Guns and Dementia

Back in June, Kaiser Health News investigation in conjunction with the PBS NewsHour published the results of an investigation in which they uncovered over 100 cases since 2012  where people with dementia used guns to kill themselves or others. Kaiser wrote about it on their website.

The shooters often acted during bouts of confusion, paranoia, delusion or aggression, common symptoms of dementia.  The victims were spouses, children and caregivers. The takeaway was that healthcare providers they talked to said they received little or no guidance on how to talk to families about gun safety.

Most patients refuse to answer if they have guns at home and doctors rarely ask if the patient has guns at home. Healthcare professional are trying to figure out how to ask patients if they have guns at home.

Dr. Altaf Saadi, a neurologist at UCLA who has been practicing medicine for five years, said the investigation revealed a “blind spot” in her clinical practice. After reading it, she looked up the American Academy of Neurology’s advice on treating dementia patients. Its guidelines suggest doctors consider asking about “access to firearms or other weapons” during a safety screen, but they don’t say what to do if a patient says they do.

Research bears this out. A 2014 study found, 58 percent of internists surveyed reported never asking whether patients have guns at home.

Dr. Colleen Christmas, a geriatric primary care doctor at Johns Hopkins School of Medicine and member of the American Neurological Association told Kaiser, “One of the biggest mistakes that doctors make is not thinking about gun access. Firearms are the most common method of suicide among seniors, she noted. Christmas said she asks every incoming patient about access to firearms, in the same nonjudgmental tone that she asks about seat belts, and “I find the conversation goes quite smoothly.”

Momentum has been building among health professionals to take a greater role in preventing gun violence. In the wake of the Las Vegas shooting that left 58 concertgoers dead last October, over 1,300 health care providers publicly pledged to ask patients about gun ownership and gun safety when risk factors are present.

Volunteers with Alzheimer’s San Diego, a nonprofit group, became alarmed when they visited people with dementia and found 25 to 30 percent of those homes had guns, said Jessica Empeño, the group’s vice president.

“We made a decision as an organization not to send volunteers into the homes with weapons,” she said.

But, for health professionals, navigating this politically fraught issue can be difficult. Here are the leading issues according to Kaiser:

Is it legal to talk to patients about guns?

Yes. No state or federal law bars health professionals from raising the issue.

Why don’t doctors do it?

The top three reasons are lack of time, being unsure what to tell patients and believing patients won’t heed their advice about gun ownership or gun safety, one survey of family physicians found.

“There’s no medical or health professional school in the country that does an adequate job at training about firearms,” Wintemute argued. He said he is now working with the American Medical Association to design a continuing medical education course on the topic.

Polling conducted by the Kaiser Family Foundation for the story suggested that few Americans are concerned about the potential dangers of elders and firearms. Nearly half of people queried in a nationally representative poll in June said they had relatives over 65 who have guns. Of those, more than 80 percent said they were “not at all worried” about a gun-related accident.”

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Health Care Proxy. Should you have one?

Under the New York Health Care Proxy Law you can appoint someone you trust to make health care decisions for you if you lose the ability to make those decisions yourself. That person is considered your health care proxy or agent

A health care proxy is a way to eliminate confusion among your loved ones and health care providers about your health care wishes should you no longer b able t make those decsions yourself. Hospitals, doctors, and other medical providers must follow the agent’s decisions as if they were your own.

Here are a some common questions and answers about health care proxies:

Who can be your health care agent?

Anyone 18 years of age or older, including a family member or close friend can be your health care proxy.

A doctor can act either as your proxy or your attending doctor, but not as both simultaneously. A number of special rules apply to patients or residents of a nursing home, hospital, or mental health facility who want to name a staff member as an agent.

What powers do health care proxies have?

Your proxy can decide how your wishes apply as your medical condition changes, but he or she is legally obligated to always act in your best interest.

The person you select as your health care agent will have as little or as much authority as you want. You may allow your agent to make all health care decisions or only certain ones.

A health care proxy is different from a living will because it does not require that you know in advance all the decisions that may arise. Nevertheless, you may give your agent instructions that he or she must follow and specify on the form the treatments you do or do not want.

Also, note that you can continue to make health care decisions for yourself as long as you’re able. You can also cancel the authority given to your agent by informing him or her or your health care provider orally or in writing.

To appoint a health care proxy, you and your agent must sign a New York health care proxy form in the presence of two adult witnesses. This is best done in an attorney’s office like the Law Offices of Jeffrey Weinstein. Mr Weinstein is an estate professional and can guide you through what you need to do to insure your wishes are carried out.

Here are some instances when you would need a proxy:

  • You are in a coma from an accident or illness.
  • You are terminally ill and not expected to recover.
  • You have Alzheimer’s or another form of dementia.
  • You are under general anesthesia, when something unexpected occurs.
  • You are in a persistent vegetative state.
  • You suffered from an illness that left you unable to communicate.

 

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Ways to prevent elder abuse

The second man to walk on the moon, 88-year-old 88 Buzz Aldrin is fighting his two youngest children who he claims are colluding with his former manager Christina Korp to seize control of his estate by alleging that he has dementia. He sued the trio in a Florida court in June. Korp and the Aldrin children deny wrongdoing and blame Aldrin’s “increased confusion and memory loss.”

