When Alzheimer’s Waited Outside the Oval Office

By LAWRENCE K. ALTMAN, M.D.

WASHINGTON — Ron Reagan’s new memoir, “My Father at 100,” has touched off sensational headlines with its suggestion that President Ronald Reagan might have begun showing hints of Alzheimer’s disease while still in the White House.

But in two interviews this month, the younger Mr. Reagan said he never meant to suggest that his father had dementia before leaving office in 1989. And he graciously took the blame for not being more explicit in a passage that described a few personal observations along with comments from the former president’s doctors.

A “rather small section of the book has attracted outsize attention,” he said in a telephone interview from Seattle, where he lives.

All he meant, he continued, was that the amyloid plaque characteristic of Alzheimer’s can start forming years before it leads to dementia. The former president’s diagnosis was made in 1993, four years after he left office.

“Given what we know about the disease,” his son told me, “I don’t know how you could say that the disease wasn’t likely present in him during the presidency.”

Had it been stated that way, the assertion about Alzheimer’s would have stirred little if any debate. Still, the issue is important for anyone — including candidates for office — because of the difficulty of distinguishing the initial symptoms of Alzheimer’s from, say, simple forgetfulness.

The disease occurs most frequently after 70, but it can strike younger people. Dr. Alois Alzheimer, a German psychiatrist, diagnosed the first case in a 51-year-old woman. It is now recognized as one of a number of types of dementia. And diagnosing it with certainty requires a brain biopsy, rarely done while a patient is still alive.

Mr. Reagan’s mental state was an issue even before he became the oldest man elected president, at 69, in 1980. Adversaries were fond of attributing his penchant for contradictory statements, forgetting names and general absent-mindedness to Alzheimer’s.

I reported on Mr. Reagan’s health, and he told me that his mother, Nelle, had died of senility — and that if he were to develop it in office he would resign.

As a follow-up to questions about Alzheimer’s, my extensive interviews with his White House doctors, key aides and others, I found no evidence that Mr. Reagan exhibited signs of dementia as president. The interviews did not include family members.

Moreover, until Ron Reagan’s memoir appeared, no other family member — and not Edmund Morris, the official biographer who spent seven years with Mr. Reagan in the White House — publicly hinted that he showed evidence of Alzheimer’s as president.

“My Father at 100” (Viking) is an affectionate, often lighthearted account of a son’s attempt to uncover his father’s character by going back to his early days. It is generally well written, except for portions of the closing chapter about Alzheimer’s — which Ron Reagan acknowledged were flawed because he “relied on memory” without checking facts about when and where the suspicion of his father’s Alzheimer’s was first raised.

He writes, for example, that after the former president fell from a bucking horse in Mexico in 1989, his doctors detected probable signs of Alzheimer’s in removing a blood clot that formed between his skull and brain. But such a procedure does not involve a brain biopsy that doctors would need to diagnose dementia.

Moreover, Mr. Reagan was flown to a military hospital near Tucson — not taken to San Diego, as his son writes — and the blood clot, a subdural hematoma, was removed weeks later at the Mayo Clinic in Rochester, Minn.

In the interviews, Ron Reagan genially acknowledged the errors and said that if he had anticipated the controversy he created, he “would have done more due diligence in terms of pinning down dates.”

When his father was president, Mr. Reagan, then a professional dancer with the Joffrey Ballet, visited him two or three times a year. Now 52, the younger Reagan has been a radio and television talk show host, commentator and magazine writer. In the book, he writes that he did not want his father to run for a second term, partly because of political differences (Ron has long been liberal) and partly because of his concern about Mr. Reagan’s health — not the possibility of Alzheimer’s, but the near-fatal gunshot wound he sustained in a 1981 assassination attempt.

Understandably, the son’s memories about his father’s Alzheimer’s focused on when it first produced symptoms. The anecdotes that he cites are either well known or lack convincing evidence for Alzheimer’s.

For example, he recounts the 1984 re-election campaign, when his father performed dismally as he floundered through his responses and was lost for words in his first debate with his opponent, Walter F. Mondale. But Mr. Reagan performed well in the second debate, 11 days later.

While spending a day in the Oval Office in 1987, the younger Reagan noticed that aides were providing his father with scripted index cards — a technique he often used when giving speeches — for phone calls lasting five minutes at most, implying signs of a failing memory. But in an interview, Mr. Reagan said it was “hard to know what to make of that” — and laughed as he said he was using similar notes in our conversation.

