A Startling Cause of Misdiagnosed Dementia

By Jeff Anderson on October 24, 2012 from www.aplaceformom.com

Look in any senior’s medicine cabinet and you’ll likely see a vast assortment of pharmaceuticals. In 2010, the Kaiser Foundation reported that the average senior is taking six prescription drugs daily. Some seniors take twice that amount. Many seniors add one or two new prescriptions to their daily routine each year until it gets to the point where it would take a database to organize them all. Often, the senior and the senior’s family do not fully understand which pill does what, when to take each pill, what side effects to look out for, and so on. It’s medication chaos.

The risk of medication chaos increases as seniors see multiple specialists and do not have a primary care physician who is responsible for the big picture and what all these medicines are doing in concert. The results can range from acute episodes of toxicity—a bad reaction leading to an emergency room visit— to outright misdiagnosis of illnesses. In fact, the Alzheimer’s Association reports, “Medication induced dementia is the most common cause of misdiagnosed or ‘reversible’ dementia.”

How Medication Side Effects Can Masquerade as Dementia
Drug interactions and side effects often mimic the symptoms of age-related cognitive disorders. For example, drugs that affect cognition and mobility, such as anti-anxiety meds, can make dementia symptoms worse—or even create a facade of dementia in people who don’t suffer from the disease, a condition known as pseudodementia. For instance, many anti-anxiety drugs commonly prescribed to seniors such as Valium and Xanax have side effects that are indistinguishable from dementia including:

• Short-term memory loss
• Disinhibition
• Hallucinations

Of course, at high does, negative reactions like these are even more likely. Other medications can also cause pseudodementia, including cholesterol lowering statin drugs like Lipitor, which many seniors take. In fact, any medicine that can cause cognitive impairment could lead to a misdiagnosis of dementia. Classes of drugs including anti-histamines, antibiotics, corticosteroids, anticonvulsants, antiemetics, muscle relaxants and opioid pain killers all carry this risk.

While the right medicine can reverse the course of serious diseases and improve a senior’s quality of life immeasurably, medications also cause problems. We received this pointed comment on our Senior Living Blog, which is worth quoting in full:

“My mother was fading fast. In the course of two months, she went from needing general assistance to not being able to stand or assist with her own transfers. She went from minor memory lapses to neither recognizing people nor her surroundings. Over the course of about three weeks, she had deteriorated to the point where she could not take her medications. Without meds, she regained her mind and most of her mobility. It came down to the medications she was on. We began reintroducing them one at a time with minimal doses for the most important issues. If we saw a return of symptoms of dementia, we would reverse course and she would come right back. It has made me wonder how many of our elderly end up in homes, or deteriorate catastrophically because they are on too much medication. It almost killed my mother. She’s 80 years old. Who cares if her cholesterol is a little elevated if the combining of her meds is destroying the last years if her life?”

This reader’s fears are not unfounded. A 2012 study published in online Medical Journal PLOS One found that 20% of the medications prescribed by seniors’ primary care physicians are inappropriate because they could cause adverse reactions. The same study from PLOS One found that 35% of seniors’ medical reactions occur in outpatient settings, suggesting that at a supportive environment with medication management, these unintended side effects would be reduced.

Senior Living and Non-Chemical Approaches
For many seniors, a move to an assisted living community can help get this medication chaos under control. Most assisted living communities require that residents have a doctor’s visit before admission. Families and physicians often use this visit as an opportunity to “press the reset button” on prescriptions. A complete reassessment of the senior’s medication regime can (and should) take place at this time. Under doctor’s supervision, many seniors are able to go off of medicines that are redundant, have outgrown their usefulness, or are outright contraindicated.

Once a senior is admitted to assisted living, a care plan is put in place. Care plans lay out goals and strategies for the resident’s care, and medicines are a big part of the equation. The community, family, senior and medical professionals discuss what medicines will be given to the resident, why, and often set goals for reducing them. In fact, seniors, particularly those with Alzheimer’s and dementia, are often able to reduce their medications after moving to assisted living communities with memory care.

For example, many seniors who have been prescribed anti-anxiety medications we discussed above find themselves in an undignified stupor that’s not only painful for loved ones to witness, but also can lead to falls, head injuries and broken bones. Today’s memory care communities instead attempt to reduce agitation and anxiety non-chemically with methods such as:

• Purposefully designing communities to make people with memory loss feel comfortable
• Using pet therapy which reduces blood pressure, improves mood, and decreases anxiety
• Encouraging family visits and community involvement

Loren Shook, CEO of Silverado Senior Living, which specializes in memory care, confirms that many residents who move to Silverado communities are able to significantly reduce their medicine intake, and with great benefit.

