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  • Are Hispanics at a Greater Risk for Alzheimer’s Disease?
  • Kansas and Missouri Alzheimer’s Care: Does Music Help Aggressive Behavior?
  • Kansas and Missouri Alzheimer’s Care: Should My Loved One With Alzheimer’s Disease be Driving?
  • More Helpful Hints for Kansas and Missouri Alzheimer’s Caregivers
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Every 70 seconds, someone is diagnosed with Alzheimer’s. Left unchecked, 16 million Americans will develop the disease, including 10 million baby boomers.

Join us and thousands of others on October 3 as we get “on the MOVE” to end Alzheimer’s.

The Memory Walk raises critical funds that support the research efforts of the Alzheimer’s Association. In addition, it raises awareness that encourages people to seek an accurate and early diagnosis, and support a better life for those living with the disease – and the millions more who must manage the financial and emotional burdens of life as a caregiver.

As elder law attorneys, we see the devastating consequences of those suffering with Alzheimer’s. Routine tasks such as bathing, dressing, eating and meal preparation become difficult or impossible. On a daily basis, we help people who are emotionally and physically exhausted get answers to the legal questions that require immediate planning.

The Elder and Disability Law Firm is a proud sponsor of the Alzheimer’s Association Memory Walk ‘09. We hope you’ll come out and support this signature fundraiser for the Heart of America Chapter and help end Alzheimer’s.

The Kansas City Memory Walk begins with registration at 9 a.m. in the parking lot of Building 40 in Corporate Woods. The one- and three-mile walks start at 10 a.m. Register online at www.kansascitymw.kintera.org or call 913.831.3888 to request a registration brochure.

Interesting read from The Telegraph…

http://www.telegraph.co.uk/health/healthnews/6168870/Blueberry-is-food-for-thought.html

The economic downturn has offered one bright spot for businesses searching for new office space, and we’ve taken advantage of it. Effective August 1, we’ll officially be occupying our new offices at Corporate Woods.

Why the move? We were able to get significantly more space in an excellent location for less than our current lease. With the better lease rates and more flexibility in negotiation, now is a good time for companies to take advantage and save some money. Rental rates are much lower than they were a few years ago so we’re thrilled that we’ve secured a great space to serve our clients in beautiful Corporate Woods. For those of you familiar with this area, Corporate Woods is just west of our current location, so we’ve moved (almost literally) across the street!

One thing that hasn’t changed is our commitment to our clients. We know families have many questions when faced with the difficult task of finding and paying for long-term care for a loved one, and we’re here to help. Give us a call now. We can assist with Medicaid qualification and planning, Estate Planning as well as Wills and Trusts, Powers of Attorney, etc. (See FreeSeniorWorkshops.com for a list of our upcoming seminars on these subjects). Initial consultations are always free. Visit our web site at www.kcelderlaw.com for more information or to request free material. We look forward to being of service.

We hope to see you in our new offices soon!

Have you ever wondered how your memory works? How new memories are developed and recalled and how they fade over time. CNNHealth.com has an interesting post worth checking out:

http://www.cnn.com/2009/HEALTH/01/28/memory.research/index.html

Great writeup in the Kansas City star on UMKC’s program aimed at training social workers to become more effective in their work with Kansas and Missouri seniors:

http://www.kansascity.com/115/story/954642.html

Interesting read from the New York Times on a possible link between Alzheimer’s Disease and Hispanic individuals:

http://www.nytimes.com/2008/10/21/us/21alzheimers.html

They note that, while Hispanics are not necessarily genetically predisposed to this illness, that they do have an increased number of risk factors including high rates of diabetes, obesity, and stroke. Moreover, financial and language barriers can discourage a family from seeking treatment for a loved one, complicating an already difficult situation.

Can music help aggressive behavior in a person with Alzheimer’s Disease? It depends. The disease progresses a little differently for everyone…some persons become agitated, and that agitation can lead to aggression. Others may never show any signs of aggression throughout the course of the disease.

