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.

Unintentional falls among those 65 and older are responsible for more than 18,000 deaths and nearly 450,000 hospitalizations annually in the United States, according to the Centers in Atlanta. Most of these falls are caused by a decline in that complex and multidimensional human skill known as balance.

We all know of someone who “just fell” and broke something, a hip, an arm, an ankle or leg. We usually write it off to just old age, weak muscles, or failing bones. If you ask the senior who fell it was usually someone else’s fault. One lady told me that a cat ran between her legs and tripped her causing an ankle and eye injury.

The debate rages on about calcium and bone density. Did someone fall and break a hip or did the hip just give way and they fell. You can read more about calcium and bone density in our nutrition section at MyNaturalSuppliments.myShaklee.com.

Balance is a function of inner ear sensations transmitted through a series of nerves to the brain and signals sent via more nerves to the muscles of the body. If you sense you are falling, you adjust your torso, legs or arms to maintain in balance.

The old adage of use it or loose it applies here just like most things in life. It does seem to apply more to brain use and muscle use though.

Inactivity in seniors as well as nutritional levels can lead to the loss of use or slowing of brain recognition and nerve transmission, thus the inability to recognize when they are loosing their balance or falling. By the time they realize the need for a readjustment to maintain balance, it is often too late.

In an article by John Hanc of the New York Times the benefits of strength and balance training are explained. Dr. Thurman explains that strength and balance training can reduce the rate of falls by up to about 50 percent.

While most public health agencies recommend 30 minutes a day of cardiovascular exercise and two or three sessions of strength training, there isn’t a recommendation for balance training.

There are a number of good balance exercises to use. The best bet is to go to a gym and use a personal trainer. Many gyms offer low impact stretching and balancing sessions. Gentle yoga would be wonderful for stretching and balance. Those yogis live to 125 you know.

At home one of those big balls to sit on and raise up feet land lets would be a good idea.

Try walking a straight line with both feet hitting the line. Kind of like when the police give a sobriety test on the street. Next try walking the line with arm out to the sides and cross over the line with each step. Put your left foot on the right side of the line and visa versa. This is the model runway walk. Have someone stand behind for safety and stand on one leg with arm out. Just raise one foot up a little. When this becomes easy, reach down and put your palms under the raised foot and balance for 15 to 30 seconds.

Remember safety first. You don’t want to get hurt exercising so you won’t fall. Have someone with you for support.

For assistance in the Phoenix area contact Care-To-Go at 480-284-8611

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Avoiding Prescription Errors

A lot of senior citizens take multiple medications, which may increases the likelihood of prescription mistakes.  Here’s a number of terrific recommendations for elders to lessen the chance  of making an error with their prescriptions:
1.    Check the label when you pick up a medication to confirm that you have the right medicine. Read back the prescription to your doctor and pharmacist.
2.    Keep all prescription in original containers.
3.    Contact your medical professional or pharmacist if you have any questions about dosage.
4.    Be sure to fill your medications at the same pharmacy.
5.    Read the patient information sheet that comes with your medication.
6.    Call the pharmacist immediately if there is a change in the color, size, shape or smell of your medication.
7.    You should not take or share another person’s prescriptions.
8.    If you are in doubt about a medication you are taking, consult your doctor and pharmacist.  Always ask about side effects that you experience or expect.
9.    Construct a list of the medications you are taking and share with your CareGiver and family members. The list ought to include the following information:
- Your full name, social security number and date of birth.  The Pharmacy needs this information if the caregiver is going to refill the medication without the client there.  Social security number and date of birth should be kept on a different sheet of paper to defend against identity theft.
- Medication name (the drugs being taken, both generic and brand)
- The strength (dosage)
- The directions for taking the medication, including frequency and what time of day medication should be taken
- What liquids or foods are being used to take or should be used to take with meds, for example, water, juice, apple sauce etc.
- Allergies to certain medicines and foods
- Pharmacy and health care providers names, addresses, phone number
- Family contact information

10.    When in skilled nursing or a hospital:
- State your name before taking any meds and always show your wrist bracelet for identification. Ask the nurse or doctor to identify each medication by name before you take it.
- Ask your nurse why your medicine has not been given at its customary time during your hospital stay.
If your medication was started in the hospital, watch for new side effects.  If you experience new side effects or your condition is not improving as it should, tell your doctor or nurse.  From time to time prescriptions need to be changed when they are not performing properly.
Be sure to ask the doctor how long a particular prescriptions will be required.  Oft times prescriptions are added in the hospital for a short term problem, but when you leave the hospital for skilled nursing or your home, the prescription remains.  Another doctor may be reluctant to change or stop a prescription from another doctor.
- Remind your physician if you have any allergies to certain prescriptions and food, or if you also have a condition that may possibly affect the use of certain meds.
1.    Tell your doctor if you are taking any dietary supplements or over-the-counter meds.
2.    Make sure your CareGiver has a current medication log listing all prescriptions, Doctor’s name, and Pharmacy.
Make sure to only take prescriptions that you really need and confirm with your doctor why you are taking it, how long you could need it, what side effects to watch for, and that it is not going to conflict with any other meds you are taking.