Medication Management and Healthy Senior Living
While decreasing the amount of prescribed medications is ideal, it’s not always possible. In some cases, seniors require every medicine they’re prescribed. But even in these cases, assisted living plays an important role. Even if medicines can’t be reduced, it’s important that that they be taken correctly. Medication management, which is offered at nearly all assisted living communities, assures that seniors get the right medicine, at the right dose, at the right time. For seniors with a cornucopia of medicines, or with memory loss, this benefit alone can be a lifesaver.

If your older loved one is on more medicines than anyone can reasonably be expected to keep track of, or is showing changes that you believe may be related to drug interactions, arrange a doctor’s visit to reevaluate medications. Talk to the doctor about what medicines are essential, and what medicines may be doing more harm than good. And if your older loved one cannot take medication safely, and you can’t be there to help, consider assisted living or homecare. Our Senior Living Advisors can help your family find the most appropriate options for loved one.

What are your experiences? Have medication side effects or reactions led to your loved one being misdiagnosed? Are you a medical professional with your own thoughts?

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Music for Senior Health and Well-Being

Photo credit: A Seattle jazz drumming pioneer, George Griffin, is bringing the joys and health benefits of music to fellow senior housing residents in Rainier Valley. -Alan Berner, The Seattle Times

How Music Improves Quality of Life for Senior Housing Residents
By Sarah Stevenson on October 4, 2012

George Griffin has spent a lifetime drumming, from his childhood years pounding on cardboard boxes to his successful career as a jazz drummer, opening for such legendary names as John Coltrane and Miles Davis. And, the Seattle Times reports, he’s still going—this time bringing the benefits of music to seniors in his independent living complex.

We already know that music and other enjoyable activities correlate with improved health and well-being in seniors, which is why Griffin’s efforts to teach drumming make such an encouraging story. According to the National Institute on Aging, studies have found that “people who are involved in hobbies and other social and leisure pursuits may be at lower risk for (and less likely to develop) some health problems, including dementia. They might even live longer.”
Not only that, recent research is indicating that social activity plays a role, too, and so does “productive activity” such as working, volunteering, and yes, playing a musical instrument. Such activities can make our senior loved ones happier, healthier, more active, and increase their sense of personal satisfaction.

Turning Independent Living into Active Living
The other seniors in Griffin’s housing complex are seeing these benefits firsthand. But it wasn’t always that way. Because the Rainier Valley complex where he lives encourages independent living, it doesn’t have any assisted living services. The problem was, independent living didn’t necessarily translate into active living. Griffin noticed that a lot of the residents were “sitting around doing nothing. I decided drumming might be a good thing.”

So, six months ago, he put up notices around the complex, saying that he was going to start up a drum line—no experience necessary. Though Griffin still plays the occasional gig as a jazz drummer, these days he’s spending a lot of time as mentor to the 3G Senior Hand Drum Line (the 3G stands for George Gentre Griffin). He’s tough, energetic, and funny, say the budding musicians in his group, and his drum practices have provided joy, camaraderie and entertainment as well as lessons in rhythm. One resident even says it’s helped her sense of balance.
It’s an inspiring story, and one that reminds us senior living doesn’t have to be dull or routine. In fact, it’s better for our loved ones’ health if it isn’t! If you have family members in assisted or independent living, do they have access to musical activities or other leisure pursuits? If so, have you noticed any positive changes to their health and well-being as a result?

Dementia: From Ancient Egypt to Today

Alzheimer's and Dementia across Space and Time

An ancient drawing of the aging brain

September is World Alzheimer’s Month, which reminds us that it’s not only Americans who are dealing with the ravages of Alzheimer’s disease or other age-related dementias. Dementia knows no borders.

Since ancient times, people have experienced age-related dementia memory impairment. According to a June 1998 article in the Journal of Neurological Science by F. Boller and MM. Forbes, “The history of dementia is probably as old as mankind itself.” A January 2006 article from the same journal, titled Dementia in the Greco-Roman World and written by Axel Karenberg and Hans Forstl, credits the Ancient Greeks as first recognizing and describing dementia.

About 2,400 years ago Plato described an illness that “gives rise to all manners of forgetfulness as well as stupidity.” Dementia in the Greco-Roman World also quotes the Roman poet, Juvenal, who almost 2,000 years ago characterized a phenomenon that’s easily recognized as dementia:

“Diseases of all kind dance around the old man in a troop. But worse than any loss in the body is the failing mind which forgets the names of slaves, and cannot recognize the face of the old friend who dined with him last night, nor those of the children whom he has begotten and brought up.”

Evidence of dementia in Ancient Egypt exists as well. A paper by Dr. Deborah Sweeney of Tel Aviv University, quotes a 25th century BCE Egyptian, Ptahhotep, describing in hieroglyphs an aging person who…
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