Care Planning for People with Memory Loss

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Sep 08, 2017

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A new Medicare billing code (G0505) now allows clinicians treating Medicare beneficiaries to be reimbursed for providing care planning to those experiencing cognitive impairment (memory loss), including Alzheimers disease.
This is a very important change in the billing system as it will allow physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified nurse midwives to offer assessment and care planning services beyond the scope of the Annual Wellness visit and receive reimbursement from the Physician Fee Schedule. What does this mean for the patient? Better and more comprehensive discussion and strategies to deal with memory loss and Alzheimers related issues.



Care planning allows newly-diagnosed individuals and their caregiver to learn more about medical and non-medical treatments, clinical trials and support services available in their community. All of this results in a better quality of life for those that maximize the information and support. Individuals receiving care planning support specific to dementia concerns typically have fewer hospitalizations, fewer emergency room visits and better medication management. Care planning is the key to care coordination and management for those experiencing Alzheimers and other chronic conditions. With this code, clinicians will have the time and resources to provide a comprehensive set of care planning services which may improve quality of life and reduce caregiver stress. Alzheimer's caregivers frequently report experiencing high levels of stress due to the overwhelming needs that are associated with taking care of loved ones. Too much stress is harmful to both the caregiver and those to whom they are providing care. Additionally, care planning promotes putting legal and financial plans in place which can provide comfort to the entire family thereby reducing the stress associated with future decisions.

Good health care requires a partnership between the patient, family and physician. Ask about the new care planning code options available through CMS Code G0505. Your physician may not yet be familiar with this new code. Share the information and plan ahead to get the most out of your medical appointments. When visiting your doctor, bring medications, provide good records, ask questions and offer honest answers. At the end of your appointment, ask the doctor to recap the most important points. Write them down. Note any follow-up steps needed (such as scheduling the next appointment or having tests done).most of all leave with a plan.For more information go to the Caregiver Center at www.alz.org or call the 24/7 Helpline at 1.800.272.3900.

Editorial Note: Debra Adams, Director Community Relations, Alzheimers Association Greater Dallas Chapter. Read more from the February 2017 Fact Sheet and at www.alz.org

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In observance of National Mental Health Awareness Month this May, the spotlight is now turning toward a previously overlooked demographic: seniors. While mental health has gained significant attention in recent years, researchers are uncovering the unique challenges faced by older adults. As we strive to pave the way for healthy seniors, its crucial to value the importance of a positive mental health mindset and habits.The psychology of aging is changing. As they start to retire, baby boomers are changing the way we think about senior citizens and mental health awareness. According to a study from the Institute on Medicine, approximately 1 in 5 older adults in the United States has a mental illness, substance abuse disorder or both.Researchers who have studied mental wellness over a lifespan noticed that older adults with chronic conditions, such as heart disease, are more likely to experience depression as well. The Centers for Disease Control and Prevention notes that for seniors, doctors may dismiss concerns of depression or loneliness, and seniors are left misdiagnosed or undertreated. In fact, due to the longtime cultural stigma around mental health issues, seniors may be more reluctant to seek help, or they may dismiss their own concerns because they do not believe that they need assistance to feel better. Reasons Why Seniors Struggle with Mental HealthThere are various reasons that seniors often struggle with mental health concerns, and while there are no set causes, research has shown that these factors are related to the risk of mental illness but do not necessarily cause it:    Medical conditions, such as stroke or cancer    Genes people who have a family history of depression may be at higher risk    Stress, including caregiver stress    Sleep problems    Social isolation and loneliness    Lack of exercise or physical activity    Functional limitations that make engaging in activities of daily living difficult    Addiction and/or alcoholism Life transitions related to the environment and changes in circumstances can also trigger periods of mental health disturbance. Transitioning from a lengthy career, experiencing family relocation or adjusting to life in a senior living community can evoke feelings of anxiety and depression in otherwise healthy seniors. During these times of transition, team members at Anthology Senior Living communities are equipped with the resources to aid residents. Dont be afraid to seek out mental health programs for older adults and encourage mental health improvement activities, such as exercising and meditation. Moving for SeniorsSome life events, such as a big move, can trigger more emotional changes in seniors. When moving into a senior living community, treat the transition with care. There are several emotional stages of moving, and some seniors could become depressed after moving to a new home. If emotions about moving arise, it can cause psychological challenges in older adults. To ensure quality of life for seniors who are moving, pay attention to any emotions or feelings your loved one might have, and help them process each consideration to help mitigate the emotional challenges that may come up.Talk to your loved one about the benefits of living in a retirement community, and if necessary, encourage conversations and utilize community and Anthology Senior Living support to gather resources about mental health services for seniors. Social Connections Are Essential for Healthy SeniorsAnother benefit of living in an Anthology Senior Living community is the opportunity to meet new people and create new social connections, which can ease the stress from moving. Communities like Anthology of Blue Ash help welcome new residents by introducing them to fellow neighbors and inviting them to dine with their new friends. Social connections are essential for not only surviving but also thriving. However, as individuals age, they frequently discover themselves spending increasing amounts of time in solitude. Research indicates that loneliness and social isolation are correlated with elevated levels of depression.