Music is the “universal language” and can continue to many areas of therapeutic intervention. Most individuals with Alzheimer’s Disease respond well to music. Their responses may depend on the type of music. There is a commonly-held belief that this population will only like “old” music, music from their era. However, any music from the time they were born is now from their era. One downfall we have when working with individuals with Alzheimer’s Disease, or the older population in general, is that we tend to limit their possibilities.

If your loved one is agitated and you try playing music they once enjoyed but it’s not helping, try a different kind of music. Some music, even classical, can be very “busy” and can tend to overstimulate persons with dementia and cause more anxiety or agitation. If they feel overstimulated and become extremely agitated, they may become aggressive and lash out as a response. They can’t always tell you how they are feeling, so they lash out instead.

White noise is often calming to a person with Alzheimer’s Disease. Actual white noise machines can be purchased, but an example of this is the noise a fan makes. Just running a fan may help them to relax. Another example is a water fountain .You may try one of these types of noise to help calm your loved one. There are CDs or cassette tapes that you can purchase with calming noises such as the ocean, birds, and wind. Once again, the birds can be over-stimulating, so if you notice your loved one becoming increasingly agitated, turn it off. Sometimes those with Alzheimer’s need complete silence, so when all else has failed, just try a quiet room!

Even though Carmen had been diagnosed with Alzheimer’s disease, she prided herself in her continuing ability to do all her own grocery shopping. She also drove to her beauty parlor appointment every Saturday morning. Her husband, Jim, had noticed that Carmen sometimes seemed confused when driving, taking an occasional wrong turn. Increasingly, she had trouble with her depth perception, which caused her to hit the brakes too early before a traffic light. At other times she would forget to stop at all.

One Saturday afternoon, a police officer knocked on the door of their home, and Carmen answered.

“I’m investigating a motor vehicle accident,” he said. “Someone ran into the car parked across the street from your driveway. Do you know anything about that?”

Carmen shook her head. “No, I didn’t see anything,” she said. “But I’ve been gone all morning. I went to my hair appointment about 10:30.”

The police officer asked Carmen to accompany him outside. Together, they looked at the rear bumper of her car. The police officer pointed to a large area where the bumper had been scraped. Red paint clung to the scraped area. Across the street, a red Ford Taurus sat, its door panel crumpled by a deep dent.

“Has anyone else driven this car today?” the police officer asked.

“Why, no,” Carmen said. “But I don’t remember hitting anything.”

Jim stood on the doorstep with his hands in his pockets. He was grateful no one had been hurt in the accident. He knew he could no longer postpone the difficult decision to keep Carmen from driving. Even though Carmen treasured the independence her automobile symbolized, Jim knew he had to take away Carmen’s car keys for good.

If you have Alzheimer’s disease, you may someday be faced with a recommendation that you restrict your driving privileges. If you have recently been diagnosed in the disease’s early stage, you may be able to continue to drive. However, at some point, you or your family members may begin to notice effects the disease has on your memory, judgment and attention. Your depth perception may fail and your reaction time may increase. You may find yourself disoriented in once-familiar areas, misjudge the speed of oncoming traffic or fail to notice stop signs.

You may be driving legally…that is, you have a valid driver’s license. But, you might not be driving responsibly. The last thing you’d want to do is cause an accident, which could harm someone else and cause legal problems and financial burdens for you and your family. The independence that driving allows isn’t easy to give up. Some people even feel lowered self-esteem when they can no longer drive. We have all grown up in a culture where driving is important to us. And, no one wants to be a burden on others for transportation. So it’s common for Alzheimer’s patients not to admit difficulty behind the wheel.

However, people with Alzheimer’s disease and their families and doctors have a responsibility to balance a person’s convenience with his or her safety and the safety of passengers and other drivers. Studies have found that, particularly in later stages, a person with Alzheimer’s disease is twice as likely to cause or be involved in motor vehicle accidents as a driver of the same age without the condition.

