Wednesday, July 14, 2010

Preclinical Alzheimer's ?

An article in the New York Times today reports that medical experts are recommending new guidelines to diagnose Alzheimer's dementia earlier. We're pretty sure the disease starts 10-20 years before people become symptomatic, in fact I was at a seminar yesterday and heard that very statement. But I view this news with trepidation.

The experts propose using MRI scans (expensive), PET scans (even more expensive), and biomarker testing (not even that common, and certainly expensive) to determine if a person "preclinical Alzheimer's". Some of the reasons given for diagnosing earlier is so that the disease can be treated. Except that there aren't any drugs on the market yet that will do that. Aricept and Namenda can only do so much, and as far as I can tell, they might not be effective in this particular instance.

Another reason given is that it will give people the chance to make plans and get their affairs in order. Except most don't do that now. It's rare that we have someone come in and say they've just been diagnosed and they want to do or review their estate planning and talk about when they might need a guardian. Of course I want people to do that, but I don't think many people in their 50's will do that if that faced with a diagnosis of "preclinical Alzheimer's".

I invite you to share your thoughts about this news. Me, I'm going to be chewing on it a while.

Tuesday, July 6, 2010

The Beers List

Just to clarify, I'm not going to talk about Shiner Bock, Rahr Ugly Pug or Corona today.

In my last couple of posts I've talked about some of the negative effects medications can have on older adults. I was pretty unhappy that the nurse at the orthopedic surgeon's office told Mom to take Benadryl, and when we told Mom's geriatrician later in the week, she too was pretty unhappy. In fact, she said she would talk to the surgeon personally.

But like that nurse, I'm sure many of you have never heard of the negative side effects of Benadryl, a common, over the counter medication. One resource available, at least to know which medications have potential negative side effects, is the Beers List (originally published in the Archives of Internal Medicine).

Now, my intent here is not to encourage everyone to go out and question every single prescription prescribed for older adults. Doctors often have to weigh the risks and benefits of a medication. Most people are going to take a strong chemotherapy drug for cancer, despite potentially toxic side effects. The issue is that even common drugs like Benadryl can have really nasty side effects in older adults, that younger people don't have, and too many medical professionals don't know that. So, use the Beers list as a resource, and be sure to talk to your doctor about why a particular medication is prescribed, so you can be an informed consumer.

Monday, July 5, 2010

It's a Rainy Day Today

It's raining this morning. Not really earth shattering news, except that it's almost July in Texas, a time when rain is a scarce commodity.

Something I often talk to the adult children of my clients about is how they can encourage their parents to spend money for care. I talk about how their parents saved all this money "for a rainy day" (see, there is a connection), and yet the parents don't recognize that it's not only raining, but it's a storm out there. But my clients aren't the only ones who don't see the rain.

As professionals, doctors, nurses, social workers and other health care providers have often failed to recognize the storm warnings. Today there is an excellent article in the New York Times  about the need to prepare for more care for older adults. This is something I've talked about before. There just aren't enough health care professionals being trained in the very specific care needs of older adults.

Just as an example, I've been to two doctor's appointments with my mother recently, one to her orthopedic surgeon, and one to her geriatrician. Mom has been having trouble sleeping since her surgery, and the nurse at the surgeon's office told Mom to take Benadryl to help her sleep. After the appointment I told Mom she was not going to take Benadryl because of the potentially negative side effects this medication has in older adults (seizures and hallucinations, to name two). Now, I chose not to argue with the nurse, and I'm sure some will criticize me for missing the teachable moment, but this is a nurse that I had gotten off on the wrong foot with, and I suspected she would not take kindly to my interference.

But this is a perfect example of how someone in a medical practice catering to mostly older adults is not properly trained. Luckily, Mom has me to tell what is OK and not OK, but I'm not a medical person, I just happen to know a little more than some. I wonder sometimes how many like Mom have followed this nurse's advice, and had a bad drug reaction, which might have resulted in a hospitalization.

I guess the moral here is that we all need to find ways to encourage young people to fall in love with the idea of working with older adults, and do what we can to support those who already do. Geriatricians are among the lowest paid doctors out there, yet they are the ones who spend the most time with their patients, and that should be rewarded.