Family members or professional caregivers who do everything for older adults with Alzheimer’s disease may just be wanting to help, but one University of Alberta researcher says that creating excess dependency may rob the patients of their independence and self-worth.
U of A psychologist Tiana Rust, who recently completed her doctoral program, says her research indicated that caregivers adopted a “dependency support script,” assuming control of tasks they believed patients seemed no longer capable of doing for themselves.
She says this model shows that the caregivers’ beliefs, rather than the person’s real abilities, drove their interactions with the patients.
Her research also showed that the caregivers’ actions were also seemingly incongruous with their values of wanting to treat patients with respect and promote their independence.
With an aging Canadian population, the number of people suffering from the disease is expected to increase over the next 20 years, she says. Thus, changing behavior becomes critical – and she’s hoping her U-of-A based research will help spark that change.
“When we create this excess dependency that doesn’t need to be there, this is a problem,” said Rust. “1.1 million Canadians are projected to have dementia by 2038. So, if we’re able to maintain and promote independence to the degree permissible by the disease, that’s important.”
Help not necessarily wanted
Rust observed several caregivers and Alzheimer’s patients in an experimental setting where they were asked to prepare a meal together.
What she found was similar to behavior patterns found in other studies with older adults: caregivers would assume responsibility for tasks that they believed patients were incapable of doing on their own.
However, she noted that caregiver actions were not always based on their observations of the patient, but sometimes on their own beliefs.
“The caregivers who believed that people with Alzheimer’s disease in general are more likely to be at risk for injury and are more accepting of help were more likely to be dependence supportive than independence supportive,” said Rust. “This suggests that caregivers are basing their behaviours partially on their beliefs rather than basing their behaviours on the actual needs and the actual abilities of the people that they’re interacting with.”
Help them to help themselves
Rust said that in followup interviews, caregivers noted that they placed importance on treating people with Alzheimer’s disease with respect and promoting their independence.
Yet, she noted that the caregivers’ actions did not always follow these goals or desires. She recounted the story of a lady whose husband suffered from Alzheimer’s disease.
The man attended a day program at a nursing home, where he would take on a number of tasks that his wife had assumed for him at home.
Rust said the woman was surprised that he was still able to perform these tasks as he had not done them in months at home. It’s an example, she says, of gauging the person’s abilities rather than making an assumption about the person’s ability based on societal beliefs related to the disease.
“People with Alzheimer’s disease have varying abilities, so it’s important to base [caregiver] interactions on the actual abilities of the person,” she said. “Observing the person and gauging what they’re capable of before jumping in and supporting the dependence of the person is definitely important.”
Training a critical component for both parties
Rust said that training for caregivers, to provide them with better understanding and proper tools that help them base their interactions with people with Alzheimer’s on the actual abilities of the person, could alleviate the potential for unnecessary intervention that would bring about patient dependence.
Teaching them to observe and assess the person’s actual needs through interaction and observation, rather than what they believe the person needs, is vital in maximizing the person’s independence for as long as possible.
One way, she says, is to assist the person by breaking up tasks such as preparing a meal into smaller, more manageable tasks that they can accomplish using verbal cues.
“The task we had given the caregivers and the residents to do was set the table, make grilled cheese sandwiches, mix juice and clean up afterwards. All of those tasks are quite big in themselves, but they can all be broken up into small activities,” said Rust. “These are all small tasks that these people with Alzheimer’s disease were still capable of doing even though they might not have been able to do the full task.
“It’s a hard role as a caregiver to try to gauge what the person can do, to know what the patient is capable of, how much they can break up these tasks. But these were all things that the caregivers mentioned in the interviews, so they’re definitely wanting to promote the independence of these residents.”
NORTH COAST, Calif. – Adventist Health’s Northern California Network will be transitioning a few administrative functions to a new location in north Santa Rosa near the Sonoma County Airport.
The transition will primarily include revenue cycle departments such as billing, portions of health information management and the pre-admission components of the admission process from the five Northern California Network hospitals in Mendocino, Lake, Napa and Solano counties.
The centralized facility, known as the Revenue Cycle Center, will reduce redundancy between the facilities, decrease the network’s overall cost to collect, improve accuracy, and better position Adventist Health to invest in updating outdated business technologies which will result in efficient, lower-cost services to patients.
