“It took my mother having a stress-related heart attack before we quit dismissing my father’s progressing dementia to ‘senior moments’ and got him a proper diagnosis of Alzheimer’s. Had we paid attention to the warning signs of this disease, a lot of prevention could have been in place.” — Brent

Know the 10 Signs of Alzheimer'sThere seems to be a blurred line between “getting old” and early warning signs of dementia or Alzheimer’s.   When does forgetting a word more often become a “problem” or a warning sign of more profound changes?  At the Alzheimer’s Association, we have a list of “10 Warning Signs” that we use as a guide to see if a visit to a physician may be needed (for more information, visit http://alz.org/alzheimers_disease_know_the_10_signs.asp).

  1. Memory loss that disrupts daily life
  2. Challenges in planning or solving problems
  3. Difficulty completing familiar tasks at home, at work or at leisure
  4. Confusion with time or place
  5. Trouble understanding visual images and spatial relationships
  6. New problems with words in speaking or writing
  7. Misplacing things and losing the ability to retrace steps
  8. Decreased or poor judgment
  9. Withdrawal from work or social activities
  10. Changes in mood and personality

When I talk to people about these warning signs, many of them say “Oh! I have all of these… does that mean I have dementia??” Not to worry, yet!  These warning signs are just a hint that it may be time to go visit a doctor and talk about the symptoms you are facing.  A lot of people don’t realize that there are reversible types of dementia, such as thyroid issues, that may cause some of these symptoms.  Going to talk to a doctor can determine the cause of these symptoms and some may actually be reversed.

A lot of these “warning signs” seem like typical age related changes.  However, there is a difference between forgetting where you parked your car and finding it a few seconds later (typical aging) and not remember what car you have (a warning sign of dementia).  Another example is confusion with time or place, again, there is a difference between thinking it is Friday when it is actually Thursday (we’ve all done that!) but remember it is Thursday a few minutes later, versus  thinking it is Summer when it is actually Winter (warning sign).

Where do you think we draw the line between “normal” aging and the beginning signs of dementia?  Even though we have these outlined signs, it may be difficult to tell.  When it doubt, I say talk to your doctor about changes so they can be recorded and monitored in the future.

Reference: www.alz.org/texas

Our Guest Blogger this week is Krista Dunn, MPH, Galveston/Bay Area Outreach Coordinator for Alzheimer’s Association Houston and Southeast Texas Chapter.

Join us for a real-time discussion about the questions raised by this essay on Tuesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.


When I think of multigenerational families, what comes to mind is the image of Big Daddy and his family from Tennessee Williams’ play Cat on a Hot Tin Roof. Now not all multigenerational families are dysfunctional (ignoring images from All in the Family now). It used to be very common in the US. In many cultures, other than the US, multigenerational families are the norm. I am reminded of homes I visited in Kuwait that were huge with many living areas for several generations of family members.

Big Daddy and his extended family

It seems to be there are three options in the US for living quarters as we age.

  • Live alone or with a spouse, sibling or a friend/peer.
  • Live with relatives from another generation.
  • Live in some form of institution, nursing home, assisted living, whatever but a place that has paid staff to help out. Options 1 and 2 can be augmented by paid staff too but let’s just focus on location not arrangements.

The trend has been to avoid institutional living until that’s the only option. However, are people choosing multigenerational settings over living alone?  Philip Cohen, professor of sociology at the University of North Carolina, said, “We’ve seen for a long time that people tend to live in multi-generational households when they don’t have as much choice as they’d like. So it seems like Americans, when they can afford to, don’t do this. So when we see a strong uptick in multi-generational living, we have to expect that it’s economic. Although frankly, the numbers have been trending up since the middle of the decade. … Well the long term decline in multi-generational living made us think that it would never turn around. The steep increase in the last few years has us wondering. I don’t know.” (Marketplace Morning Report. Multigenerational Home Numbers on the Rise. Published: August 30, 2011.)

Certainly, the institutional option has it’s risks and the trend to keep disabled people in their homes while providing home-based services has it’s downside as well. Commenting on the quality of New York’s record in providing long-term care for its residents, an editorial stated, “The state ranked 44th in the percentage of high-risk nursing home patients who develop bed sores, which is often a measure of neglectful care. It ranked 50th in the percentage of home health patients and 28th in the percentage of nursing home patients who were sent to the hospital [another indicator]. … It also ranked 50th in the percentage of disabled adults living in the community who always or usually get the support they need. This is an ominous statistic given the drive to move larger numbers of people out of institutions and into community-based care.” (New York Times Editorial. Bad Grades on Long-Term Care. Published: September 12, 2011. Note: sometimes this link takes one to a log in page – I do not know why or the solution.)

