflammatory agents, free radical scavengers and antioxidants, and monoamine oxidase-B9 (MAO-B) inhibitors. (For a list of drug companies doing research in this area see articles under Alzheimer’s disease on this web site) In addition, other approaches, such as anti-amyloid treatments that affect beta-amylase secretion, aggregation and toxicity, appear promising; treatments that hinder neurofibrillary tangle construction and nerve growth factor (NGF) induction are in the early stages of development.
In AD, progressive loss of cognitive abilities usually begins with difficulties in episodic memory (refers to the ability to remember personally experienced events such as what you had for breakfast the previous day) and soon encompassing language, visuospatial and executive dysfunction. The classical pathological features include neurofibrillary tangles, amyloid plaques and neuronal and synaptic loss.
Risk factors for developing AD include advancing age, family history of dementia, substandard education, a history of head injury and a history of smoking. Lower risk has been reported with a history of arthritis, use of NSAID’s and use of estrogen replacement in postmenopausal women.
Researchers are still trying to understand the disease process. Three genes have been identified; beta amyloid precursor protein (b -APP) and two presenilin proteins (PS1 & PS2) that cause early-onset AD (before 65 years), whereas apolipoprotein E (ApoE) epsilon 4 has been identified as a susceptibility gene for late onset disease. Other events have to occur for it to evidence penetration (Swartz RH, Black SE, St. George-Hyslop P. Apolipoprotein E and AD: a genetic, molecular and neuroimagery review. Canadian Journal of Neurological Sciences 1999; 26:77-88)
LEWY BODIES
Lewy bodies are found in the substantia nigra of patient’s with Parkinson’s disease (in the neocortex, limbic structures, and brain stem of patients with Parkinson’s disease and dementia). They are also found in association with the neuropathologic features of Alzheimer’s disease in the neocortex, limbic structures and brain stem of patients with dementia and varying features of Parkinson’s disease referred to as the Lewy body variant of Alzheimer’s disease.
The clinical criteria for diagnosis of Lewy body type are:

(A) fluctuating cognitive impairment;
(B) at least one of the following: visual or auditory hallucinations usually accompanied by delusions; mild extrapyramidal side effects of sensitivity to neuroleptic drugs; or repeated unexplained falls, transient clouding, or loss of consciousness;
(C) rapid progression to severe dementia compared to the clinical finding of Alzheimer’s disease.
The lower cerebral spinal fluid levels of homovanillic acid were significant in the Lewy body patients. This reduced metabolism of dopamine may be related in part to the presence of the Lewy bodies in the mesolimbic and mesocortical areas, and may correlate to the higher frequency of psychotic symptoms.
 To read more, go to yesterdays post and click on the part 2 link

Illusions & Delusions

Good Mornig Caregivers,
I found some good articles on aging issues that has some awesome information. It is a few part series and I will post the one part of the series each day until I have covered it all. This first section deals with delusions and hallucinations. It is a scary subject when you are caring for someone who has hallucinations. I hope you find this series helpful. There are links throughout the article that you can use to go directly to this site and find more information.

Illusions and Delusion in the Elderly-Part I

The illusion of visitors is a common occurrence amongst the elderly. It may be associated with any of the following: impairment in visual acuity, disturbance in visual association, dysfunction in the temporal or frontal areas of the brain due to dementia or stroke, and/or medication toxicity. In many cases, a combination of these factors interacts to cause the visual hallucinations and/or delusions.
In 1769, Charles Bonnet, a Swiss philosopher and naturalist, published an account of visual hallucination in his psychologically normal, visually impaired grandfather. Since then, numerous reports have been made of visual hallucinations accompanying visual loss. Conditions such as cataracts, glaucoma, macular degeneration and diabetic retinopathy are common in the elderly. The visual hallucination can be benign, simple visual distortions, or elaborate and at times menacing visual hallucinations and delusions.
Hallucinations and delusions commonly occur in conjunction with dementia. J L Cummings et al studied hallucinations and delusions in 30 patients with dementia of the Alzheimer's Type (DAT) and 15 patients with multinfarct dementia (MID). Delusions were found in 30% of DAT and 40% of MID patients. Most delusions were of the paranoid type, and involved elementary misbeliefs, such as theft of possessions.
Visual hallucinations and/or delusions occur in at least half of patients with senile dementia and no previous psychiatric history. In degenerative dementia, such as Alzheimer's disease, these symptoms are usually transient phenomena, occurring in the early to middle stages of the illness and disappearing when cognitive deficits become severe. In cerebrovascular disease, it can occur acutely and persist for months or even years. There may be an association between development of delusions and pathology of the frontal, right temporal and parietal lobes of the brain.
Families need to know more about the nature of these phenomena and their non-volitional nature to develop more realistic expectations of behavior.
Delusions are commonly seen in conjunction with dementia. Simple delusions of theft and vague suspicions directed at relatives are commonly observed. It usually represents an attempt by the amnesic patient to explain the loss of articles that have been misplaced. Unable to remember losing the object, the demented patient imagines an explanation involving theft by someone close at hand, often a caregiver. Many of the delusions that evolve from the visual experience of imaginary visitation can be viewed as an attempt to make sense out of bizarre. This input nonetheless seems real to the patient (if there are strangers in the house, they must be there for a purpose).
Dementia is overwhelmingly a condition associated with aging and predominately affects the elderly. Truly reversible causes of dementia are quite unusual and the common causes (AD, dementia caused by cerebrovascular diseases, Parkinson's disease) are chronic diseases. These conditions will not go away. There is a great need to seek treatment that will minimize the effects of the disease.
Hallucinations and dementia are hard to take when seen in our parents. Trying to persuade the individual that they are not seeing these things may be counter-productive. Professional intervention can help deal with these situations.
Illusions and Delusions-Part II-Dementia and Delirium
Illusions and Delusions-Part III-Medical Condition Delirium
FOR AN INFORMATIVE AND PERSONAL ARTICLE ON PRACTICAL SUGGESTIONS WHEN SELECTING A NURSING HOME SEE OUR ARTICLE "HOW TO SELECT A NURSING HOME".
By Harold Rubin, MS, ABD, CRC, Guest Lecturer
http://www.therubins.com

