The Tau Of Alzheimer’s

The following Bloomberg News article, After 190 Tries, Are We Any Closer to a Cure for Alzheimer’s? describes the research shift from emphasis on amyloid plaques in the brains of Alzheimer’s patients to the study of tau proteins.

The article refers to tau but does not explain its function. Why exam tau? There are at least 8 theories as to how one person develops observed symptoms of Alzheimer dementia while another does not. Earlier research focused on the amyloid plaques which were larger and appeared to have some genetic connections. However, these plaques were located outside the cells. How could they disrupt normal cell function? Older persons who show no symptoms of Alzheimer’s still have some of these plaques. Thus presence of plaques might not be a good disease indicator.

The next focus was on the neurofribrillary tangles because these are located inside the cells. Alzheimer patients have these tangles located in the memory-related areas of their brains. Tau proteins, like locust swarms, can agglomerate. These swarms can travel from one cell to another along the axons which connect brain cells. These tau “seeds” enter more cells and cause further disruption. Once a person develops enough tangles along their neural pathways, they display Alzheimer symptoms we can observe. Tau is known as one of the microtubule-associated proteins (MAP). Tau is found in the filaments which form the neurofribrillary tangles. Persons with normal mental functioning have less tau as well as less other damaging compounds.

ABREVIATIONS for the diagram below:

ApoE4=apolipoprotein E#4

AB= Beta-amyloid (plaques)

Tau= named for the Greek letter; this is one of the MAP proteins

FTD=Fibrillary Tangle Deposits

AD= Alzheimer’s Disease

Diagram of this process.

 

The new theory is to research methods to get at the tau, to prevent the tangles, which would stop the brain’s cellular disruption and thus prevent or halt the brain damage which leads to Alzheimer’s.

References:

1.Vlatcheslov Wlassoff, PhD

brainblogger.com/2014/02/25/development-0f-alzheimers-disease-is-tau-to-blame/

2.Richard A. Armstrong (26 articles on this and related topics)

http://www.termedia.pl/Review-article-What-causes-alzheimer-s-disease-,20,21432,1,1.htmlhttp://www.termedia.pl/Review-article-what-causes-alzheimer-s-disease-,20,21432,1,1.html

Vacationing Without Grandma.

Caregivers worry about vacationing. They ask themselves; “What if something happens to Mom while I’m away?”  Part of the reason caregivers suffer from stress is not the stress itself. It’s the lack of breaks from the caregiving. If you are a caregiver, you need this vacation! Your health depends on it. However, if the vacationing caregiver stays on the phone, it’s not really a vacation. How can families and caregivers let go enough to relax? Three words of advice; plan, go, relax.

Planning is the first step. Call the doctor to let them know you will be out of town.  If your senior named a successor agent under a DPOA, ask them to be on call during your vacation. Give doctor and others the name and contact information of the successor agent. Let any other staff know such as the cleaning lady or yard service. Let a near-by neighbor know. Ask these people to make any ER calls to you from their own phones. That way, it some one really needs you, you can tell who is calling.

Let the senior know well in advance. It may take a conversation, perhaps repeated conversations, to help them accept your absence. Some seniors might balk at these absences.   Be prepared for objections and claims of dire illness. Do not change your plans.

Pick up three+ post cards before you leave home. Send one the day you leave. Send the second the day you are returning. The other one(s) remind the successor agent, or cleaning lady, or neighbor about your vacation dates/place.

While away, send your senior post cards. You don’t need more than two sentences on each card. The regular cards will help your senior remember that you are away. Post cards will keep them off your phone.

Go! Get on the plane, train, ship…. You need to rejuvenate.  Record a new message on your phone that tells callers that you are away for now. Do not give a return date. Today’s phones call almost anywhere. Unfortunately, that may mean your senior could call you directly. Resist the urge to answer your phone.  Perhaps you can let a family member carry your phone. Your senior could be calling because they forgot you are away. If you see such a call, you can ask the neighbor to check-in with the senior and tell them when you will return. One such un-replied call should be enough to establish that you are out of reach. If that neighbor must do a check-in, find a gift for them.