The son noted little things that he could not explain and to which he did not attach a name at the time. Based on knowing his father’s demeanor and cognition over a lifetime, the observations created an impression “that something was amiss.” But, he wrote, he did not want to leave an impression that his “father was catatonic or mumbling incoherently” at any period in the White House.

In his last months, Mr. Reagan held court from a hospital bed in his den, uncomplaining and gently agreeable. By this time he looked younger; his face had lost many of its worry lines and wrinkles. But as he stopped eating and drinking and his kidneys failed, Mr. Reagan lost the decade-long battle with Alzheimer’s and died on June 5, 2004.

Alzheimer’s hereditary patterns are not precisely known. Ron Reagan said he is aware that he is at risk for the disease. But he has not had genetic tests for it, and has not been asked or volunteered to take part in any study of the family history of Alzheimer’s.

Care-To-Go provides home care and caregivers in the Phoenix, Scottsdale, Chandler and Gilbert areas.

As the TSA  airports try to get a handle on quick and efficient scanning at security checkpoints, new machines may not be the answer.

Our Elder Travel Companions from Phoenix and Scottsdale report longer security delays and frazzled nerves at full body scan airports.  Our seniors in wheel chairs are not subject to this screening and will continue to be checked as usual.  The Travel Companion CareGiver can be a great asset in transiting airport security.

By Gary Stoller, USA TODAY

Opposition to new full-body imaging machines to screen passengers and the government’s deployment of them at most major airports is growing.

Many frequent fliers complain they’re time-consuming or invade their privacy. The world’s airlines say they shouldn’t be used for primary security screening. And questions are being raised about possible effects on passengers’ health.

"The system takes three to five times as long as walking through a metal detector," says Phil Bush of Atlanta, one of many fliers on USA TODAY’s Road Warriors panel who oppose the machines. "This looks to be yet another disaster waiting to happen."

BODY SCANNERS: Concerns about privacy and health set off debate

The machines — dubbed by some fliers as virtual strip searches — were installed at many airports in March after a Christmas Day airline bombing attempt. The Transportation Security Administration (TSA) has spent more than $80 million for about 500 machines, including 133 now at airports. It plans to install about 1,000 by the end of next year.

The machines are running into complaints and questions here and overseas:

•The International Air Transport Association, which represents 250 of the world’s airlines, including major U.S. carriers, says the TSA lacks "a strategy and a vision" of how the machines fit into a comprehensive checkpoint security plan. "The TSA is putting the cart before the horse," association spokesman Steve Lott says.

•Security officials in Dubai said this month they wouldn’t use the machines because they violate "personal privacy," and information about their "side effects" on health isn’t known.

•Last month, the European Commission said in a report that "a rigorous scientific assessment" of potential health risks is needed before machines are deployed there. It also said screening methods besides the new machines should be used on pregnant women, babies, children and people with disabilities.

The U.S. Government Accountability Office said in October that the TSA was deploying the machines without fully testing them and assessing whether they could detect "threat items" concealed on various parts of the body. And in March, the office said it "remains unclear" whether they would have detected the explosives that police allege Umar Farouk Abdulmutallab tried to detonate on a jet bound for Detroit on Christmas.

TSA spokeswoman Kristin Lee says the agency completed testing at the end of last year and is "highly confident" in the machines’ detection capability. She also says their use hasn’t slowed screening at airports and that the agency has taken steps to ensure privacy and safety.

The TSA is deploying two types of machines that can see underneath clothing. One uses a high-speed X-ray beam, and the other bounces electromagnetic waves off a passenger’s body.

Passengers can refuse screening by the machines and receive a pat-down search by a security officer, screening by a metal detector, or both, the TSA says.

For more information on an Elder Travel Companion go to CareToGoTravel.com and for Phoenix in home care caregiver see Care-To-Go.com

As the TSA  airports try to get a handle on quick and efficient scanning at security checkpoints, new machines may not be the answer.

Our Elder Travel Companions from Phoenix and Scottsdale report longer security delays and frazzled nerves at full body scan airports.  Our seniors in wheel chairs are not subject to this screening and will continue to be checked as usual.  The Travel Companion CareGiver can be a great asset in transiting airport security.

