A Conversation with Dr. Saadia Ishaq Husain
A Conversation with Dr. Saadia Ishaq Husain on caring for elders.
Can you tell us a bit about your clinical practice?
I work as Medical Director and Attending Physician, Geriatrician at Crescent Cities Center, a skilled nursing and Long Term Care facility. This facility is part of Genesis Physician Services. Assessment and management of Geriatric syndromes is one of my areas of clinical interest.
What are some of the unique medical issues you find caring for elders?
Geriatric syndromes like fraility, polypharmacy , mood disorders, fall risk are common in this population.
How about family issues in elder care – what have you seen are common struggles?
There are different kinds of struggles when it comes to family. Some families are very close and wish to take care of their loved ones at home but lack resources. Other times, they have resources but prefer for their relative to move to a long term care setting for closer medical monitoring.
As our parents age, many of us wonder about the early signs and detection of dementia/Alzheimer’s – what are some early warning signs and what are the first steps we should take if we see those?
Early signs in functional elderly are subtle. They are able to, until some point, cover their forgetfulness by other activities that they can still do. We may see them sometimes writing an incorrect check, leaving the stove on, forgetting names, numbers, forgetting or driving directions to a familiar place.
Do seniors have different sleep/wake patterns, and how much sleep should those over the age of 65 get, on average?
Normal aging as well as dementia are associated with major physiologic changes in sleep. Changes can be seen in total sleep time as well as time spent awake after falling asleep. Difficulty with sleep initiation and sleep continuity are most commonchanges . Total sleep time decreases by average of 30 minutes per decade starting in midlife.
What options / resources are there for assistance with caring for elders at home, given our busy lives? Can you also speak to the financial aspects of what insurance may provide coverage for, and what families may have to finance themselves?
It depends on their needs. If they are skilled needs like home IV, wound care, dressing change ,therapy, they are paid by Medicare for nurse or therapist visits at home. However, if we need assistance with Activities of Daily Living like bathing, dressing, toileting, grooming, feeding and transferring, there are home care agencies that provide Home Health Aids who are privately paid on an hourly basis in a common scenario. Typically this is not paid for by Medicare. Social workers work closely with Home Health Agencies to provide families with the aid they need.
Nursing homes have traditionally been a cultural contradiction in our immigrant community. Is that changing, and have you seen more culturally sensitive centers for those who lack the ability to care for their elder family member at home? What questions should one ask about a nursing facility or home when searching?
With ongoing CMS regulations and changes for improvement, I think overall Nursing Home quality is moving in the positive and right direction. However, for immigrant communities, it can still be a cultural shock. The language barrier is first. At this age we prefer people to communicate in our mother tongue. Activities like going out for dinner, playing bingo, going out for movies, music night, etc. may not be something elderly from a different cultural background look forward to.
This area is something that needs a lot of work. I would ask about the daily schedule and flexibility in the schedule, food options, visiting hours, availability of a translator on phone or otherwise, if patient needs one. Also one should inquire about accommodation of patient’s cultural needs, religious activities like praying and celebrating their special occasions etc.
I’ve heard that illness in elderly patients can present in subtle ways, different than younger patients. What are a few “warning symptoms” for families to be tuned in to for early detection of serious health concerns?
Anything different than their normal routine. Missing meals, feeling tired, not hungry, falling or gait changes, low moods , low grade temperature (not necessarily having fevers)… Patients with severe UTI or sepsis may present with generalized weakness as the only symptom. Patient with pneumonia may present with loss of appetite and low grade temperatures and no cough. Stroke can present with acute confusion or a fall.
What do you advise families to help care for the emotional needs of elders? Many seniors seem to fall into a bit of depression or agitation following the loss of spouse or friends, or as their ability to function independently decreases, for example.
I tell them that the presence of loved ones around the elderly is the most effective medication. Families can take turns to be there for them or visit them. Assist them with their meals and basic needs. Identify early if extra help is needed.
