Nursing home patients’ response to music opens new avenues for diagnosis and therapy

A nursing home in California began playing music for residents suffering from dementia, and got responses from patients once considered unreachable.

There are thousands of nursing homes participating in an international music and memory program.

At Villa Coronado, a nursing home in San Diego, 10 residents with traumatic brain injury were given an iPod to listen to music. Over 4,500 residents in 300 California nursing homes are taking part in a statewide experiment. One of the aims of the study is to find out whether music can replace antipsychotic drugs and restraints for agitated patients. With some patients, it seems to work.

This patient population receives little or no therapy, and are mostly bedridden, isolated from the world around them. Researchers are looking to see if the music program can reduce aggressive behavior.

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For some people, music brings back memories. It can help dementia patients become more aware of their surroundings. Music will bring a smile to some patients, and can calm those who are agitated. Some patients listening to the music will smile, move rhythmically, and be more responsive to their loved ones.

Music is said to activate more parts of the brain than any other stimulus. New research suggests music therapy could help people in a coma or in a vegetative state.

The patients’ response to music may even help physicians to diagnose consciousness. Studies show there is a high rate of misdiagnosis in vegetative patients, where it is important to determine a patient’s chance of recovery. Observing these patients leads some workers to conclude that rather than a steady state, there is a spectrum of consciousness, and patients drift in and out.

Caroline Schnakers is an associate clinical professor in the Department of Psychiatry at UCLA. Her research indicates there is a 40 to 50 percent error rate in diagnosing a patient’s consciousness. Some patients appear to be unconscious, and yet have some signs of consciousness and awareness of their surroundings.

A patient in a minimally conscious state (MCS) is considered to have more chance to recover than a patient in a vegetative state. If a patient is observed to be sometimes conscious, there is more hope of recovery. The diagnosis of a patient determines medical treatment and end-of-life decisions, so it’s important to diagnose correctly.

Some patients thought to be in a vegetative state are actually in a minimally conscious state, and they respond to the music. One nursing home activities director was excited to see how music affected the residents, saying they just come alive.

Researchers at UC Davis plan to have the initial results of their nursing home study by the end of this year. But regardless of whether music is able to replace medication, it’s worth giving patients music to improve their quality of life.

For more information on the care of dementia patients: Alzheimer’s on Guide To Long Term Care.

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Insomnia increases Alzheimer’s risk

Just one night without enough sleep can cause harmful proteins to build up in the brain, increasing the risk of Alzheimer’s disease, according to a new study.

Past studies already linked insufficient sleep to increased risk of Alzheimer’s and other chronic diseases — but this recent study from Washington University,published in the Annals of Neurology, discovered what insomnia actually does to the brain.

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One of the functions of sleep is to clear the brain of waste, including amyloid beta proteins which can bond with each other and form plaques on nerve cells. These plaques build up in the brains of people with Alzheimer’s disease.

People with a genetic tendency for Alzheimer’s disease have higher than normal levels of beta amyloid proteins, even before they develop symptoms. After a night without sleep, these higher levels appeared in the healthy study participants.

Inadequate sleep has been linked to a 1.5 fold increase in the odds of developing Alzheimer’s. It’s not surprising, therefore, that research shows that sleep disorders such as sleep apnea increase the risk.

In the study, eight participants with no previous sleep or memory problems were instructed to either stay awake all night, get a normal night’s rest, or use the drug sodium oxybate to help them sleep. The sleep aid is supposed to increase the period of deep, dreamless sleep when the brain is thought to restore itself.

The scientists tested the cerebrospinal fluid surrounding each participant’s brain for amyloid proteins. Measurements were taken before the night of the test, and then every 2 hours the next day, to show how the night of sleep or no sleep affected the accumulation of these proteins in the brain.

Study participants who went without sleep for just one night had a 25-30% increase in the beta-amyloid proteins in their cerebrospinal fluid, bringing the levels to what researchers would expect to see in people who have genes for Alzheimer’s disease. Before the test, the participants all had normal levels. The pills designed to promote the deep sleep did not affect the levels of amyloid protein.

In a healthy person, normal sleep eliminates waste and restores the brain each night. But repeated nights of insufficient rest may overwhelm the brain’s recovery system, allowing amyloid proteins to build up and form plaques which interfere with the brain’s functioning.

For information on Alzheimer’s and also long term care insurance, see Alzheimer’s Section on the Guide To Long Term Care.

 

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Nurses laugh as a 89-year-old veteran dies in nursing home

An 89-year-old World War II veteran in a nursing home bed called for help, saying he couldn’t breathe.

