“In order to empathize with old-old people, we need to understand the complex interweaving of physical deterioration and developmental needs,” writes Naomi Feil in The Validation Breakthrough.
Like Feil, who has more than 30 years experience working with the elderly, I’ve found that “old disoriented people have an intuitive wisdom, a basic humanity that we all share. Behind their disorientation lies a human knowing. I have witnessed this “human knowing” in people with dementia, even when they find it difficult to articulate their thoughts. I call it “intuitive clairvoyance.”
It shouldn’t come as a surprise that old people have the same needs all of us do. But somehow we lose sight of their humanity and their right to dignity. We treat them like children. We talk about them like they are invisible even when they’re right beside us. We tell them what to do. We restrain them physically and chemically. We ignore and isolate them. We fail to provide them the things they need to live full and productive lives to the end. What a shame!
We must use our failures (as Feil herself has) to develop a deeper understanding as well as better tools, techniques, and ways of caring for the elderly and people with dementia. I believe we must change the way we see and support the elderly, in particular people who have dementia. As they become less able to do so themselves, it’s our responsibility to help them get their needs met in the final part of their journey.
Fell suggests “old-old” people and people with dementia have psychological and social needs just like the rest of us. I would go further and say these are rights, not just needs. Everyone has the right to the needs Feil’s describes:
Resolve unfinished issues, in order to die in peace.
Live in peace.
Restore a sense of equilibrium when aspects of self fail (e.g. sight, hearing, mobility, and memory).
Make sense out of unbearable reality: find a place that feels comfortable, where one feels in order or in harmony and where relationships are familiar.
Be recognized and have status identity and self-worth.
Be useful and productive.
Be listened to and respected.
Express feelings and be heard
Be loved and feel a sense of belonging; have human contact.
Be nurtured, feel safe and secure, rather than immobilized and restrained.
Have all five senses stimulated touch, sight, sound, smell, taste, and be allowed to express one’s sexuality.
Reduce pain and discomfort.
BY SUSAN MACAULAY
People with Alzheimer's have better cognition skills in the late summer and early fall, than in the winter and spring, according to a new study.
Adults both with and without Alzheimer's disease have better cognition skills in the late summer and early fall than in the winter and spring, according to a new study. (The study was published in PLOS Medicine by Andrew Lim of Sunnybrook Health Sciences Centre and the University of Toronto, Canada, and colleagues.)
There have been few previous studies concerning the association between season and cognition in older adults. In the new work, researchers analyzed data on 3,353 people enrolled in three different cohort studies in the U.S., Canada, and France, with fascinating results.
Participants had undergone neuropsychological testing and, for some participants, levels of proteins and genes associated with Alzheimer's disease were available.
The authors found that average cognitive functioning was higher in the summer and fall than the winter and spring, equivalent in cognitive effect to 4.8 years difference in age-related decline. In addition, the odds of meeting the diagnostic criteria for mild cognitive impairment or dementia were higher in the winter and spring (odds ratio 1.31, 95% CI: 1.10-1.57) than summer or fall.
The association between season and cognitive function remained significant even when the data was controlled for potential confounders, including depression, sleep, physical activity, and thyroid status.
Finally, an association with seasonality was also seen in levels of Alzheimer's-related proteins and genes in cerebrospinal fluid and the brain. However, the study was limited by the fact that each participant was only assessed once per annual cycle, and only included data on individuals from temperate northern-hemisphere regions, not from southern-hemisphere or equatorial regions.
"There may be value in increasing dementia-related clinical resources in the winter and early spring when symptoms are likely to be most pronounced," the authors say. "By shedding light on the mechanisms underlying the seasonal improvement in cognition in the summer and early fall, these findings also open the door to new avenues of treatment for Alzheimer's disease."
Source:Seasonal plasticity of cognition and related biological measures in adults with and without Alzheimer disease: Analysis of multiple cohorts. PLOS Medicine
50% of dementia cases go undiagnosed or get misdiagnosed. Precious time is lost. Early care and support can make a tremendous difference and keep life from unraveling.
