Del Mar Caregiver Resource Center was recognized in this month's newsletter, put together by retired California public employees! To read their newsletter for June, please click here.
We have another New Medicare Fraud Alert for you. This one is from the Centers for Medicare and Medicaid Services (CMS) and is translated into 18 additional languages. Californian beneficiaries have reported a substantial increase in the number of suspicious calls related to the new Medicare cards. This alert is translated into so many languages because our beneficiaries who speak languages other than English are even more at risk for being scammed. Armed with this simple, clear information and 5 helpful tips, our California beneficiaries can avoid being scammed and stay safe.
If you can share these alerts with your residents, clients, colleagues, family members and friends, we greatly appreciate your help in getting the word out to prevent fraud.
To read the alerts in English and 18 other languages, you can visit the California Health Advocates website here: https://cahealthadvocates.org/new-medicare-cards-same-old-scammers/
The Blind and Visually Impaired center invites all people with vision loss over the age of 18 to join our support group. It will take place every 1st and 3rd Friday of the month at 10:00am-2:00pm in Spanish. We meet at The Plaza Bakery, 150 El Camino Real, Greenfield. Please call Karen Levin at 831-649-3505 ex. 104 for more information. The upcoming dates are below:
El Centro para ciegos y visualmente discapacitados le invita a todas las personas mayores de 18 años a unirse- a nuestro grupo de apoyo. Se llevara a cabo cada 1er y 3er viernes del mes de 10:00AM-2:00PM en español. Nos reunimos en el La Plaza Bakery 150 El Camino Real, Greenfield,Ca. Por favor llame a Karen Levin al 831-649-3505 ex.104 para obtener más información.
Worldwide, it is estimated that nearly 47 million people are living with dementia and this number will almost double every 20 years, reaching 75 million in 2030 and 131.5 million in 2050. Individuals with dementia generally require high levels of care, most of which is provided by informal or family caregivers.
To continue reading this article, click HERE
Surgery can cause cognitive losses in some seniors By Judith Graham
Two years ago, Daniel Cole’s 85-year-old father had heart bypass surgery. He hasn’t been quite the same since.
“He forgets things and will ask you the same thing several times,” said Cole, a professor of clinical anesthesiology at UCLA and a past president of the American Society of Anesthesiologists.
“He never got back to his cognitive baseline,” Cole continued, noting that his father was sharp as a tack before the operation. “He’s more like 80 percent.”
His father probably has postoperative cognitive dysfunction (POCD) — a little-known condition that affects a substantial number of older adults after surgery, Cole said.
Some patients with POCD experience memory problems; others have difficulty multitasking, learning new things, following multistep procedures or setting priorities.
“There is no single presentation for POCD. Different patients are affected in different ways,” said Miles Berger, a POCD specialist and assistant professor of anesthesiology at Duke University School of Medicine.
Unlike delirium — an acute, sudden-onset disorder that affects consciousness and attention — POCD can involve subtle, difficult-to-recognize symptoms that develop days to weeks after surgery.
Most of the time, POCD is transient and patients get better in several months. But sometimes — how often hasn’t been determined — this condition lasts up to a year or longer.
Roderic Eckenhoff, vice chair for research and a professor of anesthesiology at the Perelman School of Medicine at the University of Pennsylvania, told of an email he received recently from a 69-year-old man who had read about his research.
“This guy — a very articulate man — said he was the intellectual equal of his wife before a surgery 10 years ago, a significant operation involving general anesthesia. Since then, he’s had difficulty with cognitively demanding tasks at work, such as detailed question-and-answer sessions with his colleagues,” Eckenhoff said. “He noticed these changes immediately after the surgery and claims he did not get better.”
There are many unanswered questions about POCD. How should it best be measured? Is it truly a stand-alone condition or part of a continuum of brain disorders after surgery? Can it be prevented or treated? Can it be distinguished in the long term from the deterioration in cognitive function that can accompany illness and advanced aging?
Some clarity should come in June, when a major paper outlining standard definitions for POCD is set to be published and when scientists will meet at a two-day POCD summit, according to Eckenhoff.
Here’s what scientists know about POCD:
Background. POCD was first studied systematically about 20 years ago. But reports of patients who appeared cognitively compromised after having surgery date back about 100 years, Eckenhoff said.
An influential 1955 report in the Lancet noted common complaints by family or friends after someone dear to them had surgery: “He’s become so forgetful. . . . She’s lost all interest in the family. . . . He can’t concentrate on anything. He’s just not the same person since.”