Recently published American Psychiatric Association guidelines for restricting driving privileges of persons with Alzheimer’s disease say that all severely impaired Alzheimer’s patients pose unacceptable risks on the road. So do some people with moderate impairment. In the early stage of the disease, some people can drive safely for a while. Others, however, cannot drive even short distances without endangering themselves or others. Discuss this issue openly with your family members and doctor. Trust them to tell you when to turn over your car keys.

The Family’s Role

Julianne had watched her widowed father’s mental condition deteriorate in the three years since he’d been diagnosed with Alzheimer’s disease. Despite his illness, he remained relatively independent, doing his own laundry and preparing his own meals. He drove to his Rotary Club meetings and church and ran occasional errands to the hardware store to get supplies for tinkering around the house.

Lately, though, Julianne noticed he’d been having trouble. Several times when she stopped by, she found wet laundry that had sat for several days in the washing machine. And the last time he made beef stew, he had added one-fourth cup of salt rather than one-fourth teaspoon, making it inedible.

Her father had driven the night before when they went out for dinner at a new restaurant in town. They enjoyed roast chicken and simple conversation. (Julianne had become accustomed to his repetitive questions and hardly noticed.) What she did notice, however, was his erratic driving when he took her home. He changed lanes without looking, nearly sideswiping a van. Then he swore at another driver who honked at him for running a red light.

Julianne resolved to keep her father from driving, but she knew from past discussions that he would ignore a plea from her to turn over the keys. Instead, she phoned her father’s doctor and asked him to write “Do Not Drive” on a prescription form and hand it to him at his next appointment.

If you are a family member of someone with Alzheimer’s disease, keeping an impaired driver off the road is your moral responsibility. Because of the independence an automobile represents, many people with Alzheimer’s disease resist giving up their driving privilege. If family members are providing care for the patient, this issue can be divisive. If you try to takeaway your loved one’s car keys, you may face his or her frustration and anger. Helping a frustrated, angry person bathe, dress or perform other activities of daily life adds tension to an already stressful situation. For these reasons, many families turn to their loved one’s doctor or the state motor vehicle department for help.

ACTION POINT!
How do you know when the time has come to stop your loved one’s driving? A good rule of thumb is when you no longer feel comfortable riding with him or her or letting your child go along. Another sign is when you notice your loved one can no longer follow recipes or perform simple household tasks. Mental abilities required for these activities are critical for driving.

Once you decide the time has arrived, you may find several actions helpful. First, consult your loved one’s doctor. An older person may find it easier to hear advice not to drive from a health care professional he or she trusts rather than from a family member. Understanding this role, many doctors are willing to comply with such a request from the patient’s family. In some states, doctors can also file a request for re-examination with the agency responsible for licensing drivers. People authorized to file such a request depend on laws in each state. Those who can ask the state to re-examine a driver’s ability to operate a motor vehicle may include police officers, family members, neighbors or others.

For example, both Kansas and Missouri laws and practices provide for retesting of drivers whose mental or physical impairments may prevent them from driving safely. In Missouri, the law authorizes the director of revenue (who oversees driver’s licensing) to require a road test, medical evaluation or both if there is cause to believe a driver is incompetent or unqualified to keep his or her driver’s license. Under the law, the Department of Revenue can order an examination of driving skills after receiving a written medical report from a physician or a letter from a law enforcement officer, family member or licensed health care worker who presents personal observation or physical evidence of unsafe driving. Reports must be in writing (no action is taken on telephone calls). The report must include the name, address, telephone number and signature of the person making the report.

Kansas law provides for additional tests to determine whether a person with mental or physical disability can keep a driver’s license. Another law authorizes the Division of Motor Vehicles to revoke driving privileges of people who are incompetent to drive.

