Volume 4, No. 1

QUARTERLY

COMMUNITY

NEWSLETTER

BROAD REACH HOSPICE

STAFF

Dr. Eric Weber Medical Director

Dr. Allen Ward Assoc. Medical Dir.

David Maloney, Administrator

Jamie Nunes, Clinical Services Director

Patti Coville Office Manager

Donna Daley Admin. Assistant

Mimi Nolan Nurse Case Manager

Debi Leo Nurse Case Manager

Katy Williams Nurse Case Manager

Lucy Elmer Nurse Case Manager

Terri Reilly Nurse Case Manager

Peggy Wilbur Social Worker/ Bereavement

Counselor

Susan Eenigenburg Pastoral Counselor

Gary Mann Volunteer Coordinator/Pastoral

Counselor

Cassandra Bindig Hospice Aide

Robin Locke Hospice Aide

Erin Rosecrans Hospice Aide

Jean Butter Hospice Aide

Annmarie Ward Hospice Aide

Renee Butter Hospice Aide

Sieglinde Rogers Social Worker/Pastoral

Counselor per diem

Rebecca Schnaible Social Worker per

diem

What is Dementia? 2

All About Dementia 4

Hospice Volunteering 7

Broad Reach Hospice 8

Inside this issue:

Winter 2016

New Beginnings?

Here we are once again in the midst of winter– the season of snow (hopefully not as much as last year!), cold and the “death” which winter represents. The green life of Spring through Fall has given way to bare trees, snow and ice covered streets and dormant lawns and gardens. Even the frigid wind seems to suck the warmth and life from us as we walk down the sidewalk, across the parking lot or sit on the beach dreaming of Spring.

I have sat at the beach on a cold but bright winter day and looked out over pretty much what this photo shows. At first it was depressing, watching the wind whip the snow around the beach, the frigid waves smashing onto the beach. All I could see around me appeared dead—even the homes around me were empty for the off-season, the owners fleeing south to avoid this “freezing tomb”. Yes, it was depressing.

Then I lifted my eyes to the horizon—that bluish-gray line of the ocean as it ended at the sky. I reflected on that horizon, and I realized that if I moved toward it I would never arrive at it. The horizon would always move ahead of me, eluding my attempt to grasp it as an end point, to discover its “identity”.

It reminds me of life—moving toward the horizon to what lay beyond—not knowing when the “winter” will end and a new beginning will be in one’s grasp. We cannot know with certainty what is beyond this physical life. Yet the horizon symbolizes Hope—our yearning for what we know we will learn once we go beyond it at our death.

Let us celebrate the lives of those who have gone beyond the horizon—and hope that our journey will be a peaceful and comfortable one in this new year.

What is Dementia?

As caregivers, it can be terrifying to imagine our loved ones forgetting cherished memories or being unable to recognize those closest to them. But the possibility of older-age dementia is one we can’t afford to forget.

According to a 2009 study for the Center for Disease Control and Prevention (CDC) at least 25% of caregivers for adults over age 50 are looking out for someone with cognitive impairment or dementia. This is a sobering statis-tic, but there is hope, too—learning about the underlying causes of dementia can help caregivers stay alert to the signs of illness and ensure that their older loved ones have the care they need in their golden years.

Genetic Causes of Dementia

Often, we wonder what we could have done differently to prevent the onset of senior memory loss. But it’s im-portant to remember that dementia can be influenced by innate factors we have little or no control over. Some of the most common types of dementia are linked with diseases or conditions that have a genetic component. Re-cent studies, for instance, indicate that there are genetic risk factors for developing Alzheimer’s disease, a condi-tion that causes a slow decline in cognition.

Other causes of dementia which have been linked to genetics include Huntington’s disease, Lewy body disease and frontotemporal dementia. However, it is important to remember that our genes don’t cause dementia; they merely increase the risk of developing a dementia-causing condition.

Head Trauma Links to Dementia

Various physical traumas like brain injury, tumors, oxygen deprivation or exposure to heavy metals can also cause dementia. Dementia pugilistica, or boxer’s dementia, is caused by repetitive trauma to the head, while post-traumatic dementia occurs after a single incident of brain injury. The dementia itself is caused either by di-rect tissue damage or by swelling, infection or fluid collection.

Here’s the good news: in some of these cases, the course of mental decline can be stopped or even reversed if the problems are addressed soon enough. Caregivers can help their loved ones by being aware of the physical causes of dementia and getting help as soon as possible if there has been an accident or injury. Also, assisted living can be a great way to prevent environmental hazards while also maintaining senior’s dignity and independence.

