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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Diabetes drug doing double duty as Alzheimer’s therapy

A drug developed for treating diabetes now shows promise for Alzheimer’s patients, according to scientists at England’s Lancaster University. The drug is described as a triple receptor agonist, or TA. It combines hormones glucagon-like peptide-1 (GLP-1), glucose-dependent insulinotropic polypeptide (GIP), and Glucagon, activating these three receptors at the same time. The new study is published in the journal Brain Research.

A group of mice with Alzheimer’s-related symptoms were tested in a spatial water maze. The TA drug was injected once a day for two months. The mice who were treated with the drug remembered their path better than the control group.

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In addition to the memory improvement, other symptoms were improved: the accumulation of plaque in the brain was reduced; brain nerve cells were protected from deterioration and loss; and chronic nerve inflammation was reduced, as well as oxidative stress in the cortex and hippocampus. Increased levels of synaptophysin indicated protection from synaptic loss that occurs in Alzheimer’s. An increase of doublecortin positive cells showed improved neurogenesis.

Other diabetes drugs have shown promise for Alzheimer’s patients. The two diseases are known to be related, and type 2 diabetes increases the risk of Alzheimer’s disease. Clinical trials are proceeding to investigate the neuroprotective effects of extendin-4 and liraglutide.

Alzheimer’s cases are expected to triple in the next forty years, requiring more long term care. The increase in patients will bring financial challenges as well as medical ones. For more information on supporting Alzheimer’s and dementia patients, see the Alzheimer’s Section on Guide To Long Term Care.

 

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The rate of dementia among seniors is going down

The rate of Alzheimer’s and other forms of dementia among seniors has declined significantly over the last ten years, according to a new study.

The Einstein Aging Study followed 1400 men and women age 70 and older from 1993 through 2015. When they entered the study they did not have dementia. Carol Derby, research professor at the Albert Einstein College of Medicine in New York City, analyzed the data. The report was published in JAMA Neurology.

Of 369 people born before 1920, 73 ended up with dementia. Of 285 born 1920-24, 43 developed dementia. Of 344 born 1925-29, 31 developed dementia. Of 350 born after 1929, only 3 got dementia. Similar declining rates have been found in Europe.

Researchers say the reasons for the decline in dementia cases are not known, but there is also a declining rate of stroke and heart attack from one generation to another (though diabetes is increasing).

Efforts to prevent cardiovascular disease in recent decades may be paying off; the incidence of stroke has declined. Since dementia risk is correlated with the health of blood vessels in the brain, it makes sense that the rate of dementia is falling alongside the rate of strokes. A recent study found that healthy lifestyles, including exercise, good diet, no smoking, and proper treatment of chronic medical conditions could prevent 35% of dementia cases.

Although the rate of dementia is going down, the actual number of people with dementia is increasing dramatically as the baby boomer generation ages, inflating the percentage of elderly people in the U.S. population.

Around the world, more than 47 million people suffer from dementia, and 7 million new cases develop each year. The number of cases of dementia is projected to double every 20 years. The number of people with Alzheimer’s disease is expected to reach 106 million by 2050.

Dementia is one of the most expensive health conditions, costing patients and families in medical fees and caregiving time. Long term care insurance can help pay for the costs. You must insure before the diagnosis! For more information see the Guide To Long Term Care – Alzheimer’s.

 

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Dancing Benefits The Aging Brain

Doctors have long recommended physical exercise to reduce or delay the onset of dementia as people age. But a new study indicates that dancing may give even greater benefits than other forms of exercise.

Dr. Kathrin Rehfeld compared the effects of different kinds of exercise on volunteers with an average age of 68. Over 18 months, participants took part in either traditional fitness training with repetitive exercises like cycling or Nordic walking, or dance lessons which featured something new each week.

The study measured changes in the hippocampus, the area of the brain that is connected with learning, memory, and balance, and is affected by Alzheimer’s and similar diseases. In both groups, the hippocampus region of the brain increased. The dancers had a noticeable improvement in balance.

The dance routines varied and included jazz, square dance, line dance, and Latin. The study was published in the journal Frontiers in Human Neuroscience.

Other studies have found similar benefits to dancing:

A study at the Albert Einstein College of Medicine found that brain-stimulating activities such as reading, writing, and doing puzzles lowered the risk of dementia by 47 percent. This study did not find that regular bicycling, swimming, or team sports lowered the risk of dementia significantly. But ballroom dancing reduced the risk of developing dementia by 67 percent!

A study from Korea found that seniors who learned to dance the Cha Cha improved their memory and cognitive function over six months when compared to controls. A study from Canada found that seniors who danced the tango twice a week improved their cognitive scores.