How to recognize the condition. There is no short, simple test for POCD. Typically, a series of neuropsychological tests are administered before and after surgery — a time-consuming process. Often, tests are given one week and again three months after surgery. But the tests and time frames differ in various studies. Studies also define POCD differently, using varying criteria to assess the kind and extent of cognitive impairment that patients experience.
How common is it? The first international study of older adults with POCD in 1999 suggested that 25.8 percent of patients had this condition one week after a major non-cardiac surgery, such as a hip replacement, while 9.9 percent had it three months after surgery.
Two years later, a study by researchers at Duke University Medical Center found that 53 percent of adults who had heart-bypass surgery showed significant evidence of cognitive decline when they were discharged from the hospital; 36 percent were affected at six weeks; 24 percent, at six months; and 42 percent, five years after their operations.
Another Duke study of older adults who had knee and hip replacements found that 59 percent had cognitive dysfunction immediately after surgery; 34 percent, at three months; and 42 percent, at two years.
Other studies have produced different estimates. A project examining adults 55 and older who have major non-cardiac surgeries is finding that “upwards of 30 percent of patients are testing significantly worse than their baseline 3 months later,” according to its lead researcher, Stacie Deiner of the Icahn School of Medicine at Mount Sinai in New York City.
Vulnerabilities. The risk of experiencing POCD after surgery is enhanced in those who are older, have low levels of education or have cognitive concerns that predate surgery. Adults age 60 and older are twice as likely as are younger adults to develop POCD.
“People who are older, with some unrecognized brain pathology, or people who have some trajectory of cognitive decline at baseline, those are the patients who you’re going to see some change in one, two or three years out,” said Charles Hugh Brown IV, assistant professor of anesthesiology and critical-care medicine at Johns Hopkins Medicine.
Researchers have examined whether the type of anesthetic used during surgery or the depth of anesthesia — the degree to which a patient is put under — affects the risk of developing POCD. So far, results have been inconclusive. Also under investigation are techniques to optimize blood flow to the brain during surgery.
Mechanisms at work. What’s responsible for POCD — the drugs administered during anesthesia or the surgery itself? Currently, the evidence implicates the stress of surgery rather than the anesthesia.
“Most surgery causes peripheral inflammation,” Eckenhoff explained. “In young people, the brain remains largely isolated from that inflammation, but with older people, our blood-brain barrier becomes kind of leaky. That contributes to neuroinflammation, which activates a whole cascade of events in the brain that can accelerate the ongoing aging process.”
At Mount Sinai, Deiner has been administering two-hour-long general anesthesia to healthy seniors who receive cognitive tests and brain scans before and after. Early results show “very good and rapid cognitive recovery in older adults after anesthesia,” Deiner said. The implication is that “the surgery or the medical conditions surrounding surgery” are responsible for subsequent cognitive dysfunction, she noted.
Advice. Many patients are not told of the risk of POCD during the process of informed consent. That should change, several experts advise.
“Beyond question, patients should be informed that the ‘safety step’ of not undergoing surgery is theirs to choose,” wrote Kirk Hogan, a professor of anesthesiology at the University of Wisconsin at Madison School of Medicine and Public Health, in an article published this year. “Each patient must determine if the proposed benefits of a procedure outweigh the foreseeable and material risks of cognitive decline after surgery.”
“Surgery is a good thing — it improves quality of life — and most older patients do really well,” said Brown of Hopkins. “Our trick is to understand who we really need to identify as high-risk and what we can do about modifiable factors.
“If you’re older and suspect you have cognitive issues, it’s important to let your family physician as well as your surgeon and anesthesiologist know that you’re concerned about this and you don’t want to get worse. That should open up a conversation about the goals of surgery, alternatives to surgery and what can be done to optimize your condition before surgery, if that’s what you want to pursue.”
“We want people to know this does happen but not be too concerned because, typically, it does go away,” said Eckenhoff. “That said, don’t try to make cognitively demanding decisions in the first 30 days after an operation. And make sure your caregivers are prepared to help with anything from paying bills and balancing the checkbook to ensuring that you’re caring for yourself adequately and communicating well with your doctor.”
This column was produced by Kaiser Health News. KHN’s coverage of these topics is supported by the Laura and John Arnold Foundation and Gordon and Betty Moore Foundation.
As I approach the end of my twenties, I’ve been pondering how best to prepare for the years ahead and, moreover, how I’ll ensure that my mom will be well taken care of, too. This is an intimidating prospect for me and my almost-75 million millennial peers. While we’re still navigating the art of adulting, how will we take care of our parents?
To continue reading this story, click HERE.
Del Mar Caregiver Resource Center
Helping family caregivers care for their loved ones and themselves.