Services are provided in the Raleigh, Durham, Chapel Hill area of North Carolina (within 15 miles of zip 27701 for standard fees)
FAQ (Frequently Asked Questions)
- How much will Medicare and Supplemental Insurance cover? None, sorry. This is upsetting to me, as well. Our insurance plans would rather wait until an elder has a fall, breaks a hip or arm or leg. They will then spend thousands of dollars on an ambulance, surgery, hospital stay, and rehab rather than spend anything toward prevention! And, the outcome is far worse; as hospitalizations are psychologically and physically taxing to an individual and elders rarely return to their "baseline" once discharged.
- Don't all elders have cognitive decline? No, some slight slowing of information retrieval is often considered 'normal' but not true cognitive decline.
- How do you know what level of cognitive decline is significant? There are standardized 'tests' and measures that help determine the degree of impairment or decline.
- What causes dementia? There is not one cause. Having a family history of dementia increases the incidence. Lifestyle history including diet, nutrition, exercise, other health conditions all seem to play a role.
- What is the best time to intervene? The best time is when an elder has mild-to-moderate cognitive decline. Once the disease progresses into the moderate-to-severe range, it is very difficult to alter the course of the disease. From my professional experience, family members usually minimize the level of impairment and intervene far too late.
- Are there other things that might look like dementia, but are not? Yes, especially closed-head/traumatic brain injuries and some serious infections.
- My elder tells the same stories over and over. That is 'normal' for an elder, right? No, it is not any more normal than it would be for a 35-40 year old to do the same thing.
- What is the difference between "dementia" and Alzheimers? Alzheimers is a sub-type of dementia. Other types include vascular dementia, Lewy-Body Dementia, as well as others.
- Can dementia be stopped, slowed down, or cured? There is no cure for dementia at this time. It cannot be "stopped" but there are some treatments (medical and lifestyle changes) that can slow the progression in some people.
- Aren't there medicines that help with dementia? There are some medicines that are heavily marketed for the treatment of dementia. However, they do not seem to be helpful for MOST individuals. A three-month trial of one of those medicines should be tried if there are no contraindications (all medicines have risks as well as potential benefits). However, if there is no notable improvement in three months, it is likely best to discontinue such use. In the people where these medications ARE helpful, it can SLOW the progression of the disease. If one does not respond positively to the medicine in three months, it is unlikely there will be any benefit from staying on the medicine longer (but there are risks).
- Why is my elder on so many medicines? Great question! Hard to answer. Often, it is because an individual is seeing a Primary Care Doctor in addition to various specialists who do not communicate with one another. Sometimes elders can be on two medicines by two different doctors to treat the same thing, which can be very dangerous (somewhat like taking double medicine, but with different names). Often, when someone gets discharged from the hospital, they continue to take the medicines they "have been taking for years" in addition to the ones started in the hospital. Again, this can be very dangerous and cause unknown duplications. Lastly, doctors sometimes start a patient on a medicine and then fail to re-assess its continuing need. Next, a new medicine is started to treat the side effects of the original medicine which perhaps should have been discontinued. Our doctors are too busy and given too little time to see each patient, so things get missed. Patients and family member are confused by the 'med-speak' and the often similar-sounding medicines with complicated names. Medication errors are a major cause of death, disability, and decline of elders.
- Can you, or someone else, give my elder their medicine so I know they are taking it correctly? No. The only home-based professionals who are allowed to administer medications in NC is an RN (or MD, NP, PA, etc.). However, there are other ways to help reduce the number of medicines, side effects, and complications, upon which I can advise you.
- What is most important to most elders? Most elders want to remain in their home (where they often function best, since it is a familiar environment) and most fear being a burden on others.
- If there were only one tip you would give to an elder and their loved ones, what would it be? NEVER go to the hospital without a close relative or friend accompanying you. This individual needs to stay with you to keep you oriented; and to help share the information the medical professionals need to treat you (such as a good history of who, what, when, where....and what medicines you are taking, as well as any recent changes that could be related to the event that landed one in the hospital). Hospitals are great places when necessary, but they increase your risk of delirium, disorientation, and other illness you would not be exposed to in your home. You want to avoid hospitals if at all possible!