The challenge of constantly learning a variety of new things may be one of the keys to the success of dance in improving mental ability. Dance requires a combination of mental and physical activity – dancers must remember the steps and executive them in rhythm. Also, dance is usually accompanied by music, and music has also been found to benefit people with Alzheimer’s and dementia. Music stimulates memories and positive emotions, and body response to rhythms; music can also have the effect of making people more outgoing and sociable.

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

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Nine lifestyle changes can reduce dementia risk

Nine factors that contribute to the risk of dementia

  • Mid-life hearing loss – responsible for 9% of the risk
  • Failing to complete secondary education – 8%
  • Smoking – 5%
  • Failing to seek early treatment for depression – 4%
  • Physical inactivity – 3%
  • Social isolation – 2%
  • High blood pressure – 2%
  • Obesity – 1%
  • Type 2 diabetes – 1%

These risk factors – which are described as potentially modifiable – add up to 35%. The other 65% of dementia risk is thought to be potentially non-modifiable.
READ  ARTICLE HERE

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Note: Insure before the diagnosis. Once diagnosed insurance is no longer available.

 

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Deaths from Alzheimer’s disease rising

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From 1999 to 2014, United States deaths from Alzheimer’s disease rose by 54.5 percent. According to the U.S. Centers for Disease Control and Prevention (CDC), the Alzheimer’s death rate rose during those 15 years from 16.5 to 25.4 deaths per 100,000 people. In 2014, 93,541 people died from Alzheimer’s.

Alzheimer’s, the leading cause of dementia and the sixth-leading cause of death in the United States, caused 3.6 percent of deaths in 2014.

Researchers expect rates will continue to rise as life expectancy increases. About 5.5 million Americans are living with the disease. That number is expected to rise to 16 million by 2050.

There is a trend for more people with Alzheimer’s to die at home rather than a medical facility. The number of Alzheimer’s patients dying at home increased from 13.9 percent to 24.9 percent from 2009 to 2014. During the same time period, the number of who died from Alzheimer’s in medical facilities fell from 14.7 percent in 1999 to 6.6 percent in 2014.

The disease mainly affects people over the age of 65. The rise in Alzheimer’s cases is attributed to the increasing numbers of older people, as medical improvements have led to fewer deaths from conditions such as heart disease. However, some of the increase may be the result of more accurate reporting by doctors.

At this time there is no cure for Alzheimer’s. It is the leading cause of long term care insurance claims. To plan for possible long term care needs in the future, see the Guide To Long Term Care.

Planning to buy long term care insurance at some point? Remember you must buy before the diagnosis. There are many conditions like Alzheimer’s that are uninsurable, here is a partial list: Are You Insurable?

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Listening to their favorite music may help people with dementia

Nursing home residents with dementia had fewer behavior problems and were able to cut back on antipsychotic and antianxiety drugs when they listened often to their favorite music, according to a recent study.

Researchers at Brown University in Providence, RI studied over 25,000 residents in 196 nursing homes around the country. They used a program called Music & Memory which provides Alzheimer’s and dementia patients with individualized music playlists.

In a national campaign led by Medicare, gerontology experts and patient advocates are seeking non-pharmacologic interventions to reduce the use of antipsychotic and anti-anxiety medications.

In nursing homes that used the program, residents with dementia were more likely to discontinue antipsychotic and anti-anxiety medications, and engaged in fewer disruptive behaviors, than in homes where the music was not used. However, the study did not show a significant improvement in mood.06_ALIVE-INSIDE_Photo-Courtesy-of-BOND360

Caregivers and family members in a documentary called “Alive Inside,” say that personalized music helps even patients with highly advanced dementia. They observe that patients look more at ease after listening to their favorite music.

The researchers studied residents who had dementia and cognitive impairment, but were not in hospice care or comatose.

The rate of discontinuation of antipsychotics rose to 20.1 percent in 2013 compared to 17.6 percent in a similar period before. The discontinuation rate of anti-anxiety meds rose to 24.4 percent compared to 23.5 percent before. In the studied nursing homes that did not use the music program, the rates did not improve.

Behavioral improvement increased to 56.5 percent in program homes from 50.9 percent before the program. Improvement in the behavior of residents helps the treated patients, but also enhances the quality of life for residents around them. Also, improvement in patients’ behavior raises the morale of nursing home staff, and may reduce staff turnover.

The study was published in the American Journal of Geriatric Psychiatry. To improve their evaluation, Baier, Thomas and their colleagues plan to conduct a second study. 

Nursing home or memory care can be costly. Long term care insurance provides not only money for care but a support system for both those needing care and their families. For more about long term care and insurance visit GuideToLongTermCare

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