Saturday, June 9, 2007

Last weekend I bought myself a pink iPod shuffle. It's little and cute and I like to take it to work to listen to music. I also like to take it on walks sometimes but I also like to just listen to the quiet when I walk. Olivia is scratching at my new rug and pulling out threads. I'm going to have to take her to get her claws trimmed again. Today I went to Target and then I came home and Mom and I went for a drive, picked up a sandwich to split and went and parked by the lake. It started to rain a little but it never did rain hard enough to matter. Talked to ME today. She had called on my b-day to wish me a happy one but I had to hang up and go help Mom in the bathroom. She called back today to find out if Mom wears Depends. She said she does; I told her Mom does too. Isn't that sad? It breaks my heart to see Mom so frustrated with her hip and her memory. And her incontinence. Old age is definitely not for sissies.

We have a VHS video that Uncle N copied for us of old home movies of Mom and ME. It is priceless to watch. I copied it onto DVD today. Aunt ME asked for a copy, but I think she already has one. It has scenes of all the Deckerts and Bartholomaeis at Grospapa's cottage on Lake H. It's very cool.

Found this article:

Forming an Alzheimer's Care Dream Team

Big Changes Needed to Make the Dream Team a Reality
By Miranda Hitti
WebMD Medical News
Reviewed by Louise Chang, MD

May 9, 2006 -- If everyone with Alzheimer's disease had a "case manager" for their Alzheimer's care, it might help Alzheimer's patients and their caregivers, a new study shows.

The study, published in The Journal of the American Medical Association, included 153 older adults with Alzheimer's disease and their caregivers.

All of the patients and caregivers live in Indianapolis. That's where researcher Christopher Callahan, MD, works at Indiana University's Center for Aging Research.

Callahan and colleagues make the case for "collaborative care," a team of specialists led by a nurse to help patients and their families navigate Alzheimer's care. But even without such a team, there are steps caregivers can take to take care of themselves while tending to Alzheimer's patients.

Alzheimer's Study

Alzheimer's disease is the most common form of dementia among older adults. But it's not a normal part of the aging process.

The Alzheimer's Association estimates that 4.5 million Americans have Alzheimer's disease, with that number set to grow as the U.S. population ages.

The Alzheimer's patients in Callahan's study were almost 78 years old, on average. Most were financially disadvantaged and had other health problems. About half were black.

Patients had "moderate" dementia at the study's start, the researchers write, based on scores from a mental skills test.

Collaborative Care

Doctors randomly assigned 84 patients to get a year of collaborative care. Advanced practice nurses were at the heart of collaborative care.

The nurses coordinated weekly meetings by a team of geriatricians, geriatric psychiatrists, and psychologists. The nurses also tracked the details of the patients' cases, including depression, medication use, and patient-caregiver attendance at group therapy sessions.

The other 69 patients got standard Alzheimer's treatment, plus information on Alzheimer's, communication skills, caregiver coping skills, and legal and financial advice. They also received patient exercise guidelines and a caregiver guide.

The researchers compared the two groups after a year (when the collaborative care program ended) and again six months later.

Study's Results

The collaborative care group had some different results from the other participants:

  • Fewer behavioral and psychological dementia symptoms at 12 and 18 months.
  • More likely to take antidepressants and Alzheimer's drugs called cholinesterase inhibitors.
  • Less distress and depression in caregivers as the study progressed.

However, collaborative care wasn't shown to improve or worsen mental skills (cognition), activities of daily living, or rates of nursing-home placement, write Callahan and colleagues.

The study shows that "care for patients with Alzheimer's disease can be improved in the primary care setting, but not without substantial changes in the system of care." In other words, the dream team for collaborative care isn't in place.

Future studies should test whether collaborative care is cost-effective, the researchers note.

Tips for Caregivers

The Cleveland Clinic (which wasn't involved in Callahan's study) offers these tips for people who are serving as caregivers for Alzheimer's patients:

  • Take time for yourself. Make sure you have time to relax. If necessary, enlist the help of other family members or even hire someone to help out.
  • Learn as much as you can about your loved one's disease so you will know how you can help. You'll also understand what changes to expect in your loved one's behavior or symptoms.
  • Help your loved one participate in as many activities in the home and outside the home as possible. Maintain the intricate balance between helping your loved one accomplish a task and actually doing the task for him or her. Allow the patient the time needed to complete daily activities on his or her own, such as dressing.
  • Consult your loved one about his or her family affairs. Although it's not easy to discuss these topics, you should be informed of your loved one's wishes regarding a living will, durable power of attorney, and do-not-resuscitate (DNR) order.
  • Set realistic goals for yourself and your loved one. Do not attempt to do everything. By setting attainable goals, you are setting everyone up for success, rather than disappointment.
  • Do not put your life on hold. Continue to meet with friends, participate in hobbies or groups, and maintain a schedule as normally as possible. You will feel more energized and are less likely to feel resentful in the long run.
  • Have someone you can talk to. You are there for your loved one -- to listen and to offer support -- but you also need a support person. Talk openly and honestly with a friend or family member. If this is not possible, join a support group. Understanding that you are not alone and that someone else is in a similar situation helps you to feel nurtured.
SOURCES: Callahan, C. The Journal of the American Medical Association, May 10, 2006; vol 295: pp 2148-2157. News release, Indiana University. WebMD Medical Reference provided in collaboration with The Cleveland Clinic: "Alzheimer's Disease: Your Role as Caregiver." News release, JAMA/Archives.

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