Category Archives: Interviews with experts

Guest interviews help readers figure out how to solve care dilemmas.

Professionals Who Go the Extra Mile — Adult Day Services for the Elderly

Taking care of a person with dementia requires a degree of patience I did not know I had. For years my world revolved around writing assignments and deadlines. It’s a career that requires perseverance and self-discipline. Ten years of freelancing for national clients convinced me that I was pretty good at it. But everything changed when my mom moved in. I felt clueless and overwhelmed. The transition was hard for both of us. Once I found the incredible people at the Adult Day program in our county, managing my work and her care became much easier.

Until Mom moved in with me, I had never heard of Adult Day Care. To me, the name sounded belittling, and I was careful not to say “day care” around my mom. No matter what stage of dementia someone has reached, you’ve got to show respect for who they are.

We are lucky to live in a county with a great Adult Day Service Center which is operated by Blue Mountain Health System. I interviewed Roxanne Downs, the director of the program to get more details about how services are organized. Although the program is located in Carbon County, this Palmerton site also has contracts with Monroe and Lehigh Counties which can refer clients who need services.

Ms. Downs feels that current services for seniors in Carbon County are well managed and located in sites that are accessible for most people. The aging population in our county is growing,  just as it is in the rest of Pennsylvania. But Roxanne feels that the county — like most others — is not financially prepared for the growing wave of elderly people.

Like most Adult Day sites, her center focuses on taking good care of their elderly participants. To do this, they work closely with their families. The center has a caregiver support group that meets regularly to discuss topics of interest to family caregivers. Past sessions have covered elder care law, the nature of Parkinson’s Disease, and trends in gerontology. Staff members at the site interview the elder’s primary caregiver every six months to adjust each elder’s care plan. The program operates on a medical model which helps identify and address health issues together with families.

Apart from meticulous daily care, the center offers handicapped accessible showers for people who have limited accessibility at home. They have a nurse on staff who can do blood work on site. This reduces the family burden of making appointment for ongoing labwork. A hairdresser is there offering weekly cuts for elders. Occupational and speech therapy can also be arranged on site.

I love the people who work there because they have been so good to my mom. Whenever any issue comes up, I get a phone call immediately and we create solutions together. Every day I am thankful for the kind attention they have given my mom and I am certain that their activities have helped my mom retain some abilities despite the progression of her disease. If you need this kind of support so you can work full-time and still care for a family member, the links on the front page will guide you to similar programs around the state of Pennsylvania. My December article in the Journal Newspapers also provides more details about elder programs in the Pocono region.

If your county doesn’t have a program like this, it may be time to become an advocate for launching one. You can begin by calling your Area Agency on Aging — and follow up with a call to your state legislator. Don’t be afraid to ask for what you really need. The elders in our community deserve the kind of support they once offered to us.

The Latest on Drugs, Treatments, and Scientific Views of Dementia

While some families are eager to get their loved ones into drug trials, my family has avoided that path. We had some horrible experiences with current FDA approved treatments and don’t believe that the potential benefits of unproven drugs outweigh risks that are hard to predict. Nevertheless, we are optimistic that science will eventually reveal the mysteries of dementia and produce more reliable treatment options. In my interview with Dr. Roy Hamilton of Penn’s Memory Center, I asked him to comment on the range of approaches currently being explored.

Before we took my Mom to the Memory Center, our family pursued some alternative approaches to fighting her symptoms. These included chelations and nutritional supplements. I asked Dr. Hamilton to assess the value of these and other homeopathic regimens for fighting the disease. He said, “Allopathic doctors – those who are educated in the Western medical tradition — must remain a little skeptical about these approaches” mainly because there is insufficient data to show if they are truly effective. But he agrees that this lack of data also makes it hard to say that alternative treatments have no value. From his perspective, it’s important to remember that even if alternative regimens are helpful to a dementia patient, “You can still have side effects or interactions with other aspects of your treatment. You need to consider that when combining them with other items prescribed by your doctor.”

Among drugs on the market today, the most effective include two FDA approved medications which are acetylcholinesterase inhibitors. Drugs in this category include Aricept, Exelon, and Razadyne. Gastrointestinal problems are the most common side effect of these drugs. Another treatment uses an NMDA receptor antagonist. This drug affects the receptor in the brain that is associated with neuroplasticity. Mementine is one drug which has fewer side effects but may be less efficacious in combating symptoms. Dr. Hamilton says that the general outlook for medication development has not been encouraging. Scientists are now experimenting with monoclonal antibodies which attack the protein that causes Alzheimer’s disease. Although these drugs are now in the last phase of clinical trials, some serious clinical side effects have been observed. One new line of research focuses on using resveratrol, a polyphenyl antioxidant from red-wine. The research in this area is too new to assess its potential value and weary caregivers, please note: Red wine is not a medicine!

I asked Dr. Hamilton how caregivers should deal with their own health in light of the common fear that we may get the disease ourselves. His advice is, “Stay intellectually active, physically active, and socially active. Follow a healthy diet. This is a good prescription to help anyone maintain cognitive function.” He also suggests joining a support group. Being a caregiver can be a very isolating experience, which “can be borne more easily when shared.” He advises caregivers to take a structured break with time off from the family member. This practice is good for caregivers, but it also improves care when we returned to our loved one feeling refreshed. Respite care and adult daycare programs can help caregivers get needed breaks.

Dr. Hamilton doesn’t feel that it’s imperative for family members of dementia patients to get tested for genetic markers of the disease since most cases are “polygenetic” and you can’t predict your odds of getting the disease by determining that you have just one genetic marker. He also thinks that the cost of genetic testing would be unjustified since it’s not clear what you could do to modify your disease if you discovered that you were susceptible. Finally, Dr. Hamilton reminded me that since about 40% of all people over the age of 80 have the dementia profile – everybody should make a long-term care plan!