Caregiver Categories

I found this great article about differet types of caregiving categories. It's a long article linked to a wonderful website with many resources. You can click on any of the links and you will be directed to their site.

About Caregiving
by Thomas Day
Click here to learn more about Thomas Day

Introduction
Characteristics Of Those Receiving Care
Characteristics Of Caregivers
The Cost Of Caregiving
Trends In Caregiving
The Plight Of Informal Caregivers
Conclusion

INTRODUCTION

Caregivers provide assistance to other people who because of physical disability, chronic illness or cognitive impairment are unable to perform certain activities on their own. So-called informal care can be offered by family members or friends, often in a home setting. Or paid or volunteer professional care, so-called formal care, can be obtained at home, in the community or from institutions such as nursing facilities or government institutions.

Roughly, 11.1 million Americans of all ages are receiving formal or informal care at any given time. This represents about 4% of the population and is comprised of about 9.5 million receiving care at home or in the community and another 1.6 million residing in nursing or intermediate care facilities. About 25.8 million family caregivers provide personal assistance to individuals 18 years or older who have a disability or chronic illness. And nearly one out of every four households (22.4 million households) is involved in giving care to persons aged 50 or older. About 43% of those receiving care are under the age of 65 and are evenly spread between ages 18 to 64. Children under 18 and receiving assistance because of disability are often characterized under different criteria of caregiving.

Sometimes human caregivers can be replaced or assisted by mechanical devices. These might include special computer systems for communication, special locomotion equipment, remote vital sign monitoring devices or remote oversight monitoring. Continued technology advances may help relieve the time commitment of human caregivers.

Since the implementation of the Medicare Prospective Payment System in 1999, home health agencies have been looking for more cost-effective ways to provide care. Telehomecare is a more effective way to deliver home care under certain circumstances. Since it is a rapidly developing field, it's difficult to define all telehomecare applications.

It usually involves two-way electronic communication between the patient and the formal caregiver such as a nurse or doctor. Communication can occur with two-way radio, telephone or as is usually the case, two-way interactive video using a computer and phone lines or satellite downlink. This electronic face-to-face home visit also requires some means for the care provider--who might be hundreds of miles away-- to access patient vital signs and receive patient-initiated medical tests. The patient or her in-home informal caregiver has been trained to use electronic monitoring or test equipment that sends the relevant video snapshots or numeric data via phone line, or radio wave to the formal caregiver.

Telehomecare is not only more cost-effective but also in many cases it provides a higher quality of care. Here are some of the ways telehomecare is proving to be beneficial:

• reducing number of visits to the emergency rooms
  
• reducing unnecessary visits to physician's offices
  
• avoiding unnecessary costly visits by health providers
  
• providing education of the patient in early symptom management
  
• monitoring vital signs on a 24-hour basis, therefore providing a potential for early intervention and/or prevention of repeat hospitalization

Although electronic monitoring of patients is also a function of telehomecare, it is also becoming a primary source of supplemental home care service not always involving the use of a home health agency. This area of assistance focuses more on the use of devices that warn of problems with homebound people who are often without caregivers for certain periods of the day. This may include 24-hour vital sign monitoring, video surveillance, emergency signaling systems or GPS locator devices for wandering care recipients.