Disease Causes of Dementia

Besides the widely known risk of cognitive decline associated with Alzheimer’s disease, there are several other diseases which can cause dementia.

Brain disease causes the vast majority of dementia cases, and its repercussions are far more serious. The damage from these diseases results in the destruction of brain cells integral to language, reasoning, memory, and emo-tion; and produces the symptoms of dementia (please see above). Most dementia cases comes from four differ-ent conditions, each with its own unique issues:

Alzheimer’s disease (AD). This is the most common type, accounting for up to 2/3rds of all cases, and the precise cause is unknown. Clumps and tangles of proteins develop among brain cells, interfering with their functionality and eventually destroying them. This usually begins in the memory and reasoning centers of the brain and then eventually progresses to include the entire cerebral cortex) the “thinking” part of the brain). At present,, this type of dementia is irreversible.

Lew body dementia (LBD). Lewy bodies are round protein structures that develop among brain cells, dis-placing them and disrupting their functioning. The precise cause of why they develop is unknown, Depend-ing upon whom you ask, LBD is increasingly considered the second leading cause of dementia, from 20% to 35% of all cases, but it is still considered a very new, relatively unknown classification.

Vascular dementia, also known as multi-infarct dementia. Brain damage from narrowed or blocked arteries causes this condition, usually as a result of a stroke. Although damage is irreversible, proper treatment of the underlying disease which caused the stroke (such as high blood pressure) can halt the further progression of vascular dementia. They symptoms of this dementia will vary according to which parts of the brain were affected by the stroke. Vascular dementia was once considered the second leading cause of dementia, but has been overtaken by LBD.

Frontotemporal dementia. In this form of dementia the brain’s frontal lobes gradually degenerate, af-fecting a person’s judgment and social behavior and appearing to change his personality. While the dis-ease is only a distant fourth in prevalence of all overall dementia cases, it is the second leading cause of dementia in people who are younger than the age of 65.

There are several other brain disorders that cause dementia, though with much less frequency than those listed above. These include Huntington’s disease ( a genetic disorder characterized by abnormal jerky body movements), Parkinson’s disease (characterized by limb stiffness and stooped posture, tremor, speech im-pairment, and a shuffling gait), Creutzfeldt-Jakob disease ( a transmissible disease of which the human form of mad cow disease is the latest example). In addition, some infections (such as meningitis, syphilis, and even AIDS) have been known to cause dementia.

Other possible causes include:

Multiple sclerosis

HIV, leukemia, meningitis, and other diseases that compromise the immune system

Thyroid disease

Diabetes-related hypoglycemia

Livor Cirrhosis

Endocrine disorders such as Addison’s disease or Cushing’s disease.

Stroke and Dementia

Dementia may also stem from strokes and other conditions that damage blood vessels and prevent necessary oxygen and nutrients from reaching the brain. Called vascular dementia, this type of impairment may or may not be irreversible, and often exists with Alzheimer’s disease.

Because this is the second most common cause of dementia, caregivers should be alert to signs of stroke and other risk factors for vascular dementia, including diabetes and high blood pressure. Seniors can also help ward off vascular dementia by maintaining a healthy heart through proper diet and exercise.

Other Causes and Risk Factors

Some causes of dementia arise from conditions that are ultimately treatable. Poisoning, medication reactions, vitamin deficiencies, nutritional disorders and even chronic lung problems can cause temporary dementia. Keeping track of seniors’ overall health is key to preventing and treating such conditions. We can also help our loved ones by paying attention to risk factors that may increase the likelihood of dementia, such as alco-hol abuse, high cholesterol and even depression.

Though it may seem daunting, caregivers who are vigilant about the warning signs of dementia are on the right path to providing relief for those under our care. Even if cognitive decline is unavoidable, understanding the underlying causes of dementia is an important first step to providing effective and timely support to our loved ones.

Dementia Care

Dementia care offers catered memory care services, attention and medication management, often in a secure as-sisted living or nursing home setting. Often in later stages of dementia, it’s to difficult for a family to take care of their loved ones as they need more specialized, expert care from trained professionals.