Relaxing is hard for caregivers. Try this metal mantra: You have the right to this time. You need to do this in order to preserve your health. How much care could you give if you became ill? You are caring for yourself so you can care for others.   Enjoy! Do not turn your vacation into a circus. Down time is valuable to caregivers. Savor your vacation experiences! Take photos.

When you return, those photos could be a discussion topic with your senior.

Happy summer!

 

 

 

Who Stole My Senior?!

An acquaintance shared a story which is all too common because families do not take the necessary steps to prevent it: the “stolen” senior.

THE STORY: This family’s senior was moved to a supportive living facility. Once she had adjusted, the family took a vacation. While away, they received a call from the facility; someone was trying to remove the senior. Fortunately, this family had executed Durable Powers of Attorney (DPOA) before the move. The staff called them because they were her DPOA agent. They stopped it. Another branch of the family who had had little contact with this senior and no contact with the DPOA agent’s part of the family had tried this.

WHY DO THEY DO THAT? Mother equals money. If the senior’s income is managed by another person, that agent has decision-making power and access to funds that are not theirs. Unfortunately, DPOAs do not carry any sureties.  Sureties work like guard dogs and insurance so the agent acts responsibly. On the other hand, a guardianship require a court hearing, a medical report, posting a bond, and an annual accounting of funds While sureties are not fool proof, they are a method of recovering both money and the person of the senior. DPOAs at least offer a clear line of decision-making. When families do not arrange for some form of a substituted decision-making, they leave their seniors with no protection.

WHY DO THEY GET AWAY WITH IT? Facilities may not take prevention steps. Let’s look at senior facilities from the inside-out. Not all staffs are professionals, especially the receptionist. If the office staff is away for the weekend, reception faces a daunting task to deal with an irate stranger demanding the removal of a resident. Other facility staff may not speak English as a first language, may not know our legal system, or may not be educated enough to face such a challenge. How many caregivers in facilities were trained to recognize DPOA documents and/or distinguish these from guardianship documents? Does your senior’s facility have an annual training program on DPOAs and guardianships? Ask!

WHAT CAN YOU DO TO PROTECT YOUR SENIOR? A. Create a DPOA as soon as possible. When the senior moves in; ensure all staff knows about their documents. Storing them only in the facility office renders them inaccessible in an emergency. A copy should be in the back of the chart.

1. Review these documents with the personal care staff. Let them ask questions and show them where it is located on the chart! Be sure this information is entered on the face sheet of the chart.
2. Provide the agent’s full contact information. We have so many devices today. Offer more than one way to reach the agent in an emergency.
3. When the agent is out of town, be sure there is a temporary note on the chart. Include any location information. What if the I-Phone falls in the lake? Does the staff know the name of the hotel? They may need to reach the agent that way. Some locations, like fishing in Alaska, many keep you out of contact. Put in a surrogate! This surrogate would also calm the senior after the emergency.
4. If your family seems like the cast of a daytime drama, share it with professional staff; administrator or social services. You are not alone. Many families choose sides and don’t speak to each other. If professional staffs are forewarned, they can respond more effectively.
5. Don’t forget the senior. They were caught in the middle of this scuffle. Who knows what the other party told them? The senior may have had a positive relationship with the other party in the past (at least that’s the way they may remember it.) (Any visitors are very important to seniors in facilities. The residents “rate” each other by the amount of contact each receives from family and friends on the outside.) Merely routing the interloper will not calm and comfort the senior. Your senior needs to hear your voice, even if it’s on the phone.  Your help for them to process things now will diffuse future issues.

An ounce of prevention is reduces a pound of crazy.

A Commentary on the AARP Article:”Eldercare Primarily Concerns Older Workers and Their Employers, Right? Think Again”.

”Eldercare Primarily Concerns Older Workers and Their Employers, Right? Think Again” describes the dual dilemma of providing elder care while holding down a job.

A significant change noted in this article is the inclusion of millennias in the caregiving population. Previous studies focused on those who are the age of millennia’s’ parents and caregivers. This article shows that caregiving is becoming a multigenerational activity.