By Gary Stoller, USA TODAY

Opposition to new full-body imaging machines to screen passengers and the government’s deployment of them at most major airports is growing.

Many frequent fliers complain they’re time-consuming or invade their privacy. The world’s airlines say they shouldn’t be used for primary security screening. And questions are being raised about possible effects on passengers’ health.

"The system takes three to five times as long as walking through a metal detector," says Phil Bush of Atlanta, one of many fliers on USA TODAY’s Road Warriors panel who oppose the machines. "This looks to be yet another disaster waiting to happen."

BODY SCANNERS: Concerns about privacy and health set off debate

The machines — dubbed by some fliers as virtual strip searches — were installed at many airports in March after a Christmas Day airline bombing attempt. The Transportation Security Administration (TSA) has spent more than $80 million for about 500 machines, including 133 now at airports. It plans to install about 1,000 by the end of next year.

The machines are running into complaints and questions here and overseas:

•The International Air Transport Association, which represents 250 of the world’s airlines, including major U.S. carriers, says the TSA lacks "a strategy and a vision" of how the machines fit into a comprehensive checkpoint security plan. "The TSA is putting the cart before the horse," association spokesman Steve Lott says.

•Security officials in Dubai said this month they wouldn’t use the machines because they violate "personal privacy," and information about their "side effects" on health isn’t known.

•Last month, the European Commission said in a report that "a rigorous scientific assessment" of potential health risks is needed before machines are deployed there. It also said screening methods besides the new machines should be used on pregnant women, babies, children and people with disabilities.

The U.S. Government Accountability Office said in October that the TSA was deploying the machines without fully testing them and assessing whether they could detect "threat items" concealed on various parts of the body. And in March, the office said it "remains unclear" whether they would have detected the explosives that police allege Umar Farouk Abdulmutallab tried to detonate on a jet bound for Detroit on Christmas.

TSA spokeswoman Kristin Lee says the agency completed testing at the end of last year and is "highly confident" in the machines’ detection capability. She also says their use hasn’t slowed screening at airports and that the agency has taken steps to ensure privacy and safety.

The TSA is deploying two types of machines that can see underneath clothing. One uses a high-speed X-ray beam, and the other bounces electromagnetic waves off a passenger’s body.

Passengers can refuse screening by the machines and receive a pat-down search by a security officer, screening by a metal detector, or both, the TSA says.

For more information on an Elder Travel Companion go to CareToGoTravel.com and for Phoenix in home care caregiver see Care-To-Go.com

No one likes staying dependent upon others. Seniors don’t embrace the idea of needing others to assist him or her. Freedom and independence can be amid the qualities that a lot of elders treasure the most-and this is why a lot of elders prefer to keep living in their very own homes. Elders don’t want to give up their independent way of life; therefore, the elders are electing to give up moving to elder care centers and assisted living facilities.

Because self-reliance is so critical to the senior, many elders often cringe at the thought of accepting home care help. Elders may believe that they have been handling everything satisfactorily on their own; consequently, elder care isn’t necessary. Rather often, though, the adult children or other family members or friends of the elder could realize that some kind of home care could be essential–possibly the elder doesn’t want to admit it or doesn’t comprehend it. Because the elder’s chief aim is to hold on to her independent life style, it’s important to mention the topic of senior care gently.

It may be better to speak about in home care with the senior on neutral ground with an friend there. Meeting with the elder person at their medical doctor’s appointment for a conversation about the subject may be a good idea for some; some could find it more comfortable to take the senior to lunch with a companion of hers who is in agreement with the plan. Regardless, the focus of the talk should be about keeping the senior at ease with the home care and helping her to make decisions.

Beside what some seniors may think, elder care could truly aid the senior to retain her independence. No, possibly she won’t be completely self-reliant as they were before; on the other hand, they will no longer have to rely on calling public transportation to take her to appointments and shopping trips because their home care aide can drive her. Also, they won’t need to call for take-out food when she does not feel like cooking, because her home care caregiver can prepare a meal for her. Yet she will still maintain her independent life style while she is still living in her own home–not in a elderly facility.

It is truly better for seniors to maintain their independence when they have a hired senior care assistant. Using a caregiver makes it simpler for seniors to complete tasks. This is because the caregiver does or helps with whatever the senior can’t do, while the senior takes care of other activities. Caregivers provide support and services that are tailored specifically to the senior for whom they are giving care; so the senior has the option of choosing what the caregiver does to help her.