A doctor, police officer, family member, employer, neighbor or anyone else who questions a driver’s ability can send a letter of concern to the state director of vehicles. Such letter must state a specific reason for the concern. It must also be signed. The letter is kept confidential; the writer’s name can be revealed only by court order.

When the director receives a letter of concern, the driver is contacted and asked to have a doctor complete a medical form. If the doctor says the driver may continue to drive, the state requires the driver to take a road test. If the doctor says the driver may not drive, the state revokes the driver’s license. (Revoked drivers may appeal the decision).

Other states have different rules and practices. In New Mexico, for instance, drivers 75 and older must get a new driver’s license each year. In addition, the state Motor Vehicle Division can require an individual to complete all testing phases if it receives information concerning the driver’s inability to operate a motor vehicle safely. Most often, information comes from a member of the driver’s family.

In some states, such as Illinois, the driver’s license authority cannot act on information that comes from a driver’s family members. Under Illinois law, the state agency must receive official notification from one of four authorized sources: the motorist’s physician, a law enforcement agency, a judge or a state’s attorney. The information must be firsthand knowledge of the condition that may impair driving ability and the reason the authorized source believes the state should take action. Family members who wish to keep a driver from behind the wheel must turn to one of the four authorized sources for a professional analysis of driving skills.

ACTION POINT!
Check with your state’s drivers’ licensing agency to see what provisions exist for revoking an impaired driver’s license.

Protecting Insurance Coverage

Unfortunately, even with a doctor’s order not to drive, or a license revocation, no guarantee exists that your loved one won’t drive. He or she may simply forget the admonition not to drive or forget that driving privileges have been revoked. Frustration or stubbornness may also help put an impaired driver behind the wheel.

In short, despite loss of driving privileges, a person with Alzheimer’s disease may drive anyway. Should that person be involved in a motor vehicle accident, serious consequences may result. Depending on the state, these consequences may include a challenged insurance claim or cancellation or denial of motor vehicle insurance.

In some states, for example, state law requires insurance companies to honor claims from a motor vehicle accident that involves an insured vehicle driven by a driver without a license. The insurance company would pay the claim, but may subsequently cancel the insurance policy.

If the state revokes a driver’s license, the insurance company may cancel the policy even if no accident has occurred. That’s because the revocation becomes part of the driver’s driving record. Many insurance companies routinely run periodic driving record checks on their insured drivers. Once the insurance company learns its insured has no driver’s license, especially if no other drivers reside in the home, the company would likely terminate the policy. If that happens,an impaired person who drives without insurance coverage would be at risk. In the event of an accident, the canceled insurance policy would not cover his or her assets from claims of accident victims for property damage or personal injury.

Insurance cancellation would also jeopardize the insurability of an unimpaired spouse, who, because of his or her older age, would likely have trouble obtaining another policy without paying rates far higher than the couple had been paying. Some states do, however, provide a remedy for this kind of situation.

For example, sometimes an impaired driver can submit a letter to the insurance company excluding himself or herself from an insurance policy so the unimpaired spouse can get auto insurance. If a loss results because the excluded driver drives anyway, the insurance company may pay liability claims for property damage or injuries to others. However, it might not pay the full amount of the policy’s limits for personal injury to the driver or damage to the insured’s vehicle. Again, the company would likely then cancel the insurance policy.

WARNING!
State laws concerning motor vehicle insurance vary. If revocation of a driver’s license becomes an issue, consult the insurance department of your state government for information concerning your situation. You may also want to consult an attorney to find out what your responsibilities are.

If the person with Alzheimer’s disease lives alone and should no longer be driving, the best course of action may be to sell his or her car. If the idea of selling the impaired driver’s car meets with objection, families can and should take other steps. For example, you could remove the car’s tires or otherwise disable the car. One way to disable a car is to disconnect the battery. Another is to disconnect the coil wire that leads from the coil to the distributor, which is as easy as unplugging an electrical cord from a wall socket.