The AARP article closes with a description of a new caregiving workplace benefit. In my opinion, the greatest caregiver benefit would resemble the closing line of the article; “Advancing the culture of understanding about eldercare needs to help make the workplace more supportive of workers who are also family caregivers- many of whom are in their prime working years”. In response to this need Senior Sidekicks has developed a course flexible and mobile enough for the workplace: Preparing to Parent Your Parent.

 

What About The Bacon?

Last weekend I was attending a luncheon with green beans on the menu.   Since these are often prepared with bacon and I am allergic; I asked. When my plate arrived late and looked different, other diners asked. I explained about the bacon. What a chorus of sympathy! Each person described how much they loved bacon, how much they ate and how badly they felt for me.

One older gentleman had indicated he was a 2-time cancer survivor.  When he entered the bacon chorus, he said he ate two pounds a week! I asked him what his oncologist thought about that. “He never asked”, the gentleman replied. I don’t know about that conversation but I do know that diet presents new issues for seniors. It should be a conversation topic.

1. Your senior may refuse certain foods because they can’t chew them. The hardest-to-chew foods are crispy; like fresh fruits and vegetables. Hard items are not eaten, so the senior doesn’t receive those vitamins.
2. Some seniors feel, “Why bother cooking meals?” Prepared meals might work if they can get the package open or if the senior is willing to heat them in the microwave. Caution, some prepared meals have higher salt levels which present other issues.
3. A bigger problem; doctors may or may not discuss dietary issues. Certain drugs interact with specific foods, such as grapefruit. Those details would be shared with the senior. Diet is more than one food.
4. Pills are not the only items which react with each other. Pills react with foods, with vitamins and over-the-counter medicines.  ASK the doctor. If the doctor’s answer seems vague, ask for a referral to a dietician. Medicare covers a consultation especially when the senior has a documented food-related issue.

Back to the luncheon conversation: I explained to the gentleman about Nitrosamines in preserved meats. I encouraged him to ask his oncologist about these compounds. At first, he seemed receptive. Then his face darkened. “I like my bacon!” he said. I could see the resistance rising. Question; did the oncologist never ask about bacon? Or did the doctor say something that was difficult for the older gentleman to accept? You decide. It may work better for you to ask these questions to help your senior.

“SOMETHING AMAZING JUST HAPPENED”

“SOMETHING AMAZING JUST HAPPENED”; a State Action Alert published by the Alzheimer’s Association, Illinois Chapter Network.  Amid the climate of gridlock in the legislature, getting this bill passed by both chambers is a triumph!

Our demographics and research have run ahead of our licensure standards. We know more now about how to care for dementia patients and we have more dementia sufferers today than at any other time in history. The bill set minimum training standards for dementia staff.

I have seen families struggling with the decision to just move a parent to a facility. That is its own an emotional hurdle. Then, they are faced with a plethora of places, each claiming to offer appropriate services. Making that choice was more difficult because it was hard to observe the difference in trained care and custodial care. The average family was not prepared. Thus they relied on other factors such as cost, insurance coverage, convenience to family, or the claims of the facility. My phone rings regularly with family complaints that their loved one was not receiving appropriate treatment. They came to me looking for a method to deal with problems or better evaluate facilities.

Illinois Senate Bill 2301 will provide families with three things:

1. This training becomes a question for families’ evaluation checklist.
2. The training will require facilities to keep records on who is trained, how often, and how recently. Families can ask to review records.
3. Minimum training standards become a point in the facility inspection checklist, for the State of Illinois. Thus families can review this factor as well as others when making their decisions.

When you read this announcement you will see two links on which you can thank legislators. Please use the links to share your experiences with evaluating facilities. Your experiences are valuable to legislators.

 

The Caregiving Daughter (As Caregiver) “Tag, You’re It”!

If you are the caregiving daughter, you are not alone. The majority of elder caregivers are women. Today’s woman will spend more years caring for an elder than in rearing her children. Women may feel they were “appointed” to this task by others like husbands or brothers. In one of my cases, the husband divorced his wife and left the area. He left his mother here to be cared for by his ex-wife! They had not agreed to this, she found her former mother-in-law in the house by herself!