A hidden camera recorded nurses failing to take life-saving measures for the patient and laughing as he struggled to breathe, and eventually died. The man’s family had secretly recorded a video, which was kept from the public for 3 years until a television station, WXIA-TV, persuaded courts to unseal it.

The family of James Dempsey of Woodstock, Georgia, sued the Northeast Atlanta Health and Rehabilitation Center in 2014. Two nurses lost their licenses after the video was made public in September, with a link sent to the Georgia Board of Nursing. The nurses did not start CPR immediately and did not follow emergency procedures; then they laughed while trying to start his oxygen machine.

The nursing home issued a statement claiming that care has improved since the incident, under different leadership. But records show continued problems at the home, including $813,000 in Medicare fines since 2015.

Watch the video here: https://youtu.be/lU6NlK3OQDc

The video will probably cause families to think seriously about care options for their loved ones, including home care in some cases. A long term care insurance policy can support care either at home or in a facility. Find out more and get insurance quotes at Guide To Long Term Care.

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Millennials are most aware about long term care insurance

Only 20% of Americans have taken steps towards financing long term care, including even researching the costs. Millennials, who have long known that Social Security may not exist by the time they retire, are the generation most likely to have taken action on long term care insurance, according to Genworth Life Insurance Company, a long term care insurer since 1974.

Of people age 65 and older, 70% will need long term care at some point. However, only 52% of baby boomers believe they will need care. Millennials and members of Generation X are more realistic; 64% of Millennials (age 34 and younger) and 65% of Generation X (age 35-50) expect they may need long term care in the future.

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Most Americans (66%) mistakenly believe government programs will cover the costs of long term care. But Medicare only pays for skilled services or rehabilitative care, not for non-skilled assistance with activities of daily living, which is the bulk of long term care services.

Here are the 2016 national average costs for long term care in the United States (costs vary by state): $225/day or $6,844/month for a semi-private room in a nursing home; $253/day or $7,698/month for a private room in a nursing home; $119/day or $3,628/month for a one-bedroom space in an assisted living facility; $20.50/hour for a health aide; $20/hour for homemaker services; $68/day in an adult day health care center.

For those who are not prepared financially to handle their care costs, the burden will fall on their families and communities. It’s important for people who are growing older to talk with their families about their possible future needs and develop a plan — including how they will pay for care if needed.

Other facts the Genworth study showed Americans were uninformed about: 52% did not know that long term care insurance can cover help in their homes; 61% did not know that long term care can be personalized and that the insurer can help them find good care providers.

Insurers say people are never too young to begin planning for long term care costs, which can be a major expense and quickly use up retirement savings. To find out about long term care insurance, see the Guide To Long Term Care

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More insights on Alzheimer’s disease – how some brains are protected

A feature of the brain’s neurons called dendritic spines may protect against dementia, according to new findings.

Neurofibrillary tangles and amyloid plaques appear in the brains of people with Alzheimer’s, but not everyone who has these formations goes on to develop the disease. Between 30 and 50 percent of patients with the plaques and tangles do not develop Alzheimer’s disease. Why not? Scientists have been looking for the reasons.

Researchers at the University of Alabama at Birmingham found the answer may lie in dendritic spines. The dendritic spines of a neuron help it make connections with other neurons and send information. These parts of the neuron may protect against Alzheimer’s disease.

Dendrites, the branched projections of a neuron that transfer electrochemical stimulation from other neural cells to the cell body, have small membranous protrustions called dendritic spines. Each dendritic spine receives input from a single axon at the synapse. The loss of dendritic spines results in the loss of synapses, which can impair cognition. Logically, subects with normal brains would have healthy dendritic spines, and those with dementia would not. The researchers tested the structures and published the results in the journal Annals of Neurology.

The scientists compared dendritic spines in 21 patients with Alzheimer’s, 8 patients who had Alzheimer’s brain changes but no symptoms, and 12 healthy patients. Using bright-field microscopy, Professor Jeremy Herskowitz and the team took images of the dendritic spines, then used the images to create a 3-D digital reconstruction.

The healthy control subjects had more dendritic spines than the subjects with Alzheimer’s. The subjects with Alzheimer’s brain changes but no symptoms also had more spines than the Alzheimer’s subjects — and almost the same dendritic spine density as the healthy subjects. The group with pathology but no symptoms group had very long dendritic spines, longer than both the other groups.

Longer dendritic spines might indicate greater neuroplasticity — the capacity to change and form new neural connections. Increased neuroplasticity could enable the neurons to bypass plaques and tangles, and still communicate with other neurons. If so, this phenomenon could explain why some people who have Alzheimer’s pathology do not show cognitive impairment.