In the Phoenix area Care-To-Go, an in-home care agency can assist

you with your prescription organization.  Care-To-Go also provides

complete in-home care elder services.  Contact Care-To-Go at 

www.Care-To-Go.com and for an Elder Travel Companion CareToGoTravel.com

What should you if the medical doctor doesn’t listen to you, or not honoring your needs relating to treatment and drug choices, or suggesting medicines or treatments that appear inappropriate for much older patients. Listed here are several examples.
The connection with the medical professional is a vital one and has to be taken seriously.  All to often seniors aren’t receiving adequate care and attention from their medical doctor.  Is the physician too busy and scheduled to tightly, or there just may be a personality mismatch.  In this case don’t be afraid to shop for a different one if you believe you are not receiving the attention and care you deserve.

When the elderly go to their medical professional it truly is a great plan to take along an advocate, a family member or a professional CareGiver.  It will serve you well to have someone else there to make sure you understand everything the medical professional is saying and if you need to get more complete information from the doctor, the advocate can facilitate.  Now and then it is a lot easier for the someone else to ask in depth questions.
By way of example a medical doctor may try to make you feel guilty when you ask to take away a medicine or a procedure from your regimen.  You may have prescriptions from a number of doctors and they may conflict with each other.  Doctors may be hesitant to change or stop a prescription prescribed by another physician.
Sometimes the problem doesn’t lie within your power; what is wrong is that the health professional isn’t listening to you or not taking your loved one’s age or situation into account when making medication and treatment decisions. In many cases, it’s like a bad relationship; communication has broken down and you, your family member or CareGiver aren’t getting what you need.

Here are the 7 indicators it may be time to "break up" with your health professional:
1.    You feel the medical professional blames, ignores, or criticizes you or the person in your care
2.    The health professional doesn’t act in response to your feedback, or becomes unpleasant or defensive
3.    It seems the health professional isn’t taking your pain or other symptoms seriously enough
4.    You discover treatments that can help that the medical doctor hasn’t told you about
5.    The medical doctor doesn’t explain treatment options clearly, resulting in mistakes
6.    The medical professional prescribes medications without comparing to medications prescribed by another doctor.
7.    The physician is reluctant to organize your prescription inventory when it comes from many different other medical doctors.

When you are dissatisfied, your best bet is to change your doctor, and change to one you can work with to provide the best care. Physicians regularly say that if a patient is going to change doctors, they’d appreciate hearing it directly rather than suddenly receiving a sneak request for medical records to be sent to another health professional. However, it’s your prerogative to find a new doctor and ask the staff to fax over the request for records. You’re not obligated to engage in another confrontation.

Either way, you’ll breathe a sigh of relief once you’re dealing with a health professional who listens respectfully, answers your questions, accommodates your requests, takes your symptoms seriously, and works with you to develop a treatment plan you can all feel good about.

In the Phoenix, AZ area Care-To-Go offers Elder Home Care services and can assist you with doctor appointments and prescription organization.  Contact Care-To-Go at 1-800-818-0407 or  Care-To.Go.com    For Elder Travel Companion services see CareToGoTravel.com.

Phoenix Home Care Caregiver Explains 19 Home Safety Tips For Seniors

Most accidents occur in the home and especially for our seniors.  Even though our seniors are in their own home and in familiar surroundings, they have a much higher accident rate than the rest of us. When you couple failing eyesight, poor hearing and decreased judgment and balance, the senior has a more difficult time moving around and staying safe. If you make the changes yourself or use a personal CareGiver, you may be able to avoid a major fall and injury to your parent.

What can you do to protect an elderly loved one from getting hurt?  Here are some steps to follow:

1. Keep outdoor steps and walkways in good condition and clear of debris. Be sure the hand rails are clean and in good condition.
   
2. Illuminate all stairways and hallways and provide light switches at both ends. Brighter lights are better.
   
3. Use nightlights or bedside remote controlled switches. Yeah the clapper works too.
   
4. Provide handrails in hallways and stairways.
   
5. Keep a sturdy nightstand next to the bed so glasses and other personal items are within reach.
   
6. Put felt or soft material over sharp edges and corners of furniture such as nightstands, tables and shelves.
   
7. Tack down the edges of carpets and rugs; remove throw rugs that slide or can be tripped on.
   
8. Keep pathways clear of furniture and other objects.
   
9. Provide handrails in the bathroom (especially near the toilet, at the entrance to the shower and in the shower) and use non-skid strips in the shower and bathtubs.
   
10. Use a shower seat and shower hose for those unable to stand in the shower.
    
11. Avoid using bath oils or lotions in the bathtub or shower.
    
12. Use kitchen appliances with thermostats and timers. The elderly find appliances with signal lights and buzzers easier to use.
    
13. Clearly mark the “off” position on stoves and ranges so a person with diminished eyesight can immediately tell if the element is off. Try some nail polish.
    
14. Set water heater thermostats or faucets so water does not scald the skin.
    
15. Install smoke detectors in the kitchen and throughout the rest of the house.
    
16. Keep a fire extinguisher handy and know how to use it.
    
17. Arrange frequently used kitchen items in an easy-to-reach cabinet.
    
18. Install one good lock that can be opened easily from the inside.
19. Keep loose magazines and mail off the floor, seniors tend to accumulate mail clutter.

For a complete home assessment contact Care-To-Go at 480-284-8611 and on the web at http://Care-To-Go.com Are you getting to the point where you need someone to help you shoulder the load taking care of Mom? A Home Care CareGiver will be able to assist your senior with household tasks to be sure they are safe and happy.

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