Women didn’t get into this caregiving position overnight. We received the dolls and toy kitchens as little girls. We were offered nurses and teachers as role models. Some of that is changing for younger women but not for those 50+ today.   Think about caregiving in terms of children. The school has both parents’ numbers as emergency contacts. Which parent would they call first? It’s usually the Mother’s number. It doesn’t matter if the Mother is an attorney and engaged in a court hearing. She has to refer the school to the father to handle the emergency. Tag; you’re it, again.

History has tagged today’s caregivers to develop a new role in one generation, that’s warp speed in demographic terms! Never before have we had so many people living to such ages. In the Bible, we read about life spans, like 120 years. Today, living to 100+ is not at all unusual. While all of us are in the same societal boat, we do not all share the responsibility equally; yet.

You, the adult daughters, tagged as caregivers, are these role model developers. You are the ones who will define this role and its need for inclusion of all family members. Our foremothers fought for the right to be included through the vote. We must follow in their footsteps and fight for the recognition and support for the caregiving role and the new caregiving phase of life. This time in history it is about more than you or your family; it’s about transitioning society. Tag; you’re it.

How can we, in the most-often-called position, spread these duties around?

1. Just as a professionally trained parent must explain to the school who to contact, so must the adult daughter explain things up front to the family. The first time a task appears you must insist on a family meeting and insist on a group-responsibility care plan. Why you?
2. You were brought up to see the need for care.
3. You can gather information on the types of tasks necessary to provide that care, outline and organize them.
4. You will have it all fall in your lap if you don’t grab the reins of the process and drive it to a more equitable arrangement.
5. Assume ignorance rather than stupidity. As described in the “son” blog, boys are not prepared for caregiving. Expecting them to know how to respond is unrealistic. Ignorance has a remedy; teach.
6. Expecting others to learn and participate is a realistic goal with time. Other members of the family may not see the issues. They may not feel that caregiving is part of their role. They may resent the intrusion into their previous lifestyle. Time, persistence, and insistence will    e-v-e-n-t-u-a-l-l-y evolve toward change.
7. Yes, this process takes more work on your part. However, the stakes are even higher if you try to do it all yourself. You can injure your health. You might not be here anymore; some caregivers die in the process. You could bring up the next generation to be poor caregivers when YOU will need their care. Without your efforts, our society might not make this transition successfully and implode! Then it become “we all fall down”.

We once mobilized for war; gathering cans, planting victory gardens, and sending Rosie the Riveter to manufacture war material. All society’s sectors were involved in some way. We can mobilize again. This time, adult caregiving daughters must lead the way.

 

Why The Son Is Like A Traveler Without GPS.

I was determined to educate my young son for his future as a father. Finding dolls for boys was a problem. Books portraying fathers with children were scarce. I settled on a pair of bunnies, the larger one holding a smaller one in “his” Velcro-covered paws. I told my son that these were father and son bunnies. Unfortunately, no one else used those terms. At first, my son corrected others mis-perceptions and told them these were father and son bunnies! After awhile, the bunnies didn’t leave our house. He took other toys outside; not these. Think about that message; only women are caregivers.

Consider these sons, now adults, who find themselves as elder caregivers. What message did they absorb? Did anyone introduce the subject of their eventual role as parent? Were they involved in elder care growing up? When do boys receive an opportunity to practice any kind of caregiving? Is it any wonder that these “boys” face their elder care situations with little prior experience?

Under these circumstances, is it any wonder that brothers leave elder care to their sisters? Perhaps they turn it over to their wives. Some sons view the role of elder caregiver along the lines of “provider”; paying for it.  Others sons see that role through a legal and financial planning lens. Some just walk away from caregiving altogether!   Elder caregiving has many more aspects that legal, financial, or hired help. After all, this adult son grew up with his parent. His history could be valuable if he applied it to help care for his parent. Only sons do not have sisters. They are left to fend for themselves. How isolated they must feel when society offers no support or guidance. Our society has failed to provide any of these men with the GPS= geriatric process system (information).

How can we help society manage our burgeoning elder population? By 2030, 1 in 5 persons will be over 60 years old! It’s about time we look at ways to empower the other half of our adult children, our sons.