The research suggests that it may be possible for the brain to rebuild neurons. The information gained in the study may help scientists to develop new therapies, especially when brain changes are detected before symptoms appear.

In 2014, a study at NYU Langone Medical Center in New York, published in the journal Science, showed that getting sleep after learning helps neurons form connections, through dendritic branches, that may help brain cells pass information to each other and facilitate long-term memory.

The scientists observed mice that were genetically modified so a particular protein in their brain cells would fluoresce when viewed with a laser scanning microscope. The fluorescence allowed the team to track the growth of new spines along each branch of a dendrite. The mice sprouted new dendritic spines within 6 hours of learning a new task. Different structural changes occurred for different types of learning.

Healthier and more numerous dendritic spines may be a genetic trait, but the brain also may respond to healthy diet and lifestyle. According to Medical News Today, research suggests that as many as a third of dementia cases can be prevented by regular exercise and an active social life.

For more information on Alzheimer’s and dementia, and care choices, see the Guide To Long Term Care.

 

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Most Americans Incorrectly Believe Health Insurance or Medicare Pays For Long Term Care

More than half of Americans, 55%, incorrectly believe health insurance or Medicare will pay for long term care, the assistance with daily living that some people need because of illness or injury.

People who are sick or injured may need help with activities of daily living such as bathing, dressing, preparing food, and so forth that they would normally do for themselves.

A recent online survey asked adults how they would pay for assistance with activities of daily living if they are unable to take care of themselves for an extended period of time. More than half, 55%, said they would use Medicare or health insurance. But Medicare and health insurance, although they cover some of the medical costs, do not pay for long term assistance with daily living. See “Who Pays for Care”

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Medicare covers these costs for a maximum of 100 days (or until you stop improving). Medicaid will pay for these costs only when the individual’s assets are down to around $2,000 or $3,000 – depending on the state of residence – and Medicaid will recover the costs from the estate after death. This is often done with a lien on the Medicaid recipient’s primary residence.  How long will your savings/investments last if paying $75,000 a year per person for care?

The survey involved 2,065 U.S. adults age 18 and older. People over age 55 were more likely to say they would pay for long term care needs with health insurance and/or Medicare. People ages 18-54 were more likely to say they would borrow money from family and friends or use a credit card or loan. Long term care costs are estimated to be $70,000 a year or more, most of which will not be covered by health insurance or Medicare.

The U.S. Government Accounting Office and The Wall St. Journal report that 72% of Americans will need long term care at some time, either part-time assistance at home or full-time care in a facility. But people need to be educated about the costs of care and how to pay for it. Long term care insurance will relieve some of the burden. Many states now have available a Partnership insurance policy that protects assets by exempting the policyowner from Medicaid spend-down. Read more about The Partnership.

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Urgent Need for Alzheimer’s Disease Study Volunteers

Many researchers are working on a cure for Alzheimer’s disease. But they have run into an obstacle recently: a shortage of volunteers for clinical trials.

There are more than 100 research studies needing around 50,000 volunteers to help. Many studies have been funded, but there are not enough participants.

177851075The trials do not necessarily require people who are elderly or who suffer from dementia, and are not all drug trials. Some studies require participants to do cognitive tests on home computers. Some record data on lifestyle factors such as diet and exercise, or genetic risk factors.

There are studies where the volunteers try out wearable technology. All these tests collect information that can help scientists find ways to help people with Alzheimer’s.

Study subjects can benefit from participating. For example, some people who have Alzheimer’s disease may find a treatment that works. Some people may discover they have a genetic risk of dementia or already are in the early stages, and get prevention or treatment when it is most effective. Many volunteers in these studies will receive medical care for free. Also, some of the drug trials pay participants.

For people with dementia who are isolated, taking part in a study may help them socially. They can make friends with people running the studies and be part of a team. They can also feel good about helping to advance science and benefit others.

Some of the problems scientists have in recruiting study participants: In some studies both the dementia patient and a care partner must be involved. It’s harder to enroll two people. Some drug trials exclude people with certain medical conditions from participating.

Many drug studies require subjects in the early stages of dementia; at this stage there are few, or no, symptoms, so the disease hasn’t yet been identified, making it hard to find subjects.

There are sometimes legal obstacles if a dementia patient is not considered competent enough to give consent. And there are risks with experimental therapies, even though animal studies and FDA reviews are done before human trials.

For information on upcoming trials and on volunteering, visit the Alzheimer’s Association website, they have TrialMatch, a free database where you can find studies that may be right for you.

 

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