Geriatric Care Manager’s busy week
May 29, 2009 at 10:00 am | Posted in Megan Milchman, GCM | Leave a commentTags: GCM, Weekly
Tuesday: M to her primary care doctor. She is found to be in good health for the most part. They did find a small nodule on her thyroid gland, but are not to worried at this stage.
Wednesday: I go to see Ma, her OT got lost on the way to her house and I am unable to wait, but I call and find out that she did eventually show up.
A is still doing well, for the first time in awhile she is feeling good.
Mr. A is doing so much better. He is much happier with everything now, even though he will be going into an assisted Living Facility as much as he did not want to go.
Thursday: Ma goes to see the neurologist, he will be sending her for more tests, before any diagnoses is really made.
P, fell on Sunday while walking back from her pool. I took her for a follow up exam with her doctor. She still has weakness and can’t move her arm that much. The doctor believes that she may have a fracture that did not show on the X-ray. I will be taking her to a specialist next week.
Geriatric Care Manager in Bergen County, NJ
May 24, 2009 at 10:30 am | Posted in Megan Milchman, GCM | Leave a commentTags: GCM, Weekly
Monday: I visit with M, she is doing really well now, but unforunately she tells me that she had to put one of her cats down, because she was very ill. She said “I had to do it, she was suffering, it was the right thing.” You could tell that she was very troubled by it, but didn’t want to talk quite yet. She was holding on to her other cat, not letting it go.
I go to Mr. A’s house, I called an hour before hand, but when I arrived he still had not showered or dressed. I waited 45 minutes for him to get dressed. He is having a very difficult time with decision making lately.
Tuesday: I go to Mr. A’s house, I call him first, the cleaning service is coming for the first time today and I have to be there to let them in and take him out otherwise he will kick them out. When I arrived he was not dressed, and was really disshelved. He was very upset that I was there “without calling” and that “noone told me about the cleaning people”. I had a very difficult time getting him out of the house. We finally get out and I take him clothing shopping and grocery shopping. We arrived back to his house shortly before they finish cleaning.
Wednesday: Ma is having a rough week, first a close friend passes, then her Uncle. The Aide decides that it is all to much for her to handle, so she only goes to her Uncle’s funeral. She looks as though she is doing well with everything.
Mr. A, another hard day for him, he refuses to get dressed and refuses to go out. He is very agaitated and keeps saying “I am having a bad day, leave me alone”.
P, she is happy to see me. She is taking all her meds and is doing great.
Thursday: PA, she is doing fine, she has some leg swelling, but refuses to do anything her help it. She says that “it doesn’t bother me”.
A has a new Aide, she said “Barbara was difficult, I finally got fed up and told her and now I have someone new.” I go over everything with the new Aide, she seemed to be well informed.
Mr. A, it has just been a really rough week for him. I go today and he was wearing the same dirty sweats he has been wearing. He is very agitated and says ” I need help, I can’t do this on my own anymore.” He kept talking about calling his son. He refuses to go shopping or to the bank, even though I told him that I will not be there again until Tuesday. He did not care. He said that we can go next week. I feel really bad, beccause the decline has been really fast.
Have a good weekend, Enjoy the holiday.
Weight Loss and Dementia
May 21, 2009 at 11:37 am | Posted in Sophia Heftler, GCM | Leave a commentTags: Alzheimer's Disease, Dementia, Study, Weight Loss
There are so many new studies related to Alzheimer’s Disease and dementia it’s sometimes difficult to know what to believe. I read about a new study just yesterday which I found very interesting but I’m not sure that I trust the results. I do, however, think there is some merit to the findings published.
The study, which was conducted by the University of South Florida, suggests that rapid weight loss in older adults may be an early warning sign of dementia. The study was conducted over the course of eight years and followed 1,836 Japanese Americans.
Those who participated in the study who started out with a lower body mass index (less than 18.5) were 79 percent more likely to develop dementia than those participants who were heavier. The study also found that people who lost weight at a fast rate were almost 3 times more likely to develop dementia than those who lost weight slowly over time. These results mirror a study published in 2006 that found women who developed dementia had a drop in their weight as early as a decade before the onset of memory loss.
So, does this mean it’s actually helpful to be overweight or obese as a means of protecting yourself against dementia? Not so fast!!! Previous research found that excess weight around the stomach in middle age may increase the risk of developing dementia later in life.
What to believe??? The best thing I would recommend to everyone is that anytime a loved one suffers a significant sudden weight loss it’s time to see their geriatrician or primary care physician. And as a matter of preventative medicine and general good health I would suggest you maintain a nutritious, balanced diet, exercise regularly and engage in frequent social activities…and as we learned the other day, work for as long as you can to reduce your risk of developing dementia!