1. Each family could begin the conversation at home. Bring the caregiving topic to the table and bring your children. They won’t be children forever; some day they will be your
2. Role playing could help anyone develop a repertoire of elder-sensitive communication methods. Adult sons (fathers) could try role-playing the teen who speaks slang in conversation with the grandparent who has some hearing loss!   The teen plays the grandparent!
3. Identify specific tasks teenage boys could do to help the primary caregiver such as collecting laundry and returning it cleaned. Mowing a grandparent’s lawn or putting up their holiday lights also contribute. Instead of automatically appointing the girls in the family to visit with a grandparent switch off between brothers and sisters.
4. Include the boys; they are the future elder caregivers for current adult sons.   Eagle Scouts used to have a baby care badge; do they have an elder care badge? Investigate. Does your congregation have a youth group? Does your high school have a community service program? What projects do these groups offer that involve elders? It’s time to request an elder care focus since it is our largest demographic issue.
5. Religious congregations might be another opportunity. A men’s support group for caregivers would create a safe place to bring up topics that men don’t usually discuss. Existing men’s groups may not have opened this topic before; it’s time to consider caregiving topic. Sports and elder care share something; stats. Statistics are a good place to start the elder care conversation since men already swap sports stats. The goal is to show how different things are today. It’s not just for those who are elders now, but for adult sons who will be future elders.
6. Identify families who are involved in elder care situations and invite the men in those families to speak to men’s groups and youth groups. Shared experience mentors others. A male role model who is trying to provide elder care sends a powerful message. Notice I used the word “trying”. It is the sincere effort, not the proficiency that counts.

We all age. We all need opportunities to learn caregiving for the aged.

 

Why Is A Daughter-In-Law Like A High Wire Juggler?

Previously, I have discussed caregiving adult children as a group. It’s time to look at each family position separately. Today, we begin with the most stressful family position, the daughter-in-law. In the family circus, the daughter-in-law’s position matches the juggler on a high wire. Not only is she separated from the ground of family history, she is also required to keep many other roles going at the same time.

Statistics show that the majority of caregivers are women. A woman will spend more years caring for an elder than rearing her children. The elder receiving care is often the in-law.

Any caregiving adult child manages at least five other roles; house, spouse, children, job and pets. The daughter-in-law’s relationship to her spouse involves other elements. She did not grow up with her husband. In other times, perhaps couples grew up together. That is rare today. A daughter-in-law only knows what she has seen through her marriage, or what her mother-in-law has said.

Who was this man as a child? How did he relate to his mother in the past? Was he as good a child as his mother reports? Or did he smile sweetly at his mother and pulled all the girls’ pigtails when she wasn’t looking? If he does not admit to this behavior and his mother does not report it, how is a daughter-in-law to know? If there are any other disconnects in bytes of family history, then the daughter-in-law operates on partial information. Imagine trying to drive a car with low air tire pressure. Her lack of complete data makes it harder for her to maneuver in this relationship.

What did her husband’s birth mean to her mother-in-law? Was her husband the mother-in-law’s longed-for son that everyone expected her to produce? In the Bible, we see many women praying, promising and suffering in other’s eyes because they did not have a son. How many future mothers-in-law will analyze their feelings and share them with their daughters-in-law? Such a background would provide perspective.

What impact did the birth of this son (now husband) have on his family? Did their finances change? Was the mother-in-law’s’ health affected? How did other siblings react to this new baby? How did this birth affect the (now) mother-in-law’s marriage? How many mothers-in-law would be willing to share these parts of their own marriage with their daughters-in-law? Not many.

A daughter-in-law can only guess at what her mother-in-law really viewed her son. One son showed me his wedding album. His mother’s photo was picture of despair! According to the daughter-in-law, his mother spared no opportunity to express how his bride did not measure up to mother’s standards! I met this couple. They seemed very compatible, and had a healthy new baby. The mother–in-law described her son as a gift to the world! I found him to be an amiable fellow, reasonably intelligent, and his looks would not frighten children. However; he did not look like movie star. He had not invented a cure for cancer. He did not write the latest great American novel.