Lots of caregivers become friends with the seniors they assist because they spend so much time together. The hired companions really start to become almost like part of the family. The elder will no longer think about any loss of freedom or independence at all,she will simply be content to still be living in her own home, with the assistance of her home care caregiver.

For more information on Home Care in the Phoenix area visit Care-To-Go.com For a

Personal Travel Companion anywhere, contact CareToGoTravel.com

One of the most important ways to help your communication is not to ask "how are you" but also what are you feeling If you think about it, how are you is one of the most common questions we ask, but it can be a rather thoughtless one. The expected answer is OK or good. It does not lead to much discussion. When you ask, "What are you feeling?" you are digging deeper. Someone who is asked that may get the notion that you want to know how they are doing.

When you ask, what are you feeling be ready to hear anything. The person could say he thinks a great deal about death or he is worried about whatever the future has in store for the children. Or perhaps he is fearful that he won’t survive a year. Be ready to pay attention and hear the reaction he tells you. You do not have to have a response, but you have to be ready to hear the pain and anguish that the inquiry may provoke.
Communication with your loved ones must be direct and on an adult level.  The last thing an elder wants with a serious affliction is for you to be condescending or treat them like a kid. Your loved one needs straight talk constantly being empathetic and kind. Here’s a opportunity for caring support from their loved ones and their friends.
Elders with cancer every now and then need to get an opinions of those near to them on their illness, treatment, and treatment outlook. Stay open and honest, but don’t endeavor to respond to questions that you don’t know a good answer to. A senior with cancer will sense your honesty and appreciate it.

While having their illness, the elderly with cancer and serious diseases may express frustration and anger to friends and family. Remember that seniors with serious diseases pass through quite a few stages including denial, negotiation anger, and acceptance. Within the denial and anger stages, their conversation can offend families and their friends, but it can help to bear in mind that elders frequently shift their feelings onto friends and family close to him or her. Your loved ones do this since the people closest to them are safe. They know you will still be there for him or her, even if they act badly or create tension. Often, the senior is really frustrated and angry concerning the illness and the losses it brings, but that is hard to discuss. So they could take out their feelings on family, friends, or anyone else that happens to be near by at the time.

Commonly a high quality caregiver helping in the home can be a bridge for communication among family members.
More help for seniors posts can be found on Care-To-Go.com

Among the most overwhelming physical conditions linked to aging is the loosing of eyesight as a result of conditions like macular degeneration, glaucoma or cataracts.  As this happens it becomes obvious how important eyesight is to the elderly.  In later life seniors spend a lot of time just looking out the window, reading and watching TV.

Here are a few ideas to consider which could reduce the probability of this resulting in  problems at home:

Security In The Home
1.    Eliminate anything the elderly might trip over, such as small coffee tables, games on the floor, small rugs.
2.    Ensure there are clear pathways to and within all rooms.
3.    Paint doors and door trim colors that contrasts with the wall colors, so the doors will stand out more. Do the same thing with stair rails.
4.    Place yellow strips on the edge of steps and also at the beginning and ends of ramps.
5.    Install grab bars for the shower and tub areas.
6.    Ask your loved one and let him or her tell you what kinds of assistance, could be valued.

Patients and Physical Concerns
7.    Try to be as accepting as possible during the adjustment time, because frustration and anger could be forthcoming.
8.    Studies have found that eating big quantities of some carbohydrates that cause blood sugar levels to rise and fall rapidly may have a better probability of developing some vision reduction when they age. Some examples of these foods are: white bread, white rice, potatoes, pasta, sugars and corn syrup.
9.    Encourage your senior to get together with a support group, where other seniors in an identical situation share their feelings about and strategies to cope with the loss of vision.
10.    Encourage your loved one to take part in eyesight treatment services, then accompany her or him to several. This will teach you what your senior can do independently, enabling you to support his or her successes.
11.    Encourage your loved one to get help from someone trained in vision issues, either individually or in groups.
12.    A lot of people with eyesight reduction are told to discontinue smoking, because smoking will double their chance of having macular degeneration, one of the main causes of vision loss in the elderly. Support your loved one to get help to stop smoking.

More help for seniors tips and articles are available at Care-To-Go.com   Home Care CareGivers in the Phoenix area are available for Senior assistance