As a registered nurse and professional geriatric care manager it’s a challenge for me to keep track of all the studies and their recommendations, but I will continue to do my best to keep you informed of new developments as I become aware of them.
To find out more about this, or any other information I have posted feel free to email me at sophia@distinctivecare.net or to call our offices at (201) 857-5283.
Interesting Alzheimer’s Disease Study Results
May 19, 2009 at 10:00 am | Posted in Sophia Heftler, GCM | Leave a commentTags: Alzheimer's Disease, Dementia, Prevention, Retirement
I was reading the Bergen Record today and came across a Good News article that reported on a new British study published Monday that found working a few years past retirement could stave off Alzheimer’s Disease!
Experts from King’s College London analyzed data from more than 1,300 people with dementia, considering factors including education, employment and retirement. The results showed that the later people retired, their risk of avoiding Alzheimer’s Disease decreased. In fact, they were able to determine that each extra year of work was associated with a six-week delay in the onset of dementia.
One of the paper’s co-authors, Simon Lovestone, reported, “The intellectual stimulation that older people gain from the workplace may prevent a decline in mental abilities, thus keeping people above the threshold for dementia longer.” He did add that doctors do not fully understand how to delay or prevent dementia, previous studies have suggested that more education may lower dementia risk.
More research is needed to confirm the study’s findings. Suzanne Sorensen, head of research for the Alzheimer’s Society, stating that people who retired earlier may have done so because of health problems like high blood pressure of diabetes, which increase the risk for dementia.
Sorensen said, “It could also be that working helps keep your mind and body active which may reduce the risk of dementia.”
The most common of all dementias, Alzheimer’s Disease accounts for approximately 60% of all cases.
Our nurses and counselor at Distinctive Care Geriatric Care Management have attended many training classes and we utilize this training in our assessments and care planning. If you are dealing with a loved one who is experiencing a decline in their cognitive function or their ability to perform their activities of daily living call our office to schedule a cognitive screening assessment to help determine whether or not they may be suffering from mild cognitive impairment or possibly dementia. Early detection and treatment are important to slow the progression of the disease.
We have offices throughout Bergen County and can be reached at 201-857-5283.
Bergen County GCM
May 15, 2009 at 9:31 am | Posted in Megan Milchman, GCM | Leave a commentTags: GCM, Weekly
Monday: M, it’s been a week since she has been out of the hospital and she seems to be doing really well. She is happy with her choice of not going to a rehab facility and everything seems to be working for her. She is going to be receiving PT in her home.
Tuesday: Mr. A, his son tooks the car away this past weekend after I took the keys. He is down about what is happening, but seems to be adjusting. Now we just need to figure out how to get him to bathe and change his clothing. He seems to be attached to these pants that he has been wearing for 3 weeks now. I don’t know how much longer he is going to be living on his own, he has been talking about moving in with his son. I will plan for him to see his psychiatrist this week.
P, she is finally coming around to me and seems to enjoy my company. I have been putting her meds into medi-minders and she is not having a problem. She wants to go to lunch, so we go to the diner around the corner and each have soup and share a salad and talk about what happened on Mother’s Day. She said that she would like to have lunch together on a weekly basis, so I will try to make that happen.
Wednesday: I call the psychiatrist and manage to get an appointment today for Mr. A. First I have to go see MA. She is doing well, but it seems as though she is beginning to lose her energy again. She has an appointment with the neurologist coming up soon. We talk about PT/OT and that she will be starting up with that soon, I that I will try to be there for the first visit, so there is no more misunderstandings.
Mr. A we go and see the psychiatrist, who in the ends sees that he is coping the best way he knows how and she doesn’t see any problems. His son tells me to talk about his move with him, he thinks that things will be better, when they are closer.
Thursday: P is doing good, she had some redness on her legs, but it is being treated and healing.
A, she is doing well, she says that she feels weak and can’t move, but I see a little bit of energy in her. The doctor tells her not to worry, nothing is wrong. She says what can she do but listen to the doctor.
Mr. A, doesn’t want to do much with me today, I walk around the house to look for evidence that he has showered or cleaned up, but find nothing.
At least he still feeds the cat.
End Stage Dementia and Tube feedings
May 13, 2009 at 9:30 am | Posted in Megan Milchman, GCM | Leave a commentTags: Alzheimer's Association, Alzheimer's Disease, End-Stage, Tube Feeding
At this stage many people are confused as to what to do for their loved one, especially if there is no Living Will/Advanced Directive in place. End Stage Dementia can be difficult for the patient, family/caregiver, and anyone else who is involved in the care of this person.
By the End-Stage the person is completely dependent on others. They can no longer walk, talk, and eating may be difficult. What do you do at this point? Ask questions and become educated. Also go with what you feel, don’t allow anybody to choose for you, especially if it not something that you would do.
