Posts Tagged ‘Syndrome’

Folic Acid Does Not Prevent Memory Decline

Sunday, July 18th, 2010

The addition of folic acid to the list of vitamins and supplements for the prevention of memory decline is addressed in this meta-analysis. Wald et al conducted a meta-analysis of 9 randomized controlled trials on folic acid, with or without vitamin B and its effect on memory, speed of information processing, language and executive function (decision making). The median duration per study is 6 months and the median age of participants is 75 years.

The results showed no effect of folic acid in the prevention of cognitive decline (memory, speed of information processing, language and decision making) among individuals without preexisting dementia.

The pooled standardized mean difference
in cognitive function test scores was 0.01 (95% CI,
-0.08 to 0.10) after a median treatment of 6 months; an
increase of 1% of a standard deviation of a cognitive
function test score, with confidence intervals excluding
an improvement or a deterioration greater than 10% of 1
standard deviation.

Studies of longer duration are needed in order to address the role of folic acid in the prevention of cognitive decline.

Source: The American Journal of Medicine (2010) 123, 522-527

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Coping With Dementia: Violence and Aggression

Sunday, May 16th, 2010

Tips from the Alzheimer’s Disease International website:

Violence and aggression

“Violence and aggression are caused by the illness.”

From time to time, the person may become angry, aggressive or violent. It is not a personal attack on you, but a part of their illness. There are many reasons why a person with dementia may feel angry. They may not like being helped with things they used to do on their own, or may simply be frustrated due to an inability to do things.
Angry Skull
These short-term changes happen for a variety of reasons such as the person’s sense of loss of social control and judgment, loss of the ability to express negative feelings safely, and loss of the ability to understand the actions and abilities of others. It is therefore worth finding and avoiding the causes of unwanted certain reactions.

If the person feels angry, aggressive or violent, keep calm and try not to show fear or alarm. Give them more space and try to draw their attention to a calming activity.

This is one of the most difficult things to cope with for a caregiver, and if violence occurs often, you will need to seek help. Talk to someone for support, and speak with your doctor about help with managing the person.

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Coping with Dementia: Alcohol and Cigarette Smoking

Sunday, May 16th, 2010

Modified from Alzheimer’s International UK:

Alcohol and cigarettes

“Supervise drinking and smoking to make sure accidents don’t happen.”

There is no problem for a person with dementia drinking alcohol in moderation if their medication allows. However the person may forget they have just had a drink and so have another one. This cycle can lead to repetition with the person becoming drunk or unmanageable.

1. Do not buy or store alcohol at home.
- reduce the number of bottles of alcohol available in the drinks cabinet
- empty or dilute some of them.
2. Distract the person with another activity, so that they do not think about drinking.
3. Provide water, juice, light soda, and other healthy cool drinks.

Tobacco Smoking Elderly

Cigarettes introduce a greater danger because of the risk of fire and damage to health.
1. Do not buy or store cigarettes at home.
2. Always supervise the person when smoking
- but remember the dangers of second-hand and third hand smoke!!!
3. Discourage smoking altogether and enroll in a smoking cessation program
4. Make sure that the clothes they wear and the furniture in the house are fire-resistant.
5. Install a smoke alarm, which can alert you to any danger.

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Preventing Alzheimer’s Part 2: The NIH Consensus 2010

Tuesday, May 4th, 2010

Part 2: Cognitive Engagement and Physical Activity

1. Cognitive Engagement.

Cognitive Training – modest benefits on cognitive functioning and a small but statistically significant effect on reducing the extent of age-related decline in cognitive function at a 5-year follow-up. Very small but statistically significant benefit on instrumental activities of daily living—for example, managing finances, managing medications, keeping house, and, in a subgroup analysis, benefit on driving performance in the elderly.

However, these results from a single trial must be replicated to confirm the benefits of cognitive engagement on preventing
cognitive decline over a longer time period and in study subjects with varying levels of baseline cognitive abilities before a firm recommendation can be made.

2. Physical Activity. Increased physical activity, including walking, may help maintain or improve cognitive function in normal adults.

Tai chi PGH Geriatric Clinic

Although encouraging, these data should be viewed as preliminary. Work is ongoing to further investigate the benefits of
physical activity.

Factors associated with decreased risk of Alzheimer’s disease and cognitive decline were cognitive engagement (as indicated by literacy and social enrichment), physical activities in later life, and a diet low in saturated fat and high in vegetable intake. Light to moderate alcohol intake
is reported to be associated with reduced risk of Alzheimer’s disease, but results are inconsistent for cognitive decline

Source: NIH State-of-the-Science Conference:
Preventing Alzheimer’s Disease and Cognitive Decline
April 26–28, 2010

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Preventing Alzheimer’s Part 1: The NIH Consensus 2010

Tuesday, May 4th, 2010

Part 1: Supplements and Medicines for Alzheimer’s Prevention

Available scientific evidence is inadequate to conclude that any known preventive strategies are effective. This conclusion is based on a review of published literature of randomized, controlled trials (RCTs), the most rigorous, highest quality evidence.

