“Long-Term Care Insurance: How to Choose It”

As this article in Barron’s indicates, there are only three ways to pay for long-term care (sometimes called “custodial care”): out-of-pocket, Medicaid, or via long-term care insurance. This article provides an overview of LTC insurance — who’s in the “sweet spot (those in their late 50s) and how policies vary (maximum monetary benefit, maximum life of a policy, elimination period, and inflation adjustments).

The full article link is below. You can only access the full article online if you are a Barron’s subscriber.


Barron’s: Long-Term Care Insurance: How to Choose It
It’s not easy finding a comprehensive and affordable plan. Some guidelines will make the quest less difficult.
by Nancy F. Smith
April 11, 2015


“Hospital discharge: It’s one of the most dangerous periods for patients”

This article by Kaiser Health News (KHN) stresses that the time after hospital discharge is a dangerous period. “Bad coordination often plagues patients’ transition to the care of home health agencies, as well as to nursing homes and other professionals charged with helping them recuperate, studies show.” The example given in this article, published in the Washington Post, is of a woman who died as a result of medication mistakes made by a pharmacy technician and two RNs at a home health agency.

The article mentions a few other danger-points worth repeating:

  • “At hospitals, federal data show that fewer than half of patients say they’re confident that they understand the instructions of how to care for themselves after discharge.”
  • “In nursing homes, case management frequently comes up short. A 2013 government report found more than a third of facilities did not properly assess patients’ needs, devise a plan for their care and then follow through on that.”
  • “And at home health agencies, where failures to create and execute a care plan are the most common issues government inspectors identify, followed by deficient medication review, according to KHN’s analysis.”

See: www.washingtonpost.com/news/to-your-health/wp/2016/04/29/from-hospital-to-home-a-dangerous-transition-for-many-patients/


Status of DLB and PDD Research

This write-up, published yesterday (4-21-16), from Alzforum is about the status of research into Lewy body dementias (LBD), which includes Parkinson’s Disease Dementia (PDD) and Dementia with Lewy Bodies (DLB). This summary is based upon discussion among experts at an NIH conference in Maryland at the end of March 2016. The NIH held a similar conference in 2013.

This is well worth reading. Here are key excerpts of the summary:

  • “Topping the priority list at the 2013 summit, and again this year, were clinical trials of repurposed drugs, investigational compounds, or non-pharmacological methods to treat the symptoms of LBD, said Jennifer Goldman, Rush University Medical Center, Chicago. Few advances have been made on that front. In the past three years, a handful of clinical trials has been completed for DLB, mostly for drugs used in Alzheimer’s…” Two clinical trials on Aricept (donepezil) were conducted in Japan.
  • “Three clinical trials have targeted PDD, Goldman said, one finding that rivastigmine is safe for this disorder, another that memantine lessens caregiver burden, and another that pimavanserin may relieve psychosis…”
  • “The committee further recommended compiling an inventory of available autopsied LBD brains to prepare for large, coordinated studies.”

Brain Support Network, by the way, has handled many LBD brain donations over the last nine years. If you’d like us to assist your family with brain donation arrangements, let us know. Obviously, autopsied LBD brains are critical for research.

Check out the link to the Alzforum website as there’s an interesting image of a pareidolia test. Apparently those with dementia with Lewy bodies tend to misinterpret random stimuli.

“At 2016 Summit, Field Tackles AD-Related Dementias One By One”
Series: Alzheimer’s Disease-Related Dementias 2016 Summit, Part 2 of 2
21 Apr 2016


Dangers of Polypharmacy

This is one of the best recent articles I’ve read on polypharmacy–taking five or more medications a day.

The New York Times – Health
The Dangers of ‘Polypharmacy,’ the Ever-Mounting Pile of Pills
by Paula Span
April 22, 2016

Here are some key points made in the article, published in today’s New York Times:

  • While drug interactions can occur in any age group, over 15% of older adults are at risk for a major drug interaction.
  • Older people are more vulnerable. “Most have multiple chronic diseases, so they take more drugs, putting them at higher risk for threatening interactions. The consequences can also be more threatening. ‘They’re more prone to fall, because they don’t have the same reserves of balance and strength’ as the young or middle-aged, [Dr. Michael A. Steinman, a geriatrician at the University of California, San Francisco] said. ‘And if they do fall because they’re dizzy, they’re more likely to get hurt.'”
  • “Some common combinations that cropped up in the study and could spell trouble: aspirin and the anti-clotting drug clopidogrel (Plavix)…; aspirin and naproxen (Aleve); …the cholesterol drug simvastatin (Zocor) and the blood pressure medication amlodipine (Norvasc).”
  • “[Patients] and families can ask their physicians for brown bag reviews, including every supplement, and discuss whether to continue or change their regimens. Pharmacists, often underused as information sources, can help coordinate medications, and some patients qualify for medication reviews through Medicare.”
  • We don’t consider when medications should be stopped.

Some of you may want to check out the NYT website and investigate some of the links within the article.


Issues in Dementia Diagnosis, Research, and Lexicon (Alzforum – April 20, 2016)

A nice write-up was posted today to Alzforum on the recent Alzheimer’s Disease-Related Dementias (ADRD) summit at NIH. This year’s summit was focused on Lewy body, frontotemporal, vascular, and mixed dementias. Here are some interesting quotations from the write-up:

  • Because many dementia patients are unaware of their problem, they often don’t tell their doctors. “Families participate in that, too. It is human nature,” said David Knopman, Mayo Clinic, Rochester, Minnesota. This leads to significant under-diagnosis. “Primary care practices are also problematic: physicians don’t have time for a mental status exam or to talk to families, and they aren’t always familiar with all the various dementing illnesses,” Knopman said.
  • Treatable causes of dementia are quite common, [Neill Graff-Radford, Mayo Clinic, Jacksonville, Florida] said: sleep disorders, thiamine, copper, or other nutritional deficiencies, and certain medications, to name a few.
  • The diagnostic criteria for DLB and FTDs work well, and even when the dementia is progressive, symptoms can be controlled early on in some cases. For instance, medications can control sleep disorders, cognitive impairment, and motor problems of DLB, and treating hypertension may slow the progression of vascular dementia.
  • What’s more, an accurate diagnosis can direct people toward clinical trials and help predict their rate of decline, Graff-Radford said.
  • “There’s a dearth of researchers and geriatricians from a time when we could not fund Alzheimer’s and related dementias,” said Maria Carrillo, Alzheimer’s Association in Chicago.
  • Knopman said scientists need to better define the syndromes and etiologies they study and describe them with more precise language. Among Alzheimer’s and Parkinson’s researchers, entrenched debates about terminology have arisen because clinicians classify diseases based on symptoms, whereas pathologists classify them based on molecular pathologies.

Here is a link to the full write-up: http://www.alzforum.org/news/conference-coverage/ad-related-dementias-summit-2016-progress-aims-dollars