The effect of disconnecting the coil wire is similar to the effect of removing the flint from a cigarette lighter. You can flick the lighter all you want, but it won’t fire up. With a car, you can turn the key, but the spark created by the coil cannot reach the distributor to start the car. Replacing the wire when an unimpaired driver wants to use the car is easy, too. Ask an auto mechanic to show you how.

Alternatively, the unimpaired spouse could give the loved one with Alzheimer’s disease a “new” set of car keys that look like the old ones but don’t fit the car. Parking the car out of sight, perhaps down the street, around the corner or in a neighbor’s garage is also a good idea.

ACTION POINT!
If you have a loved one who should no longer drive, for his or her own safety as well as for the safety of others, take action to keep him or her off the road.

Are you caring for a loved one with Alzheimer’s Disease in Kansas or Missouri? Get your FREE copy of our informative report, The Alzheimer’s Survival Guide, and learn the 9 Steps to Peace of Mind for You and Your Loved Ones.

Caring for a friend or family member can present a variety of challenges…here are some more helpful hints that our Alzheimer’s Resource Center have found to be effective. As always, please feel free to contact us or request our free guide to caring for a loved one with Alzheimer’s Disease in Kansas and Missouri if you have any questions that aren’t answered here.

Is your loved one crying? Depressed? Wanting to be alone? Wanting to stay in bed?

We all have a right to our blue days, and at times, the person with this disease just feels deeply sad. They sense the changes in their lives, and they feel their losses. Put your arms around them and say it’s okay to cry, it’s okay to feel sad. Bit by bit, you may coax them up and about. Try old, familiar stories or old familiar prayers. If they refuse still to get up, come back in a little while and try again, or have a different person try. Music can make an extraordinary difference. Play music they once loved; it will help them to reconnect to life.

In this case, you will be involved in a lot of physical care. Use touch. Stroking and rubbing of hands and feet (unless medically not advised for some other reason) will help keep the person “in touch,” and help with circulation to prevent skin breakdown. Your loved one will also need to be turned from side to back to the other side at regular intervals to prevent skin breakdown, commonly called bedsores.

Is your loved one bedfast (i.e. unable to get out of bed at all, or only with great effort)

Even if the person cannot move on their own, they can be repositioned — such as moved to an upright chair, or a recliner if available. They can therefore be involved in the social activity going on around them and can be a part of it, too. Don’t forget pet therapy or music.

A home health nurse can give instructions on how to do exercises that are appropriate for your loved one.

Is your loved one with Alzheimer’s bored? Tense? Restless? Picking at things? Here are a few things you can try…

• Offer snacks or liquids. A person with Alzheimer’s may have missed a meal or forgotten they had one.
• Suggest that your loved one help with simple and repetitive tasks, like folding and unfolding laundry. Bring out the familiar pieces of games they once enjoyed, such as Monopoly, Parcheesi, or other board games. Also try giving them playing cards or crossword puzzles. It doesn’t matter if they do any of it well, or even at all. The object is to keep them occupied with familiar items and tasks.
• Restless and wandering patients need a safe place to wander and pace. They may just move around, or they may need a purpose, like carrying the newspaper from one part of the house to another, or going through old mail. Pet therapy can also work wonders. Be sure the animal is a calm breed, such a golden retriever. Or a smaller, lap dog may work better for others.

Is your loved one tense? Refusing to move? Irritable? Worried? Afraid?

• Always first ask or observe if your loved one is in pain. If not, remember these behaviors are often about feeling unsafe. Recall that persons with Alzheimer’s have lucid times that come and go. Try to imagine how frightening they must feel. Do comforting things. One is always to approach the person from the front. Hold their hand if they will let you, or just touch a shoulder and tell them they are in a safe place. Reduce any noises from a radio or television that may be creating confusion or anxiety for them. Try calming music from years ago. Tell them they are in a safe place. If they will allow you, hugs can do wonders!

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