Second Baptist Church hosted Dr. Linda Nichols, Dr. Robert Burns, and Rev. Dennis McDuffie in a seminar Saturday, April 21, on Aging Gracefully. Dr. Nichols is a nationally known caregiver researcher based at the Memphis VA Medical Center. Dr. Burns, the Mid-South’s best known geriatrician, trains medical professionals. Rev. McDuffie is chaplain at Methodist North Hospital and teaches advance directives there. Here are some memorable moments from the discussion.
Onset of dementia is subtle. 5% of people over age 65 and at least 10% over age 85 have dementia. The commonest cause of dementia is Alzheimer’s, but there are many other causes including strokes and Parkinson’s disease. The earliest signs of dementia are loss of executive function – inability to balance a checkbook, inability to drive a familiar route, and failure to pay bills. Dementia is adversely affected by many medications including Benadryl and Tylenol PM. The Beers’ list provides names of drugs contraindicated in the elderly. WebMD, Consumer Reports, and pharmacists (consult window) are good drug information sources. Prevention of dementia is assisted by staying physically active, remaining cognitively active (crossword puzzles, books, volunteer service), and controlling other medical illnesses. According to Dr. Burns, “Nothing makes your mind rot quicker that Judge Judy and constantly watching TV.”
Taking the car keys from a loved one with dementia is a difficult task. Reasons to do so are getting lost, minor accidents, unexplained car damage, and your own nervousness. Be sure that your elderly relative has a GPS locator at all times. If the driving situation is unclear, go for a ride. If the ride is scary, get the keys. If necessary, ask the relative’s physician to notify the Tennessee Motor Vehicle Division that your loved one is a threat to public safety. The state will test your loved one and cancel the license if indicated, but you must still get the keys. Another method is to disable the car. Finally, there’s the “TV lawyer solution.” Tell the elderly relative that a car accident with a distracted teenager could result in a major lawsuit. Even if not at fault, the elderly relative would be blamed due to the dementia diagnosis or medications. All assets would be lost. This technique works almost without fail.
Dr. Nichols encouraged caregivers not to challenge their loved ones’ delusions. For example, when an elderly demented person is looking for her mother, attempt to distract her. Do not try to force her back into reality and upset her by saying her mother is dead.
Assisted Living and Nursing Homes
Assisted living requirements include the ability to make needs known, feed oneself, and exit a building within 13 minutes. This means the person can be neither bed-bound nor chair-bound. Bare-bones assisted living consists of a room, meals, and laundry services. Cadillac-assisted living adds medication administration, group activities, and assistance with dressing. Costs range from $1100 to $8000 per month. Indications for assisted living include inability to manage medications; failure to cook and eat meals (often with weight loss); or safety issues such as wandering, failure to lock doors, and burning pots on the stove. Memory care is a type of assisted living for people with worsening memory loss. Memory care occurs in a locked unit with plenty of structured activities.
Nursing homes are designed for those with progressively worsening dementia, pressure sores, inability to feed oneself, or reduced mobility. Nursing homes cost from $72,000 to $80,000 annually with a hospital stay usually a prerequisite. Medicare Part A will cover hospital care, a rehabilitation hospital, skilled nursing rehabilitation, or hospice care. However, nursing home care must be covered by cash, Medicaid, or partially by long term care insurance. The VA has more extensive benefits than the general public, and every veteran should investigate what is available.
The latest and best Advance Directive is the appointment of a Health Care Agent who is empowered to make health care decisions for you if you lack medical decision-making capacity. The state of Tennessee publishes a two-page Advance Directive for Health Care that can take the place of all previous advance directives including a Living Will and Durable Power of Attorney for Health Care. Access at https://www.tn.gov/content/dam/tn/health/documents/Advance_Directive_for_Health_Care.pdf. This new document does not require an attorney but does require a notary or two witnesses. The witnesses must not be hospital employees, your health care agent, or alternate agent. One of the witnesses must be someone not related to you and not entitled to any part of your estate.
Give copies of your Advance Directive for Health Care to your agent and alternate, the hospital, and your primary care physician. Keep one for yourself in an easily accessible area. The pamphlet Five Wishes is a twelve page publication that allows a person to thoughtfully complete the two-page Advance Directive for Health Care.
There is a difference between living and being alive. Rev McDuffie concluded with, “If I’m not me anymore, I have some other place to go.” An advance directive is a loving thing to do for your family and keeps them from having to make agonizing, life-or-death decisions.