Warm Weather Activities for Seniors

As winter fades away and nature awakens, spring and summer emerge as seasons of renewal and rejuvenation. The longer days, milder temperatures and blooming landscapes invite us outdoors, offering a perfect opportunity to explore activities for seniors and embrace the new growth of the seasons. After months of indoor confinement due to cold weather, spring presents an ideal time for seniors to venture outdoors and engage in various activities that promote health and well-being. Whether its strolling through the communitys landscaped grounds, tending to garden beds or participating in outdoor exercise classes, the possibilities for enjoying the warmer weather are endless. The transition from winter to spring symbolizes a fresh start a chance to shake off the colder months and embrace a renewed sense of energy. 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Types of Alzheimer's Disease

Types of Alzheimer's Disease Different researchers classify Alzheimer's Disease using vastly different stages.  Alzheimer's Disease has a genetic component that becomes active in some people and dormant in others. Alzheimers creates an environment that promotes brain changes in those affected.  Lastly, amyloid plaque is the brains protective response to vastly different lifestyle insults.Alzheimers Disease is an imbalance of multiple systems within the body. People with Alzheimers disease usually have more than one type and present multiple risk factors.One of the things I like most about breaking Alzheimers into types is once you know where you stand, it is easy to begin to resolve. Dr. Bredesens books provide many examples from his patients.   Also, please keep in mind that in the descriptions below, I am cutting and pasting most of the information.  I do not want to risk misinterpreting any of Dr. Bredesens research and misinforming you. Type 1Type 1s primary characteristic is inflammation.  It tends to run in families as it is common in people who carry one or two ApoE4 alleles (ApoE in itself is considered an inflammatory gene). Individuals begin to lose the ability to store new information in the hippocampus for individuals who carry two copies of ApoE4 this tends to start in the late fifties or early sixties. For those with no copies of ApoE4, symptoms present typically in the sixties or seventies. A reduced hippocampal volume chronic inflammation encourages the brain to destroy synapses faster than it creates them.Biochemical Markers of Type 1 An increase in C-reactive protein (CRP), which is made by the liver in response to inflammation. 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As part of homeostatic adjustment, the body prefers to minimize extra energy usage. However, since neurons are critically important for healthy functioning, they receive signals in the form of chemicals that tell them to continue working. These chemicals are called trophic factors.Many of these trophic factors are synthesized and released by glial cells of the nervous system, the non-neuronal cells that interact closely with the neurons. Glial cells, particularly the astrocytes and Schwann cells, are well-known producers of trophic support molecules.One of the best-characterized trophic support molecules is called brain-derived neurotrophic factor, or BDNF. BDNF is a large protein. BDNF is normally synthesized and produced by cells of the nervous system and is important for making changes in neurons or for the growth of nerve cells. BDNF signals through the activity of several different receptors, the most well-known being the TrkB receptor. Other neurotrophic factors used by the nervous system that are important as trophic support molecules include nerve growth factor (NGF), neurotrophin-3, glial-derived neurotrophic factor (GDNF), and ephrins. Trophic factors, such as NGF and BDNF, control the development and survival of specific groups of