Sources:

Mayo Clinic, 2010-2012

National Institute on Aging. 2012

Centers for Disease Control and Prevention, 2009

Medline Plus, 2011

WebMD, 2005-2012

[This material is from A Place For Mom, www.aplaceformom.com ]

All About Dementia Treatment

When someone in your life shows signs of dementia, just figuring out what to do next can feel overwhelming. As caregivers, we can feel angry, devastated or simply powerless. Arming yourself with information can help: re-searching what dementia treatment options are out there and which one might be right for your loved one. De-pending on what the specific cause of the dementia is, you might chose to treat the underlying conditions or its symptoms. There are also a number of alternative treatments, home remedies and assisted living options to make day-to-day life more comfortable and ease the difficulties caused by dementia.

Treating the Underlying Causes of Dementia

When mental difficulties are caused by treatable conditions, the best course of dementia treatment can be to tackle these underlying health problems. Drug treatments have been proven effective n treating some aspects of Alzheimer’s disease; likewise, drugs that treat high blood pressure and other conditions leading to stroke can al-so prevent the resulting vascular dementia. Dementia caused by nutritional deficiencies, thyroid disease or heart problems can also be treated addressing the underlying illness.

Dementia Treatment for Symptoms

With some causes of dementia, curing the underlying conditions isn’t possible, and so dementia treatment focus-es on easing the symptoms. This can help reduce distress and disruption for the caregiver as well as the patient. Different types of drug treatments, of course, apply to different categories of symptoms.

Cognitive symptoms are generally treated with cholinesterase inhibitors or memantine, which boosts the brain’s communication networks and improve cognitive functioning.

Muscular symptoms may be treated with anti-Parkinson’s medication, though this type of dementia treat-ment can have unwanted side effects.

Behavioral symptoms and delusions are controlled using antipsychotic drugs, antidepressant medications or sedatives, although these, too, may have side effects.

Alternative Non-drug Treatments for Dementia

Alternative and drug-free options are another way to approach the issue of dementia treatment. Alternative rem-edies that some have found helpful include vitamin E, omega3s, coenzyme Q10, ginkgo biloba, and huperzine A.

Remember that some herbal treatments can interfere with regular drug treatment, so be sure to check with a professional before administering any alternative medicine.

There are also many non-drug dementia treatments and therapies to address specific issues—such as speech therapy, aromatherapy, music therapy and regular exercise. Some types of exercises stimulate the brain and body, such as tai-chi, which was recently shown to promote cognitive improvement in the elderly. Regular men-tal activity, whether with puzzles, computer games or other stimulating hobbies, also protects against future brain shrinkage and improves mental activity.

Home Dementia Treatments

Caregivers can create a safe, supportive, and healthy environment for loved ones with dementia by following a few simple guidelines:

Make sure the home environment is safe, calm and stable

Communicate clearly and slowly, using gestures when appropriate.

Encourage regular exercise and a healthy lifestyle

Anticipate your loved one’s needs

Help manage physical and behavioral problems

Make use of reminders, notes, rituals to aid memory

Take care of the caregiver—seek out support or counseling if you need it!

Assisted Living or Home Care?

One of the most important considerations in dementia treatment is whether and when to place a family member in assisted living or long-term care. Sometimes, the progression of the disease gets to a point where caregivers can no longer emotionally, physically or financially support their loved one. For those who favor homecare, treatment options such as a visiting nurse or adult day care can be excellent ways to relieve some of the pres-sure on caregivers.

Regardless of which options you prefer, remember that professional resources and assistance—including sup-port groups and community organizations—are always available to help you get you loved one the dementia treatment that is right for him/her.

Medications and Dementia Care

The treatment of dementia depends entirely on the nature of the underlying cause and whether it is considered reversible or not. In general, the reversible cases of dementia, such as vitamin deficiency or metabolic disorders, can be treated very successfully with straightforward methods. For example, doctors can halt and reverse the dementia effects of hypothyroidism by prescribing the appropriate thyroid hormone; depression can be man-aged effectively by combining psychotherapy with antidepressant medications; and if certain medications are causing side effects of dementia, simply stopping usage of the offending drugs will resolve the dementia. Howev-er, because most dementia cases are irreversible, treatment will usually involve medications to ease the symp-toms and the creation of a safe and supportive environment to help with patient function as well as he can for as long as possible.