Get the facts. A nursing home will still allow your loved one to stay there, even if you decide not to go ahead and place a tube.
Get all your options and weigh them.
Facts: Peg tubes may not prevent lung infections. Peg Tubes are not required by law, it is YOUR choice. Tube feedings can be stopped at anytime. You are NOT starving your loved one. At end-stage Dementia, patients may not feel hungry or thirsty anymore and sometimes, feeding and hydrating them can cause more discomfort.
I am not telling you I am for or against tube feedings. I am also not telling you what you should do. I am giving you facts that you can use to help you along in your decision making process.
Good Luck!
Tube feeding myths and facts, Altenheim Nursing Home
Early Stage Alzheimer’s Disease
May 12, 2009 at 8:37 am | Posted in Sophia Heftler, GCM | Leave a commentTags: Alzheimer's Association, Alzheimer's Disease, Cognitive Screening, Early Onset
On Friday the staff of Distinctive Care Geriatric Care Management attended the NJ Alzheimer’s Association annual confernce New Directions in Research and Care. The conference was amazing and there were internationally renowned presenters speaking about the new developments in the field of Alzheimer’s Disease research.
I had the privilege of attending a panel discussion featuring two couples in which one of the partners had early stage dementia. It was fascinating to hear them describe what prompted them to be evaluated for the disease and what life has been like since receiving the diagnosis.
One couple was older and they did not live together. The woman and the gentleman’s daughter had noticed changes in his memory, mood and behaviors. They in turn had informed his son who lived out of town and it was during a visit to his son that he was told about the changes they all had observed. Upon his return home he made an appointment to have a complete evaluation conducted and received the diagnosis of Alzheimer’s Disease. He is currently living alone and his girlfriend worries about him being alone in the house. He is still driving but knows that in the future he will have to give up the keys to his car. His family and friends have been very supportive and the medication seems to have slowed the progress. His brother also has the disease and they talk about it often. He and his girlfriend attend a support group for people with early stage Alzheimer’s Disease.
The other couple was a married couple in their early fifties. The wife, age 52 had been diagnosed with early onset, early stage dementia and at this point she seems to have progressed to a moderate level. She had been an executive with a major television network and is currently on permanent disability. The couple have two daughters, age 13 and 11. They are aware of their mother’s diagnosis. The couple reported that she had initially been misdiagnosed as suffering from anxiety, but as her symptoms continued to worsen she went to a memory center for a complete work up and received the diagnosis of Alzheimer’s Disease. They said the biggest issue for them currently is the feeling that they are all alone and have lost many of their friends. The husband has been having a difficult time being the primary caregiver, care manager and working fulltime. He reported that he is taking an antidepressant. The girls see a therapist every other week and there currently is no support group available for them.
The biggest thing both couples stressed was the importance of early diagnosis and treatment. They both indicated that it is much better to be able to deal with the known rather than to be wondering what was wrong and that taking the medication early had slowed the progression and kept them much more functional than they would be if they had waited to start treatment.
At Distinctive Care we know the importance of early diagnosis and treatment which is why we have developed our Cognitive Screening Program. We offer this service at all three of our Bergen County offices and it helps Clients decide whether they should persue further testing, or if they are just experiencing mild age-related memory loss. Please call (201) 857-5283 to learn more about this program.
A tough week for a GCM
May 8, 2009 at 10:10 am | Posted in Megan Milchman, GCM | Leave a commentTags: GCM, Life
Monday, Visit with M, she was in the hospital and came home yesterday. She is not feeling well, but it is only 1 day out of the hospital. She has had a very busy day as well, with people coming in and out. I leave so she can rest.
Tuesday, Mr. A, we go grocery shopping he seems to be better with me coming daily.
P, the medi-minders that I introduced to her last week worked out. She was still a little confused, but not as confused as last week. We are still waiting for the doctor to call in the refills.
Wednesday, Mr. A goes to the neurologist and we learn that he is no longer allowed to drive. When I drive him home we discuss the doctors visit and by time we get him home, he agrees to give me the keys to his car.
Ma, I meet with her and fill her medi-minders. We then discuss the misunderstading that she had with her OT and everything is straightened out.
I go back to P, her medication has finally been called in. I bring her the medication.
Thursday, Very busy morning. I bring Pa her mothers day gift and review her chart, nothing new with her. G is doing well and her daughter is there when I arrived, so I discuss everything with her. B who has been in the facility for a week is doing really well.
A, I fill the medi-minders, nothing has changed with her.
Mr A, he is sad and teary eyed that he has lost his car and really doesn’t remember much of yesterday.
Friday is all day at the Alzheimers Association Conference.
Mark Heftler
Sophia Heftler
Pat Linard
Christine Clark, GCM
Joanne Jordan, Office Manager
Amy Shein, GCM
Deborah Varisco, GCM
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