neurons. Type 1, Type 1.5 & Type 2 Alzheimers Disease lead to the imbalance between the production and destruction of neural synapses. Type 3Type 3s primary characteristic is exposure to toxins such as mercury, toluene, benzene (candles), or mycotoxins (mold). Type 3 tends to occur in those who have the ApoE3 allele rather than ApoE4 and does not typically run in families.Type 3 hits individuals at younger ages, typically late forties to early sixties. Symptoms do not begin with memory loss but rather with cognitive difficulties involving numbers, speech, or organization. Individuals will start seeing difficulties with: Math, such as calculating tips or bills. Speech, such as finding the right words, or spelling or reading correctly. Rules of games, such as poker or bridge. Depression and attention deficits are common. The brain ultimately loses recent and old memories.Patients with Type 3 are often diagnosed initially with something other than Alzheimers Disease such as depression or frontotemporal dementia. Biochemical Markers of Type 3 Low triglyceride levels as compared to cholesterol levels. MRI scans show shrinkage of the hippocampus. Neuroinflammation and vascular leaks are presented on a specific MRI called FLAIR (Fluid-attenuated inversion recovery) as white spots. Decreased zinc levels. Normal levels are between 90-110 mcg/dL. Elevated copper levels. Normal copper levels are between 90-110 mcg/dL. High blood levels of toxic chemicals such as mercury or mycotoxins (caused by molds). The pituitary gland and adrenal glands become dysfunctional, which can show up in lab tests as hormonal abnormalities. Type 4Type 4s primary characteristic is low blood flow to the brain. Type 4 or Vascular Alzheimers Disease, is caused by a reduction of blood flow to the brain, which ultimately deprives the brain of essential oxygen and nutrients. The brain is an extremely vascularized tissue, meaning it requires large amounts of oxygen. A lack of oxygen to the brain leads to hypoperfusion (low blood flow) and compromises the blood-brain barrier which allows for harmful substances to leak in and damage neurons. Cerebral vasculature is extremely important as it is one way the body clears the accumulation of amyloid-beta.Biochemical Markers of Type 4Leakiness present in vascular tissues.Individuals with cardiovascular disease have a high risk for Type 4 Alzheimers.These individuals do best when they prioritize healing underlying insulin resistance. Type 5Type 5s primary characteristic is brain damage. Type 5 or trauma-induced Alzheimers, results from traumatic brain injuries (TBI) which disrupt normal brain function, including learning and thinking skills. Certain types of TBIs may increase the risk of developing Alzheimers disease years after the injury takes place.One of the most impactful studies showed that those with a history of moderate TBI had a 2.3 times greater risk of developing Alzheimers than older adults with no history of a head injury and those with a history of severe TBI had a 4.5 times greater risk.Biochemical Markers of Type 5There are no biochemical markers for Type 5 as it is triggered by injuries to the brain such as: Blunt force trauma Concussions Physical Abuse Chronic traumatic encephalopathy (CTE) Now that we have broken down Alzheimers Disease into 6 different types and identified their characteristics and potential causes we can begin to address what you need to do to prevent and begin to heal the damaging insults to the brain.  We will begin to work on that next week. OR if you want to jump ahead, purchase Dr. Dale Bredesens books.  Here are the links to purchase them on Amazon.The End of Alzheimers 2 Books Collection Set By Dale Bredesen Paperback October 26, 2023LINK: https://amzn.to/462LcY3 The End of Alzheimer's Program: The First Protocol to Enhance Cognition and Reverse Decline at Any Age Paperback September 6, 2022LINK: https://amzn.to/3xNcrct