How about advice for children caring for aging parents – certain legal considerations they should look into, and also how to manage the stress of the caregiver role?
Again taking turns and getting extra help is important. Caregivers should not feel exhausted on a day to day basis. If a caregiver is always tired, something is not right and needs to change. Caregivers should not feel guilty or bad expressing their concern of work load to social workers, other family or PCP.
How important is establishing a daily routine/pattern for elders? How about exercise?
Daily routine is important in all ages but crucial in the geriatric population. At the same time we cannot be very rigid if a person is not up to it on a certain day. It is important to do some exercise as a routine for mental, psychological as well as physical wellbeing. Some nursing homes have exercise routines for elderly based on their capacity.
How would you advise helping seniors balance a sense of independence while also maintaining safety? (For example, when it may not be safe to drive alone, etc.)
There is no easy answer to that. Taking away your driving license is taking away all your independence. That is how they feel. It needs a lot of education and reinforcement and replacing that activity with something enjoyable is important. It is a team effort and the decision should be made in collaboration with families and a plan of care should include alternatives.
What is the most rewarding aspect of your job caring for elders, and what would you advise others in regard to this special generation?
I lost both my parents. I have a special place in my heart for elderly patients. Every parent, every elderly person, has the right to be cared for and loved in this time of their lives more than ever before. It is very rewarding when they hug me and feel loved and cared for. Sitting by their bed and holding their hands and listening to them makes my day and theirs too. My advice is that if we get the opportunity to take care of elders, be mindful of their needs as they may not express them like other people. They need company and should not feel lonely. They should be taken care of as a whole person rather than as a list of medical problems.
The 5 Most Common Questions About Alzheimer’s Disease
1. What is the difference between dementia and Alzheimer’s disease?
“Dementia” and “Alzheimer’s disease” are often used interchangeably, but they are different. “Dementia” is an umbrella term for a variety of diseases and conditions that develop when nerve cells in the brain no longer function properly. Symptoms of dementia include changes in one’s behavior or judgment, memory, and ability to plan activities and finish tasks.
Alzheimer’s disease is the most common type of dementia, at 60-80%. With Alzheimer’s disease, changes in the brain eventually affect basic bodily functions such as walking and swallowing.
There are over 100 types of dementia. After Alzheimer’s disease, the most common form is vascular dementia from tiny, almost imperceptible strokes, at up to 20%.
Some researchers believe that up to 45% of dementias are “mixed dementia”—Alzheimer’s disease plus another dementia.
Other types of dementia include dementia from Parkinson’s disease, Frontotemporal dementia, and Lewy Body dementia. “Early onset” (or “Familial” Alzheimer’s disease) occurs before age 60, and comprises 5-7% of Alzheimer’s disease cases.
2. Is there a test to diagnose Alzheimer’s disease?
No tests exist to confirm a diagnosis of Alzheimer’s disease. However, doctors can diagnose “probable Alzheimer’s disease” with 90% accuracy with neuropsychological testing and by ruling out other causes of memory problems and cognitive decline. A medical history can rule out depression; lab work can rule out urinary infection, thyroid dysfunction, and vitamin deficiencies; and a CT scan and MRI can rule out strokes, trauma and tumors.
A new PET scan is available in some memory care clinics, in which an intravenous injection of florbetapir, a radioactive drug approved by the Food and Drug Administration in April 2012, binds to amyloid plaques, a protein most researchers think plays a role in Alzheimer’s disease. Amyloid PET scans show plaques on 96% of people with severe Alzheimer’s disease and two-thirds of those with mild cognitive impairment. Researchers caution that one-third of people aged 65 and over exhibiting normal cognition also show amyloid plaques on these PET scans—and they may never develop Alzheimer’s disease. That’s a large false-positive rate. And at this time, Medicare does not cover the test, which costs several thousand dollars.
3. If there is no cure for Alzheimer’s, why is early diagnosis a good idea?
If you suspect that you or a loved one are showing signs of cognitive decline, there are a number of reasons why early detection and diagnosis are important:
The cognitive decline may be caused by something treatable, such as depression or a vitamin B12 deficiency, and early diagnosis prevents further decline.
It’s important to discuss the diagnosis with family members and begin the search for appropriate support services. Such a discussion reduces anxiety by naming the problem.
Medication and other approaches may be used to manage symptoms.
Early diagnosis gives people the option of joining clinical trials.
It allows more awareness of how some combinations of medications make symptoms worse. It alerts doctors and family members to the possibility that the person may need assistance with daily tasks such as cooking and managing medications.
It may reduce falls and other accidents because caregivers are more aware of the dangers.
It allows an awareness of financial problems such as the person giving money to scams.
It allows the person with dementia and their family members to plan for the future.
It’s important to note that under the Affordable Care Act, anyone with Medicare Part B is eligible for an annual wellness visit that includes a cognitive assessment, an evaluation of risk factors for diseases such as Alzheimer’s, and recommendations for referrals to programs to help reduce those risk factors (such as seeing a nutritionist or joining a smoking cessation program). This annual visit is fully covered with no deductible, co-insurance, or co-payment.
4. Is Alzheimer’s hereditary?
In Familial (early-onset) Alzheimer’s (5-7% of Alzheimer’s cases), gene mutations cause a cascade of effects in the brain leading to increased amyloid, a protein that many researchers believe plays a role in the development of Alzheimer’s disease. If one parent carries the mutated gene, the child has a 50% chance of developing the disease; if both parents carry the gene, the risk increases to 75% percent.
In Alzheimer’s disease over age sixty, there is something called a “risk factor” gene—APOE ε4 allele. This gene increases your risk somewhat if you inherit it from your parents. According to the National Institute on Aging, “Some people with one or two APOEε4 alleles never get the disease, and others who develop Alzheimer’s do not have any APOEε4 alleles.” For that reason a blood test for the allele is not recommended for people at risk for Alzheimer’s disease.
Some studies suggest that you are more likely to develop Alzheimer’s disease if your mother had it.
5. Is there any way I can reduce my risk of developing dementia?
There are no proven ways to prevent Alzheimer’s disease, the most common type of dementia. Take heart, however. Research suggests many ways you may be able to reduce your risk.
Some researchers say that exercise may be our most powerful antidote for dementia. The Alzheimer’s Association recommends 30 minutes of daily exercise. A study by neurologists at Rush University Medical Center shows that daily activity of all kinds—from formal exercise to activities such as washing dishes, cleaning, and cooking—may reduce the risk of developing Alzheimer’s disease, even in people over age 80. In another study, subjects who walked forty minutes a day for a year regained volume in their hippocampus, reversing brain shrinkage. In a third study, people with mild cognitive impairment who did resistance weight training two times a week over six months showed an increase in their memory and executive function (the ability to multi-task).
If you can, try to avoid the most common risk factors for Alzheimers. In addition to factors you can’t control, such as a family history of Alzheimer’s, these risk factors include serious head trauma; poor cardiovascular health; high blood pressure; stroke; diabetes; high cholesterol; obesity in middle age; and smoking. To that list I’d add two lesser-known risk factors: sleep apnea and high blood sugar levels. Both sleep apnea and pre-diabetes (blood sugar levels that are normal but high) are woefully under-diagnosed, so if you suspect that you have either, please get tested. Both conditions affect the health of your brain.
As far as diet is concerned, there is little agreement on what exactly will help prevent dementia, though doctors say that what is good for the body is good for the brain. And no dietary supplements have been proven to reduce the risk of dementia, though there is anecdotal evidence that coconut oil may be helpful.
Social activity and mental stimulation are crucial. Combining social activity and mental stimulation with regular exercise is more effective than doing only one or the other. Sports, cultural activities, emotional support, and close personal relationships are all key.