A recent Toronto study said that as many as 50 percent of Canadians with dementia are not diagnosed early enough, losing precious time when care and support can make a tremendous difference in their quality of life.
Earlier diagnosis has four main advantages:
It opens the door to important information and resources. These include support through local Alzheimer Societies or Alzheimer's Associations, which help people with dementia focus on their abilities to remain independent in their homes and communities longer.
With early diagnosis, people can access medications that, although not effective for everyone, have the greatest impact when taken early.
On a practical level, an early diagnosis gives someone the chance to explain the changes happening in their life to family and friends.
An early diagnosis allows families to plan ahead, medically, financially, legally and personally.
"Seventy-four percent of Canadians know someone with dementia and more and more Canadians will continue to develop the disease. We want to make sure they're getting the help they need at every stage of the disease," says Mimi Lowi-Young, CEO, Alzheimer Society of Canada. "As devastating as the news can be, early diagnosis brings relief to families, gives them control over their situation and adds more years of living active and fulfilling lives."
TEEPA SNOW VIDEO: See why Lewy Body dementia (LBD) poses special challenges to caregivers. Learn how LBD is different from Alzheimer's. Watch Teepa Snow demonstrate some of the unique stresses of caring for LBD.
Researchers at Indiana University have found early evidence that tiny snippets of genetic material called microRNA may help with early detection of conditions such as Alzheimer's disease.
The study, published June 18 in Nature Scientific Reports, found that changes in microRNA are detectable in mice long before they start to show symptoms from neurodegeneration. These microRNA changes may represent an early warning sign, or "biomarker," for the condition.
"Identifying biomarkers early in a disease is important for diagnosing the condition, and following its progression and response to treatment," said Hui-Chen Lu, a professor in the Linda and Jack Gill Center for Biomolecular Science and the Department of Psychological and Brain Sciences, a part of the IU Bloomington College of Arts and Sciences, who led the study. "You need something that can predict your future."
There is currently no treatment to stop or reverse the effects of neurodegenerative diseases such as Alzheimer's, Parkinson's, ALS or Huntington's. It's also estimated that Alzheimer's disease alone, which is the most common of these disorders, will affect 14 million Americans and cost taxpayers $1.1 trillion by 2050.
Unlike regular "messenger RNA," which direct cells to produce specific proteins, microRNA plays a regulatory role, increasing or decreasing the number of proteins that messenger RNAs encode. A single snippet of microRNA can impact the function of tens or hundreds of proteins in the body.
Due to their stability in urine and blood, there is growing interest in using microRNA as biomarkers for disease prediction and diagnosis. Lu's study is an early step to learn whether microRNA can be used to detect neurodegenerative disorders.
To explore this question, Lu and colleagues analyzed microRNA and messenger RNA in two groups: a healthy group and a group genetically modified to develop symptoms of dementia. The team found the highest level of "dysregulation" -- or deviation from normal levels -- in the microRNA of the dementia group before their physical symptoms developed.
"Higher levels of pre-symptomatic microRNA dysregulation are significant because it strongly suggests that it may have a role in changes in the brain in later stages," Lu said.
The team then compared the microRNA changes to the messenger RNA changes to identify biological pathways affected by microRNA dysregulation. Their analysis suggested that changes in microRNA affected pathways related to immunity in the dementia-prone model.
In response, the team then conducted additional tests to study a specific type of microRNA that was elevated in the dementia model. The microRNA -- called microRNA 142 -- is known to play a major role in inflammation, a part of the immune response.
They found that introducing this microRNA into the brain triggered a significant neuroinflammation. The result is important since many other studies have shown that chronic inflammation contributes to many types of disease, including neurodegeneration, Lu said.
She added that the next step will be to learn whether microRNA 142 is easily detectable through a blood test, a key quality for a truly non-invasive biomarker.