kw: observations, science, medicine, dementia
This article in The New Scientist describes a new test that allows an ophthalmologist to see cells dying in the retina of the eye. An abnormally high rate of apoptosis is an early warning of probable Alzheimer's dementia.
At present, the test has been developed in mice, comparing cell death in the retina between mice that are prone to Alzheimer's and mice that are not. The test involves injecting a fluorescent dye into the back of the eye, so I don't expect it to become popular!
Showing posts with label dementia. Show all posts
Showing posts with label dementia. Show all posts
Monday, June 14, 2010
Thursday, June 10, 2010
Care or cure?
kw: musings, aging, dementia
Yesterday's post about Making the Rounds With Oscar renewed my consideration of aging and dementia. I found a document online that gave me some numbers ("Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study" by B. L. Plassman et al, found here).
Of course, the most important variable is age. In the sample, made in 2002, the breakdown of people 71 and older is thus, by decade:
As an example, my Father found the most economical option he could for caring for my Mother, supplementary care in addition to his own efforts. This was enough for a time, and the cost was a few thousand dollars monthly. But once her care required round-the-clock attention by professionals, the cost rose to $9,000 monthly, and he was still wearing himself out doing just a portion of the care, and with some help from one of my brothers who lived two hours away.
In a few years, the numbers of Americans requiring such care will be about ten million. $90 billion per month comes to $1 trillion per year. Public spending for dementia care in 2009 was about $170 billion. Contrast either figure with the national budget for dementia research, just over a billion dollars (I found it hard to determine any figures at all, let alone accurate ones).
We need to do better than that. An effective preventive or treatment will always be less costly than meliorative care. It will be even more economical of the time and emotional well-being of family members.
Yesterday's post about Making the Rounds With Oscar renewed my consideration of aging and dementia. I found a document online that gave me some numbers ("Prevalence of Dementia in the United States: The Aging, Demographics, and Memory Study" by B. L. Plassman et al, found here).
Of course, the most important variable is age. In the sample, made in 2002, the breakdown of people 71 and older is thus, by decade:
- 71-79 5.0%
- 80-89 24.2%
- 90+ 37.4%
As an example, my Father found the most economical option he could for caring for my Mother, supplementary care in addition to his own efforts. This was enough for a time, and the cost was a few thousand dollars monthly. But once her care required round-the-clock attention by professionals, the cost rose to $9,000 monthly, and he was still wearing himself out doing just a portion of the care, and with some help from one of my brothers who lived two hours away.
In a few years, the numbers of Americans requiring such care will be about ten million. $90 billion per month comes to $1 trillion per year. Public spending for dementia care in 2009 was about $170 billion. Contrast either figure with the national budget for dementia research, just over a billion dollars (I found it hard to determine any figures at all, let alone accurate ones).
We need to do better than that. An effective preventive or treatment will always be less costly than meliorative care. It will be even more economical of the time and emotional well-being of family members.
Wednesday, June 09, 2010
How does the cat know?
kw: book reviews, nonfiction, animals, dementia
A couple of years ago Dr. David Dosa was told about Oscar, a somewhat standoffish cat who always seemed to know when someone was about to die, and would snuggle up to them during their last hours. One of six cats resident in the nursing home where Dr. Dosa works, Oscar seems to take seriously his role as an end-of-life comforter to both the dying ones and their families. The doctor, initially skeptical, finally decided to investigate, and interviewed the families of all the former residents who had most recently passed away. They all had stories about Oscar, and how they had appreciated his attention and presence at the end of their loved ones' lives.
Their stories make up a large part of Making Rounds With Oscar: The Extraordinary Gift of an Ordinary Cat. Dr. Dosa's own story makes up the rest. He had more than stories to go on. He had his own experiences. He observed Oscar's "vigil" with more than one patient. He noted how Oscar, usually so quick to bat away a hand that tried to pet him, willingly received caresses from the dying person's family members. He even observed how Oscar stayed in the room of one patient who was sent to the next-door hospital (a place the cat could not go), until that patient died over there.
Doctor Dosa's main charges are 41 dementia-afflicted patients, who die with great regularity. Steere House is apparently one of the better places to die with dementia. However, it was only after he began his interviews that the doctor learned the most important lessons about dementia and the people who care for a loved one who has it. Two major points stuck with me: Learn to love who he or she is now, for whoever the person was before is gone; and Live in their world, because they can't return to ours.
The first point really means saying goodbye to someone whose body is still present, then learning to care for them as they have become, perhaps becoming a friendly stranger because they don't know you any more. I only knew my grandfather as a silent, friendly man who enjoyed being led around the block by one of his grandchildren. We were born too late to know him "before". This made it easier to recognize what we had to do with our mother when she slipped away, mentally.
