Good Medical Care for the Elderly and How to Get It

Do not resuscitate orders | A family's dilemma

The Boston Globe today (December 3, 2007) explores the complicated subject to DNR orders -- do not resuscitate orders. When are they appropriate? What if the elderly patient waits too long? What decisions must be made and how can they be made?

The problem is, says the Globe's writer Patricia Wen, many families aren't sure about how to discuss this difficult subject. Often they wait too long, and by the time it's obvious that this decision needs to be made, the elderly loved one is not mentally competent to execute the required documents.

My book Taking Charge: Good Medical Care for the Elderly and How to Get It, discusses end-of-life decisions, the Five Wishes (called by the Miami Herald "the Living Will with a Heart"), and how and when to have this difficult conversation with your elderly loved one.

The Boston Globe article, by Patricia Wen may be read here:

For many, 'Do Not Resuscitate' too painful to discuss
Relatives, doctors often delay in offering patients the option

Living with Alzheimer's

On March 29, 2007, the New York Times published an article about “early Alzheimer’s” disease. The article—Living with Alzheimer’s before a Window Closes—describes this as a period “when short-term memory is patchy, organizational skills fail, attention wanders and initiative comes and goes. But there is still a window of opportunity — maybe one year, maybe five — to reason, communicate and go about [one’s] life with a bit of help from [others.]”

A recent study done by the Alzheimer’s Association reveals that about 5 million Americans have Alzheimer’s and that about half of them are still in the early stages. The New York Times article discusses coping methods and also contains lots of resources for caregivers.

Aging with Down syndrome--A cruel complication

A report on March 12, 2007 in the Atlanta Journal-Constitution states that researchers believe they have identified the link between Down syndrome, a disorder that is the most common genetic cause of mental retardation, and Alzheimer's, a progressive brain disease that destroys a person's memory and mental ability.

Persons with Down Syndrome have an extra copy of chromosome 21 in their DNA. An excessive amount of a substance that accumulates as plaque in the brains of people with Alzheimer's is caused by this abnormality.

Neurologist Jim Lah of Emory University School of Medicine states that the brains of almost all people with Down syndrome will exhibit some of the changes associated with Alzheimer's by the time they are in their 40s. That's about 20 years earlier than in the general population.

People with Down syndrome usually died young until recently. (In 1983, for example, the life expectancy of someone with Down syndrome was just 25, according to the National Down Syndrome Society). However, advances in medical care and better overall health now mean that someone with Down syndrome can live to the age of 50, 60 or even longer.

But people with Down syndrome "end up developing Alzheimer's with virtually 100 percent certainty if they live long enough," said Lah. "If all Down syndrome victims lived to be age 80, I think you could say with confidence that all of them would develop outward signs of dementia."

The entire article may be read here.

Techorati tags: Down syndrome, Alzheimer's, caregiver, caregiving

Alzheimer's Disease and the Artist

On October 24, 2006, the New York Times published an article about the effect of Alzheimer's disease on an artist. Written by Denise Grady, "Self-Portraits Chronicle a Descent Into Alzheimer’s" begins with these words:

"When he learned in 1995 that he had Alzheimer’s disease, William Utermohlen, an American artist in London, responded in characteristic fashion.

“From that moment on, he began to try to understand it by painting himself,” said his wife, Patricia Utermohlen, a professor of art history.

Mr. Utermohlen’s self-portraits are being exhibited through Friday at the New York Academy of Medicine in Manhattan, by the Alzheimer’s Association.

The paintings starkly reveal the artist’s descent into dementia, as his world began to tilt, perspectives flattened and details melted away. His wife and his doctors said he seemed aware at times that technical flaws had crept into his work, but he could not figure out how to correct them."

William Utermohlen’s self-portraits reveal his descent into dememtia over the span of nearly four decades. A slideshow of Mr. Utermohlen's self-portraits reveals the steady progression of his disease and the viewer is overwhelmed by how much the paintings project an inner awareness of his loss.

You may read the entire article here: