How An Adam Sandler Movie Is Helping Dementia Patients


For 94-year-old Louise Irving, who suffers from dementia, waking up every day to a video with a familiar face and a familiar voice seems to spark a flicker of recognition.

"Good morning, merry sunshine, how did you wake so soon?" Irving's daughter, Tamara Rusoff-Hoen, sings in a video playing from a laptop wheeled to her mother's nursing home bedside.

As the five-minute video plays, with stories of happy memories and get-togethers, Irving beams a bright smile before repeating the traditional family send-off.

"Kiss, kiss ... I love you."

Such prerecorded messages from family members are part of an apparently unique pilot program at the Hebrew Home at Riverdale aimed at helping victims of Alzheimer's disease and other forms of dementia break through the morning fog of forgetfulness that can often cause them agitation and fear.

It's an idea borrowed from an unlikely place: the 2004 Adam Sandler movie "50 First Dates," in which a brain-injured woman played by Drew Barrymore loses her memory every day and a suitor played by Sandler uses videos to remind her about him.


"It was fluff, but it made me think, 'How could that translate to our residents with memory loss?'" says Charlotte Dell, director of social services at the home.

"We're looking to see if we can set a positive tone for the day" without using drugs, she says. "What better way to start the day than to see the face and hear the voice of someone you love wishing you a wonderful morning?"

As in the movie, every day is a new day, and the video becomes part of the morning routine. Relatives who take part are urged to say good morning, use memory-triggering personal anecdotes and remind the residents that attendants will be helping them get dressed and ready for the day.

Alzheimer's disease and other dementias afflict a growing number of Americans as baby boomers age and people live longer. The Alzheimer's Association says more than 5 million Americans have Alzheimer's.

The personal morning video appears to be a new wrinkle in dementia caretaking.

"Memory tools like videos and photos get a lot of use, but to have a couple of minutes with a loved one as a way to start out the day, I haven't heard of anything quite like that," says Ruth Drew, director of family and information services for the association.

Robert Abrams, a geriatric psychiatrist at NewYork-Presbyterian Hospital, called the program "both innovative and thoughtful."

"You've got a group of people with dementia who don't really grasp the nature and purpose of their surroundings or the circumstances that compelled them to be there," Abrams says. "Consequently, they're alone and at sea and feel frightened and even abandoned by family."

Experts caution, however, that Alzheimer's patients vary widely, and techniques that may work beautifully for one might not work for another.

The program at the Hebrew Home is limited to residents in the early and moderate stages of dementia who are likely to recognize the people in the video and understand what they say.

"Do we know for sure that they know, this is my daughter, this is my son? No," Dell says. "But they recognize them as somebody they care about and love."

The program is starting with residents who are known to staff as difficult in the morning and who refuse care, a description that Rusoff-Hoen acknowledges fits her mother.

"Some of her agitation comes from, 'Who the heck are these people? Why am I here?'" she says.

Although Rusoff-Hoen, who lives a couple of hours away in Ghent, visits her mother three days a week, she said the video program helps fill in the gaps. "I am there with my mom, loving her and wishing her a wonderful day and helping her to feel better because there's not a lot I can do for her," Rosoff-Hoen said.

The Hebrew Home plans to evaluate the program after this month and may expand it to more of the several hundred residents in its memory-care "neighborhoods." Dell says anecdotal evidence from the staff is "very positive."

Irving's son-in-law, Mihai Radulescu, also made a video for her. In it, he kids her about being "a delinquent" because she once worked for a bootlegger.

On the recording, he repeatedly reminds Irving, "I know where you are. ... I will always find you," because she has expressed a deep fear of being lost.

Other videos include a woman reminding her mother, in Spanish, to eat and take her medications, then tearing up at the end and saying, "I love you, Mom."

On another video, a man encourages his mother, saying, "You used to tell me that attitude is everything. ... You said that it's best to start off on the sunny side of the street."


The Rising Costs of Elder Care


The steep cost of caring for the elderly continues to climb. The median bill for a private room in a nursing home is now $91,250 a year, according to an industry survey out Thursday.

The annual "Cost of Care" report from Genworth Financial tracks the staggering rise in expenses for long-term care, a growing financial burden for families, governments and insurers like Genworth. The cost of staying in a nursing home has increased 4 percent every year over the last five years, the report says. Last year, the median bill was $87,600.

"Most people don't realize how expensive this care can be until a parent or family member needs it," said Joe Caldwell, director of long-term services at the National Council on Aging. "And then it's a real shock."
The annual report from Genworth, which sells policies to cover long-term care, looks at costs for a variety of services, including adult daycare, and home health aides. And nursing home bills are rising at the fastest pace, twice the rate of U.S. inflation over the last five years. One year in a nursing home now costs nearly as much as three years of tuition at a private college.

For its report, Genworth surveyed 15,000 nursing homes, assisted living facilities and other providers across the country in January and February. It found wide differences from state to state. In Oklahoma, for instance, the median cost for a year in a nursing home came out to $60,225. In Connecticut, it was $158,775. Alaska had the highest costs by far, with one year at $281,415.

So, who pays the nursing-home bill? "A lot of people believe Medicare will step in and cover them, but that's just not true," said Bruce Chernoff, president and CEO of The Scan Foundation, a charitable organization. Medicare will cover some short visits for recovery after a surgery, for instance, but not long-term stays.

Often enough, experts say senior citizens wind up spending their savings until they hit their last $2,000, and at that point they can turn to Medicaid, the government's health insurance for the poor, to help cover the bill. As a result, Medicaid pays for more than half of the country's long-term care bill. That cost accounts for more than a quarter of Medicaid spending, according to the Kaiser Family Foundation.

Genworth and other insurers offer long-term care policies to help people shoulder the financial burden. But people have to be healthy enough to qualify for coverage. Those who take out policies find their insurance bill rises steadily as they age.

Caldwell described Genworth's survey as essentially a marketing pitch. "Of course they want people to see how much it costs to sell long-term care insurance," he said. "What they're not telling you is that the long-term care coverage is becoming more and more unaffordable for middle-class families."

Mounting costs have also pushed many insurance companies out of the business. Four of the five largest providers have either scaled back their business or stopped offering new policies. The largest provider, Genworth, has struggled under the weight of old policies.

Less-intensive care remains much cheaper than staying at a nursing home, according to Genworth's survey. One year in in an assisted-living facility runs $43,200. A year of visits from an agency's home health aides runs $45,760.




ALZHEIMER'S: A Difficult Diagnosis For Patients and Doctors


5.3 million Americans have Alzheimer's disease, an incurable brain condition that causes dementia that worsens over time and eventually leads to death. For patients and their families, Alzheimer's is among the most-feared medical diagnosis.And likewise, for some doctors, informing a patient of an Alzheimer's finding is arguably the most difficult diagnosis to share. 

Diagnosis withheld
According to a March 24 report by the Chicago-based Alzheimer's Association, medical professionals are less likely to tell their patients of a diagnosis of Alzheimer's disease than other chronic illnesses such as cancer, for fear of inflicting emotional distress, The Washington Post reported.

The association's report found that only 45 percent of people with Alzheimer's disease or their caregivers said they learned of the diagnosis from their doctors. In contrast, the report said, 90 percent of patients with the four most common cancers - breast, colorectal, lung and prostate - said they heard the diagnosis from their physicians.The perceived stigma of Alzheimer's disease and the reluctance to create additional stress for patients are common reasons some doctors don't immediately disclose the diagnosis, the report states.

The association's 2015 Facts and Figures report also notes that Alzheimer's patients and their caregivers said that their doctors were more likely to discuss the diagnosis after the disease had become more advanced. 

Not an easy topic

Dr. Lewis E. Winans, senior medical director at Reading Hospital, described Alzheimer's as devastating and difficult to diagnose. Certainly, doctors don't want to make the diagnosis until they are sure, he said.

Talking to patients about Alzheimer's is more difficult than talking about cancer, he said, because there has been so much medical progress in treating various cancers.

"The problem is (with Alzheimer's) there is no treatment to cure it," Winans explained. "There is medicine that slows the progression.

"In the public's perception, Alzheimer's today is where cancer was decades ago, The Washington Post reported, citing a 1961 survey that found that nearly nine of 10 doctors at the time made it a policy not to tell patients they had cancer, fearing that patients would lose hope.