After the meeting, I asked his mother about her son’s birth situation. She told me she had married late because she had to work to support her parents. She was not sure she would even be able to marry, much less have a child. When she married and became pregnant, she had complications. In those days there was no way to determine the gender or health of a child until birth. When her only child turned out to be a boy! A healthy one! The future mother-in-law believed her prayers had been answered. He was a gift; to her.

This man (husband) was also an only child. Thus, caring for his mother would be his responsibility. Since he worked outside the home and his wife did not, it actually fell to her; the daughter-in–law. Daughters-in-law often find they are the actual caregivers. Now that we have seen the issues they face let’s review what we can do to support daughters-in-law in their caregiving duties.

1. Recognize the issues and missing information. Don’t assume the daughter-in-law knows how things were in early years.  Share more background.
2. Corroborate information. Are there other, older relatives, friends who can supply more background? Ask people for information.
3. Have a chat about this situation before it becomes a crisis.
4. What does the son (husband) really expect on the elder caregiving issue?
5. Does he know, in a day-in-the-life manner, how caregiving impacts his wife? Share those details.
6. What other duties could the husband take over to relieve some pressure from his wife? How can HE explain, to his mother, the need for care to come from his wife so his mother will accept it and treat her better?
7. Have a social history chat. This one is tricky to do but rewarding. Each spouse could share what they observed about elder care when they young. Compare notes. Where do their experiences match? What does not match? These are the areas where the couple needs to work on a plan and make mutually acceptable
8. Recognize that the son (husband) is in the middle. Both parties need to accept that idea and develop ways to avoid him being pressured from both sides. The solution is NOT that the daughter-in-law should acquiesce to all of his mother’s demands.
9. If mother tells her son one thing and his wife says another; recognize that both stories may be true (in part).   If the opportunity arises, the husband might observe their interaction at first, before stepping in.   What are the irritants? How could these be addressed with both parties? Perhaps professional help may be necessary to save the family or marriage.
10. Take a stand. One resolution the “amiable son” (described above) developed was to have a firm chat with his mother about his commitment to his wife and their future. He affirmed that he would see to her care in later years. He also affirmed that he would not accept her criticism of his bride. Perhaps she was not her choice, but she was his choice and he would stand by their covenant.

FOOT NOTE: That mother-in-law was very unhappy until the grandchild was born. Then parent, adult son, and daughter-in-law made their peace (détente) with each other. This arrangement enabled mother-in-law to develop a relationship with her grandchild.

 

How’s Your Sleep?

A recent study in the Journal of the American Medical Association (JAMA) described the relationship between sleep quality, insomnia symptoms, fatigue, and depression in adults 55 and older. The study is: Being Mindful of Later-Life Sleep Quality and Its Potential Role in Prevention.

Modern people may not think about sleep, some even see sleeping short hours with pride. This study points to the negative results from lack of sleep. Since day time fatigue is a result, could your senior be at greater risk for falls due to poor sleep? When is the last time you checked on your seniors’ sleep quality? Does your senior believe that day-time fatigue is a sign of “just getting old”? This study does not support that idea.

While this study focused on seniors, the same could also apply to caregiving adult children. Are you staying up later to complete all the chores for yourself and your senior? Are you preparing two sets of taxes this year; yours and theirs?   This study included the term, “daytime dysfunction” as one of the negative outcomes. Daytime dysfunction could include car accidents or near misses. Could errors at on your job or injuries at home result from daytime dysfunction be caused by your poor sleep? Perhaps, in reducing our sleep or ignoring your senior’s sleep issues, we are setting everyone up for failure.

The study discussed ways to improve sleep without medication. Instead, it discussed therapy, cognitive behavioral therapy, and mindfulness training. Since seniors may take other medications, adding more increases the chances for medication conflicts.   There is always a chance that the very medication to promote sleep could leave the senior groggy the next day instead. I have observed that some doctors are less inclined to write a prescription for mindfulness training. Caregiving adult children may need to insist and locate the classes. You should know that mindfulness training in the professions is becoming quite common. If your senior was born in the era of mental help=mental hospitals; therapies may not be acceptable. Taking a class to help them improve their sleep could work better. Such a class would work even better if you and your senior attended. After all, you both need your sleep to keep your health.   Sleep well.