In reviewing blogs discussing the ins and outs of maintaining multigenerational homes, many of the posts dealt with healthy participants. One post did comment on the converse.  This is from Rockville Mama, “Parents eventually get old and frail and sick. Then what? There’s no ’sharing’: you look after them like they looked after you when you were little, it is really hard and there’s very few options for help for people in this situation in this country. You should talk to people (especially women) who have had to quit jobs to be able to look after both their kids and their sick parent/s. So the issue is not just how to I manage the ’space’, the chores and the personal conflicts. I do think though, despite all the challenges, this is the best system there is for people of all age to have a supportive family life. It requires a lot of give and take: which it seems like people now simply do not want to be bothered with.”  (New Your Times. Tips for Multigenerational Households. Posted: December 8, 2008)

With apologies to Charles Dickens for the title, today let’s look at some aspects of long term care.

The specter of “The nursing home” is raised when one has reached that point where one is alone to the extent that family cannot provide in-home care. This is a complicated area that most people do not plan for and either can afford it or cannot. If you can afford it, it just reduces the legacy you leave to your relatives. If you really cannot afford it, e.g., you have nearly nothing but your modest home, then government programs pay for it. If you fall in the middle, it looks to be an expensive activity.

Approximately 70 percent of Americans turning 65 today will need long term care at some point in their lives. This figure comes from both Leading Age (http://leadingage.org), a Washington-based lobbying group that represents nursing and retirement homes and the National Clearinghouse for Long-Term Care Information (http://www.longtermcare.gov).

Who pays now. “On an aggregate basis, the biggest share, 49 percent, is paid for by Medicaid.  On an individual basis, however, ‘who pays for long-term care’ can look very different. This is because people with their own personal financial resources do not qualify for Medicaid unless they use up their resources first paying for care, so-called ‘spending down.’  If you have reasonable income and assets, most likely you will be paying for care on your own” (http://www.longtermcare.gov/LTC/Main_Site/Paying_LTC/Costs_Of_Care/Costs_Of_Care.aspx#National).

I could not find information on this question: How many people who do not qualify for Medicaid need long term care but don’t do it and instead struggle along on their own until their health is so deteriorated that they only need the 90 days provided by Medicare? This seems to be an area worth exploring and one no doubt filled with sad stories.

Private insurers have found it difficult to sign up enough customers for long term care insurance to make the business profitable. A new twist is to pair long term care insurance with whole life insurance (http://www.bloomberg.com/news/2011-05-18/insurers-pair-long-term-care-with-life-to-entice-older-buyers.html). On the other hand, MetLife will stop selling new policies in December (http://www.bloomberg.com/news/2010-11-11/metlife-halts-sale-of-long-term-care-insurance-after-review.html).

Speaking about private long term care insurance Catherine Theroux, a Limra spokeswoman, said, “This is a market that is
challenged even in the best of times. It’s an expensive product and it’s not something people want to talk about.”

The Federal government has taken a small step to fill the gap. This recent legislation is explained in a Bloomberg article, “The health-care law President Barack Obama signed in March 2010 created a program that will pay a daily cash benefit that averages $50 or more to those who can no longer care for themselves, for workers who enroll in and contribute to the program. Details of the plan, called the Class Act, such as the cost of premiums for workers who enroll, haven’t been released, said Lauren Shaham, spokeswoman for Leading Age.” Currently the median cost of a private room in a nursing home is about $213 a day, so the government program really is a small help.

Senator Lindsey Graham, a Republican from South Carolina, said, “The Class Act is a Ponzi scheme that would make Bernie Madoff blush. It’s billed as an insurance program for long-term care, but really it’s just a huge and very costly government accounting trick”  (http://www.bloomberg.com/news/2011-05-18/insurers-pair-long-term-care-with-life-to-entice-older-buyers.html).  Republican viewpoints being what they are we might take this opinion with a grain of salt but it does highlight the fact that few workable solutions are available, that a real analysis of the issues and potentials has not yet been done, and that there is no consensus as to policy.

So, where do health care providers fit in? How can you advise and help your clients/patients? It’s tricky, but given the trials and the options of becoming a participant in the long term care community perhaps the real solution lies in prevention, staying healthy and strong. I sort of hate to say it but perhaps we really do need to follow Former President G. W. Bush’s advice on health care, “Don’t get sick.”