Summary of Detailed Interventions:
1. Vitamins, Nutrients, and Dietary Supplements.
Vitamin E – no evidence that this factor altered the onset of the Alzheimer’s disease.

Gingko biloba – A recent, large long-term RCT showed no reduction in the incidence of Alzheimer’s disease, leading to the conclusion that there is not sufficient evidence to support the efficacy of gingko biloba.

2. Medications
Cholinesterase inhibitors (donepezil, rivastigmine, galantamine) – this class of drugs is not effective in preventing Alzheimer’s disease.

Anti-hypertensive medications – negative with insufficient evidence for protection against Alzheimer’s disease.

NSAIDs—rofecoxib, naproxen, and celecoxib—suggest an increased incidence of Alzheimer’s disease with treatment.

Conjugated equine estrogen, one combined with methyl progesterone – suggest an increased incidence of dementia (including Alzheimer’s disease) with treatment.

Together, these trials suggest that no known medication can be said to reliably delay the onset of Alzheimer’s disease.

Source: NIH State-of-the-Science Conference:
Preventing Alzheimer’s Disease and Cognitive Decline
April 26–28, 2010

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Do’s and Dont’s When Hoarding Becomes Dangerous

Monday, April 19th, 2010

When there is imminent danger to the person with hoarding or to others in the household, it may be necessary to seek professional help.

hoarding photo from anxietystress.org

hoarding photo from anxietystress.org


For individuals with compulsive hoarding who are ready to work in the home and wish the help of family members or friends, the following can be helpful:

DO:
1. Decide together on the goal, e.g., clearing an area of the home.
2. Help the person remain focused on the task in front of him or her. Simply remind the person what he or she is supposed to be doing at the moment.
3. Provide emotional support. Express empathy, with statements such as, “I can see how hard this is for you,” Cheer on and praise the effort the individual is making to overcome this problem and expressing their belief in the person’s ability to make progress.
4. Help the person make decisions but do not make decisions for him or her. Good questions to ask are: “Is it useful?” “Do you need it?” “Can you do without it?”
5. Help the person with hauling. Many people with compulsive hoarding have accumulated so many things that they can become overwhelmed by the enormity of removing such a large number of items.

DON’T:

1. Don’t touch anything in the person’s home without his or her specific permission. Ignoring the person’s wishes and handling their things without their permission breaks trust and can damage the relationship with them.
2. Don’t argue with the person who has the hoarding problem as this produces negative feelings and slows progress. When conflict arises, take a break.
3. Don’t tell the person with the hoarding problem how he or she should feel.
4. Respect that items that appear useless in fact have great value to the person is instrumental in helping the individual to overcome this problem.

More Information:
The Obsessive Compulsive Foundation

See related blog in our March Archive

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Tips to Reduce Clutter and Hoarding

Sunday, March 28th, 2010

Hoarding

Some people will hoard or save numerous items, including dirty clothes, food, and papers. Losing a meaningful role in life, work, friends, family, and a good memory can have an impact on a person’s need to hoard and or to “keep things safe”. Hoarding in this population is oftentimes triggered by the fear of being robbed.

When working with persons who have dementia, it is essential that you keep their safety in mind. Order, routine and simplicity are most helpful. A house or room that is relatively uncluttered is the ideal environment.

Ten Tips to Consider

1. Let go of ideal notions of cleanliness. Your patient may value items that appear to you as worthless. Parting with their belongings (even used paper cups) can cause severe emotional distress.

2. Ask your patient if they can donate or sell their belongings to charity.

3. Focus on fall prevention. Create pathways free of debris, loose cords or slippery rugs. Some frail patients hold onto furniture or other items while moving through the room; preserve their “props” until other assistive devices (canes, walkers) can be introduced.

4. Focus on fire prevention. Red flags include newspapers stored on top of or inside a hazardous area.

5. Be creative and negotiate. Consider photographing belongings, as this may help the patient part with things and preserve memories.

6. Begin by reorganizing a small corner of a room, a single table, or just a section of the table.

7. Have a friend or relative present during a major cleanout, preferably one who already has a supportive relationship with the patient. Clean-outs can be overwhelming to people with severe hoarding behavior. Have a back-up plan in case emergency psychiatric services are needed.

8. Discuss how to safeguard valuables in the cleaning process. Have a written contract. Agree on what to do with valuables that turn up, such as money, jewelry, or collectibles.