I had heard the second point before, from my brother. He told of going to visit our mother right after a cancer operation. She wasn't in her room, but was found in the hallway, having unplugged all her tubes and needles. She was trying to escape. In the midst of a dementia-induced episode of paranoia, she was convinced she was a prisoner being held captive by phony doctors. My brother went along with this, and explained to her that he needed her to stay put and gather information about what the doctors and nurses were doing; that he was able to get in to see her "without getting caught"; and that in a few days he would "spring her". She happily settled into a day or two of spying on everyone until she gradually forgot her fears. And my brother and father did indeed "spring her" a few days later.
I also remember how flat exhausted our father got, caring for her as she deteriorated over a ten-year span. Eventually, he had to have round-the-clock help to take care of her. In my opinion, he waited longer than he should have to "rent" some help. Since none of us live close, though, that is what he had to do. My parents eventually both moved into a "retirement hotel" where help was easier to get, and less costly, and my parents were both much happier during my mother's last year. Having cats around would have made it even better, even if none were as prescient as Oscar.
Dr. Dosa has medical troubles of his own (mainly arthritis), but he is rather young, with a young family. He learned from the families of former patients just how precious is his own family time, and he learned from Oscar just how "in the moment" a cat is, and how that is also possible for people. Whether this cat has senses we don't understand, or is simply able to empathize with grieving families, he is a working cat. He gets tired after a person he's been with dies, and takes time for himself. There is a lot to learn from a cat like Oscar.
I got a book about a cat; its real story is about coping with terminal dementia.
A couple of years ago Dr. David Dosa was told about Oscar, a somewhat standoffish cat who always seemed to know when someone was about to die, and would snuggle up to them during their last hours. One of six cats resident in the nursing home where Dr. Dosa works, Oscar seems to take seriously his role as an end-of-life comforter to both the dying ones and their families. The doctor, initially skeptical, finally decided to investigate, and interviewed the families of all the former residents who had most recently passed away. They all had stories about Oscar, and how they had appreciated his attention and presence at the end of their loved ones' lives.
Their stories make up a large part of Making Rounds With Oscar: The Extraordinary Gift of an Ordinary Cat. Dr. Dosa's own story makes up the rest. He had more than stories to go on. He had his own experiences. He observed Oscar's "vigil" with more than one patient. He noted how Oscar, usually so quick to bat away a hand that tried to pet him, willingly received caresses from the dying person's family members. He even observed how Oscar stayed in the room of one patient who was sent to the next-door hospital (a place the cat could not go), until that patient died over there.
Doctor Dosa's main charges are 41 dementia-afflicted patients, who die with great regularity. Steere House is apparently one of the better places to die with dementia. However, it was only after he began his interviews that the doctor learned the most important lessons about dementia and the people who care for a loved one who has it. Two major points stuck with me: Learn to love who he or she is now, for whoever the person was before is gone; and Live in their world, because they can't return to ours.
The first point really means saying goodbye to someone whose body is still present, then learning to care for them as they have become, perhaps becoming a friendly stranger because they don't know you any more. I only knew my grandfather as a silent, friendly man who enjoyed being led around the block by one of his grandchildren. We were born too late to know him "before". This made it easier to recognize what we had to do with our mother when she slipped away, mentally.
I had heard the second point before, from my brother. He told of going to visit our mother right after a cancer operation. She wasn't in her room, but was found in the hallway, having unplugged all her tubes and needles. She was trying to escape. In the midst of a dementia-induced episode of paranoia, she was convinced she was a prisoner being held captive by phony doctors. My brother went along with this, and explained to her that he needed her to stay put and gather information about what the doctors and nurses were doing; that he was able to get in to see her "without getting caught"; and that in a few days he would "spring her". She happily settled into a day or two of spying on everyone until she gradually forgot her fears. And my brother and father did indeed "spring her" a few days later.
I also remember how flat exhausted our father got, caring for her as she deteriorated over a ten-year span. Eventually, he had to have round-the-clock help to take care of her. In my opinion, he waited longer than he should have to "rent" some help. Since none of us live close, though, that is what he had to do. My parents eventually both moved into a "retirement hotel" where help was easier to get, and less costly, and my parents were both much happier during my mother's last year. Having cats around would have made it even better, even if none were as prescient as Oscar.
Dr. Dosa has medical troubles of his own (mainly arthritis), but he is rather young, with a young family. He learned from the families of former patients just how precious is his own family time, and he learned from Oscar just how "in the moment" a cat is, and how that is also possible for people. Whether this cat has senses we don't understand, or is simply able to empathize with grieving families, he is a working cat. He gets tired after a person he's been with dies, and takes time for himself. There is a lot to learn from a cat like Oscar.
I got a book about a cat; its real story is about coping with terminal dementia.
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