Wherever the truth lies, what is happening to Aldrin is becoming more and more common and not just to the rich and famous. The exploitation of the elderly is growing and is vastly underreported.

Julie Schoen of the National Center on Elder Abuse told AARP, “It’s such a hidden crime. Within families, victims don’t want to prosecute. There’s a huge gap in our system when it comes to recording these crimes. We need better research. Ninety percent of perpetrators are family members or other people the victim knows well, such as caretakers, neighbors or friends.

Schoen suggests some ways to help protect you and your aged loved ones.

  • When a person is still mentally sharp, help him or her make a plan that designates power of attorney and health care directives. “We tend to want to keep financial matters private, but if we don’t have those discussions, that’s what blows things apart.”
  • Stay connected with older loved ones through regular phone calls, visits or emails.
  • Develop a relationship with your parent’s caregiver. “They’ll be less likely to financially exploit Mother because they know you’re paying attention.”
  • Become a “trusted contact” to monitor bank account and brokerage activity.
  • Sign up for a service such as EverSafe to track financial activity and notify an advocate of unusual withdrawals or spending.
  • Set up direct deposit for checks so others don’t have to cash them.
  • Do not sign any documents that you don’t understand.

If you need legal help protecting an aging loved one, please call us here at the Law Offices Of Jeffrey Weinstein.   347-305-8752.

 

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Some people with markers of Alzheimer’s don’t develop the disease

A new study from The University of Texas Medical Branch at Galveston, published in the Journal of Alzheimer’s Disease  has uncovered why some people that have brain markers of Alzheimer’s never develop the classic dementia that others do.

Alzheimer’s is the most common form of dementia and affects more than 5 million Americans. People suffering from Alzheimer’s develop a buildup of two proteins that impair communications between nerve cells in the brain, plaques made of amyloid beta proteins and neurofibrillary tangles made of tau proteins.

Curiously, researchers were at a loss to explain why not all people with those signs of Alzheimer’s ever develop any cognitive decline.  The question then became, what sets these people apart from those with the same plaques and tangles that develop dementia?

Giulio Taglialatela, director of the Mitchell Center for Neurodegenerative Diseases said

“In previous studies, we found that while the non-demented people with Alzheimer’s neuropathology had amyloid plaques and neurofibrillary tangles just like the demented people did, the toxic amyloid beta and tau proteins did not accumulate at synapses, the point of communication between nerve cells. When nerve cells can’t communicate because of the buildup of these toxic proteins that disrupt synapse, thought and memory become impaired. The next key question was then what makes the synapse of these resilient individuals capable of rejecting the dysfunctional binding of amyloid beta and tau?”

To answer this question, researchers used high-throughput electrophoresis and mass spectrometry to analyze the protein composition of synapses isolated from frozen brain tissue donated by people who had participated in brain aging studies and received annual neurological and neuropsychological evaluations during their lifetime. The participants were divided into three groups, those with Alzheimer’s dementia, those with Alzheimer’s brain features but no signs of dementia and those without any evidence of Alzheimer’s.

Results showed that resilient individuals had a unique synaptic protein signature that set them apart from both demented AD patients and normal subjects with no AD pathology. Taglialatela said this unique protein make-up may underscore the synaptic resistance to amyloid beta and tau, thus enabling these fortunate people to remain cognitively intact despite having Alzheimer’s-like pathologies.

Taglialatela sai they still didn’t understand the mechanisms responsible for this protection,” but “understanding such protective biological processes could reveal new targets for developing effective Alzheimer’s treatments.”

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Dementia and alcohol

In the United States alone, 5.7 million Americans are thought to have Alzheimer’s disease. Experts estimate that by 2050, this number will have reached 14 million. According to recent estimates, almost 50 million people worldwide currently have dementia and this number is expected to double every 2 decades, reaching over 130 million by 2050.

Research has found that dementia has various risk factors such as high blood pressure, lack of sleep and lack of physical exercise. Now research has found alcohol may play a role. A new study followed  9,000 people over a 23-year period to draw conclusions on the link between alcohol consumption and dementia risk.

The researchers assessed their alcohol consumption and potential dependence regularly using standard questionnaires and by looking at alcohol-related hospital admissions.

The combination of French and English  reasearchers also examined hospital records for cases of dementia, as well as for any diagnoses of conditions, such as heart disease or diabetes.

In the UK anything over 14 standard U.K. alcohol units per week counted as heavy drinking. In the U.K., a standard glass of wine counts as 1 unit of alcohol, and 14 weekly units is the maximum threshold for what is considered harmful drinking.

In the U.S., the Dietary Guidelines for Americans recommend that men should not drink more than two drinks per day and women should not exceed one drink per day.

The average follow-up period for the study was 23 years. During that time, 397 people developed dementia. The researchers team took into account for various sociodemographic factors that may have influenced the results.

The study was published in the BMJ (Britsish Medical Journal) and in an  editorial comment, Sevil Yasar, from the Johns Hopkins School of Medicine in Baltimore, MD, weighed in on the findings.

[A]lcohol consumption of 1-14 units/week may benefit brain health; however, alcohol choices must take into account all associated risks, including liver disease and cancer.”

 

 

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