9. Consider relocating an individual to a new room if the clutter is the result of physical or mental frailty. A new environment can provide a fresh start and enable the patient to receive needed services sooner.

10. Plan for on-going maintenance and supervision to maintain a decluttered environment.

Adapted From: Weill Medical College of Cornell University

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Protect Seniors from Heat Stress

Tuesday, March 9th, 2010

Heat exhaustion is a form of heat-related illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids.

Warning signs vary but may include the following:

* Heavy sweating
* Paleness
* Muscle Cramps
* Tiredness
* Weakness
* Dizziness
* Headache
* Nausea or vomiting
* Fainting
* Skin: may be cool and moist
* Pulse rate: fast and weak
* Breathing: fast and shallow

To protect yourself from heat stress and heat stroke, follow these tips:

# Drink cool, nonalcoholic beverages. (If your doctor generally limits the amount of fluid you drink or has you on water pills ex. furosemide or hydrochlorothiazide, ask him how much you should drink when the weather is hot. Also, avoid extremely cold liquids because they can cause cramps.)
# Rest.
# Take a cool shower, bath, or sponge bath.
# If possible, seek an air-conditioned environment. (If you don’t have air conditioning, consider visiting an air-conditioned shopping mall or public building to cool off.)
# Wear lightweight clothing.
# If possible, remain indoors in the heat of the day.
# Do not engage in strenuous activities.

seniors swim
If you are living with or taking care of an older person

* Visit older adults at risk at least twice a day and watch them for signs of heat exhaustion or heat stroke.

* Encourage them to increase their fluid intake by drinking cool, nonalcoholic beverages regardless of their activity level.

Warning: If their doctor generally limits the amount of fluid they drink or they are on water pills, they will need to ask their doctor how much they should drink while the weather is hot.

* Take them to air-conditioned locations if they have transportation problems.

If You Don’t Have Air Conditioning:
• Take a cool shower, bath or sponge bath.
• Create cross-ventilation by opening windows on two sides of your house.
• Keep windows open at night.
• Keep curtains, shades or blinds drawn during the hottest part of the day.
• Cover windows when they are in direct sunlight.
• Electric fans may help, but when the temperature reaches the high 90s, fans won’t prevent heat-related illness.
• Go somewhere that’s air-conditioned like the shopping mall, the movies, the library, a senior center or a friend’s house. If you don’t have a car or no longer drive, ask a friend or relative to drive you. If necessary, take a taxi. Don’t stand outside waiting for a bus.

More heat stroke and heat stress information from the CDC link: Centers for Disease Control and Prevention USA

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2010 Clinical Guideline for Fall Prevention

Monday, February 1st, 2010

Excerpts from the American and British Geriatric Societies Clinical Practice Guideline 2010:

Prevention of Falls in Older Persons

Summary of Recommendations

SCREENING AND ASSESSMENT

1. All older individuals should be asked whether they have fallen (in the past year).
2. An older person who reports a fall should be asked about the
frequency and circumstances of the fall(s).
3. Older individuals should be asked if they experience difficulties with walking or balance.
4. Older persons who present for medical attention because of a fall, report recurrent falls in the past year, or report difficulties in walking or balance (with or without activity curtailment) should
have a multifactorial fall risk assessment.

Photo of the 4-step balance assessment demo at the Training of Trainors program, COMADD and Palo SHS:

TOT 4 steps group

The multifactorial fall risk assessment should include the following:

Focused History
1. History of falls: Detailed description of the circumstances of the fall(s), frequency, symptoms at time of fall,
injuries, other consequences
2. Medication review: All prescribed and over-the-counter medications with dosages
3. History of relevant risk factors: Acute or chronic medical problems, (e.g., osteoporosis, urinary incontinence, cardiovascular disease)

Physical Examinations
Functional Assessment
Environmental Assessment

Details are available at the AGS Website

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Geriatric Nurses Seminar November 2008

Sunday, November 9th, 2008

Geriatric Nurses Association of the Philippines

In cooperation with the

Philippine Society of Geriatric Medicine

November 04, 2008

Through Channels

Dear Fellow Nurses:

Greetings!

The Gerontology Nurses Association of the Philippines (GNAP) is pleased to invite you to the 2nd seminar entitled “Geriatric Syndrome: Skin and Nutrition Problems”. This will be held on November 18, 2008, Tuesday, 1:00-5:00 pm at the University of the Philippines College of Nursing, Seminar Room, 2nd floor. We shall be having a guest speaker from the International Institute on Ageing.

The registration fee for the seminar, inclusive of snack will be P250.00 for members, P350.00 for non-members and P500.00 for those attending and seeking membership. We appreciate your calling Ms. Paz Dumlao at UP Manila College of Nursing Tel No. 523-14-94 for reservations by giving your name, address and telephone/cell number. This will help us in the planning of the activity.

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