"In our society, we have been dealing with cancer more openly in the last couple decades," explained Dr. Kolin D. Good, chairman of psychiatry at Reading Hospital. "We have cancer walks, and people talk about it on television. Alzheimer's disease has not reached that level. There is still a lot of work being done and a lot of research.

"Good noted that the Academy Award-winning performance by Julianne Moore in the movie "Still Alice," about a Columbia University professor dealing with the early onset of Alzheimer's, has increased public awareness of the disease.

Dr. Lorraine J. Spikol, a neurologist at Lehigh Valley Medical Center, understands well why some physicians and caretakers are hesitant to talk about Alzheimer's with their patients. She sees about 1,000 patients a year referred for the condition."

Some doctors are not always confident that a patient has Alzheimer's," Spikol said. "Family doctors don't always want to tell patients they have Alzheimer's because it is extremely unpleasant. They also don't want to tell people because their lives will change for many years."

There are drugs available that help improve memory, but unfortunately none that can cure the disease, she added. 

Positives of disclosure

According to the Alzheimer's Association, telling a patient the truth about an Alzheimer's diagnosis should be standard practice, and disclosure can be delivered in a supportive manner that avoids unnecessary distress."

Based on the principles of medical ethics, there is widespread agreement among health-care professionals that people have the right to know and understand their diagnosis, including Alzheimer's disease," Dr. William E. Klunk, chairman of the Alzheimer's Association Medical and Scientific Advisory Council, said in a prepared statement. The report's findings "shine a light on the need for more education for medical students and practicing health-care providers on how to effectively make and deliver an Alzheimer's diagnosis," said Klunk, who is also a distinguished professor of psychiatry at the University of Pittsburgh.

The benefits of promptly and clearly explaining a diagnosis include better access to quality medical care and support services, the opportunity for patients to participate in care decisions and to get the maximum benefit from available treatments, the report states.

Recognizing Loneliness and Boredom as Problems for People with Dementia


They’re easy to overlook, but loneliness and boredom are frequent concerns among people with Alzheimer’s disease and other types of dementia. Although their memory might not be perfect, the feelings of people with dementia are very real, and can impact the majority of their day. In fact, the emotions of people with dementia sometimes can last longer than the memory of what caused them. Challenging behaviors can emerge as well, when loneliness and boredom go unchecked.


Loneliness

According to the United Kingdom Alzheimer's Society Dementia 2012 Report, 61% of people with dementia felt lonely, and 77% were depressed or anxious.

A second study conducted by the University of Michigan reported that 60 percent of older adults experience feelings of loneliness, although this study didn’t focus solely on those with dementia. Interestingly, the researchers noted that while family is important, friendships may be even more critical in combating feelings of loneliness.


Boredom

Boredom in Alzheimer's is linked to several other concerns, including depression, anxiety, apathy, wandering, agitation and more. Anecdotal evidence would indicate that the prevalence of boredom for people who have dementia is quite high, although there are few studies that specifically measure boredom.

One physician, Dr. William Thomas, was so convinced that loneliness, helplessness and boredom are plagues for people in long-term care facilities that he founded the Eden Alternative, a philosophy program dedicated to making "life worth living" for older adults.


How Can You and I Help Reduce Loneliness and Boredom for People with Dementia?

Unfortunately, there's not a "One size fits all" answer here. However, you can start with these 6 suggestions:

  • Be mindful of how the person with dementia feels. If he appears lonely, take time to chat with him.
  • Look for ways to capture her attention. If she always perks up when there's a baby nearby, make the extra effort to bring your little one around to see her.
  • Engage him in meaningful activities. In order to do this, you will need to find out who he is as a person, and what his interests have been prior to the development of dementia.
  • Seek out friendships for your patient or loved one. Help her foster a connection with someone with whom she might enjoy talking.
  • Offer an appropriate, caring touch. Give a hug around her shoulders or greet him with a gentle handshake. Much of the physical touch people with dementia receive is related to meeting their physical needs; appropriate touch can communicate that you value them as a person and may reduce feelings of loneliness.
  • Use his name. This conveys respect and provides a reminder that he is important, cared for, and known by name.