There are currently five prescription drugs that have been developed for Alzheimer’s disease (AD) that can de-lay and slow the progression of dementia in patients with AD. Four of these drugs are called cholinesterase in-hibitors, and are usually known by their brand names:

Aricept ®

Exelon ®

Razadyne ® (formerly known as Reminyl ®) Cognex® (no longer actively marketed) They work by preventing the breakdown of a brain chemical called acetylcholine, and are usually only effective in mild to moderate cases of dementia. Because these only work for a limited time to delay symptoms, it is im-portant to start treatment as early as possible for maximum effect, which is why early diagnosis is so critical. There is a fifth drug, Namenda®, which is used to treat moderate to severe cases of dementia and works by an entirely different mechanism. It regulates another brain chemical called glutamate and helps to prevent cell death, but as in the other for drugs it can only delay the progression of dementia and cannot “cure” it. Namenda® may be used in conjunction with any of the four cholinesterase inhibitors. While these medications were developed and approved for use in patients with AD, they have been found to be very helpful in patients with Lewy Body Dementia (LBD) and, to a lesser extent, patients with vascular dementia. One of the most important things that doctors will usually do first in dementia care is to treat any associated de-pression with appropriate medications and psychotherapy. Even if the dementia is not “caused” by an underly-ing depression (pseudodementia), treating the depression can greatly improve the patient’s overall condition and quality of life. Sleep disorders can be treated with the appropriate medications as well, although shorter acting sedatives in lower doses are usually preferred. These sedatives can also be used to treat anxiety if necessary. The attending physician may also recommend treating associated psychosis or behavioral agitation with antipsy-chotic medications if those symptoms are present. These drugs have been fond to be somewhat effective in re-ducing hallucinations and behavioral problems, but they have no been approved for use in dementia patients by the FDA ad their use considered very controversial. Dementia Research Progress Each year, advances in research science and biomedical technology continue to shed new light on the underlying nature of the brain diseases that cause dementia. And with the aging baby boomer population, the government is on a mission to learn more about dementia and cure Alzheimer’s disease by 2025. With these new discoveries come renewed hope that scientists will someday soon develop an effective cure or preventive for the millions who suffer from it. But while the progress has ben rapid, it is not always steady, tidy, nor linear, so it’s extremely difficult, if not impossible, for the average person to keep up with the latest dementia information. That is why it is so important to consult with a qualified physician (such as a geriatric internist, a geriatric psychiatrist or a neurologist) who is informed of the most recent advances in diagnosis and treatment. Talk to your doctor about the options, resources, and dementia information available to you in your area—she or he may be just the right person who can help you, or may be able to refer you to a specialist who can. If you sus-pect that you or someone you love may have dementia, don’t wait to act—the sooner you find out what’s wrong, the sooner you or your loved one can be helped. - This article is from A Place For Mom, a website of information for senior care— www.aplaceformom.com .

BECOME A

HOSPICE VOLUNTEER

“What do we live for, if not to make life less difficult for each other?”

George Elliott

VOLUNTEERS PROVIDE COMPANIONSHIP AND SUPPORT TO THOSE

MAKING THEIR TRANSITION FROM THIS LIFE TO THE NEXT.

THEY SHARE STORIES, WRITE LETTERS, READ A BOOK, PROVIDE A

LISTENING EAR, A HAND TO HOLD, PLAY A MUSICAL INSTRUMENT,

HELP A VETERAN OR HELP IN THE OFFICE ALL BECAUSE THEY

CARE!

We are especially seeking Veterans to help our Veteran patients!

Online Training Available!

Train at home at your schedule!

For more information contact:

Gary Mann, Volunteer Coordinator/ Pastoral Counselor

Broad Reach Hospice and Palliative Care

508-945-4601 or garymann@libertycommons.org

Broad Reach Hospice Community Services

Caregivers Support Group: Open to all Every Tuesday 1:30—2:30 in

Library at Liberty Commons 390 Orleans Rd. N. Chatham, MA

Bereavement Support Group: Offered every Spring and Fall

Palliative Care Consults: Dr. Allen Ward is available as needed. Contact

BRH Office at 508-945-4601

Volunteer Training Program: Online Training Sessions offered

throughout year. Contact Gary Mann at 508-945-4601 or email at

garymann@libertycommons.org for information and/or to enroll..

Educational Presentations on End-Of-Life Issues , Hospice and

Palliative Care: Available upon request. Contact Office at 508-945-4601

390 Orleans Road

North Chatham, MA 02650

Phone: 508-945-4601

Fax: 508-348-0150

Email: DavidMaloney@libertycommons.org

Other Resources for Hospice End-of-Life Care

National Hospice and Palliative Care Organization: www.nhpco.org

Hospice Foundation of America: www.hospicefoundation.org

National Cancer Institute: www.cancer.org/cacncertopics

We Honor Veterans: www.WeHonorVeterans.org

Hospice Network: www.hospicenet.org