The centralizing of these functions will not affect the way in which patients access care, the organization reported.
Services which interact directly with patients will remain located on hospital campuses to ensure a convenient experience.
The transitioning of functions to the Revenue Cycle Center will create new space within the hospital campuses to add or improve patient services without the cost of new facility construction.
The new facility will be home to approximately 120 employees, most of whom will be transferred from their current campus-based positions.
The phased transition is slated to begin in the fourth quarter of 2012 and continue through the first half of 2013.
Northern California Network is part of Adventist Health, a faith-based, not-for-profit integrated health care delivery system serving communities in California, Hawaii, Oregon and Washington.
Our workforce of 28,700 includes more than 21,000 employees; 4,500 medical staff physicians; and 3,000 volunteers. The Adventist Health network includes 19 hospitals, more than 150 clinics (hospital-based, rural health and physician clinics), 14 home care agencies, six hospice agencies and four joint-venture retirement centers.
For more information visit www.sthelenahospitals.org .
Twenty percent of U.S. women (18.7 million) ages 19-64 were uninsured in 2010, up from 15 percent (12.8 million) in 2000, according to a new Commonwealth Fund report on women’s health care.
An additional 16.7 million women were underinsured in 2010, compared with 10.3 million in 2003.
The report estimates that once fully implemented, the Affordable Care Act will cover nearly all women, reducing the uninsured rate among women from 20 percent to 8 percent.
“Women, particularly those in their childbearing years, are uniquely at risk for being unable to afford the care they need, having trouble with medical bills, and having high out-of-pocket costs,” said Commonwealth Fund Vice President and report co-author Sara Collins. “The Affordable Care Act will ensure that U.S. women have affordable, comprehensive health insurance that covers the services they need, including maternity care. And women will no longer have to worry about being denied coverage for a preexisting condition or that they will have to pay higher premiums because of their gender or health.”
In “Oceans Apart: The Higher Health Costs of Women in the U.S. Compared to Other Nations, and How Reform Is Helping,” Commonwealth Fund researchers examine differences in how women fare in the U.S. compared to women in 10 other countries – Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the U.K. – all of which have universal health insurance coverage.
The report finds that while uninsured women in the U.S. were most likely to face problems with medical bills and getting needed health care, even insured U.S. women were more likely to face these problems compared to women in other countries.
Women in the U.S. said they have problems paying medical bills at double the rate of women in any of the other countries. One-fourth (26 percent) of women in the U.S. ages 19 to– 64 had medical bill problems, compared to 13 percent in Australia, 12 percent in France, and 4 percent in Germany.
About two of five (39 percent) women in the U.S. spent $1,000 or more on out-of-pocket medical costs over 2009-2010, compared to one-fourth (24 percent) in Switzerland, 1 percent in Sweden and 0 percent in the U.K.
More than two of five (43 percent) women in the U.S. said that over 2009-2010 they went without recommended care, skipped seeing a doctor when they were sick, or failed to fill prescriptions because of cost, compared to 28 percent in Germany and Australia, 8 percent in the Netherlands, and 7 percent in the U.K.
Half (52 percent) of women in the U.S. said they were confident that they would be able to afford the health care they need if they became seriously ill. In contrast, nearly all women in the U.K. (91 percent) and three-fourths (77 percent) in the Netherlands and Switzerland (76 percent) were confident they could afford needed care.
Uninsured U.S. women struggle most
When looking just at uninsured U.S. women, the report finds even more substantial differences compared to women in other countries: 51 percent of uninsured U.S. women had a problem paying medical bills and 77 percent went without needed health care due to costs, more than double the rates reported by women in other nations.
Within the U.S., there are strong geographic differences when it comes to women’s health insurance, with 30 percent of women in Texas uninsured, compared to only 5 percent of women in Massachusetts, which enacted a universal health insurance law in 2006 that is similar to the Affordable Care Act.
The Affordable Care Act is helping women
According to the report, The Affordable Care Act is already making health insurance and needed health care more affordable and available to women:
Moving forward
According to the report, new subsidized insurance options, including a substantial expansion in eligibility for Medicaid and premium tax credits for people with incomes up to $92,200 for a family of four, will help ensure that nearly all women will have access to affordable, comprehensive health insurance.
Among the five states where more than one quarter of women lacked coverage in 2009-10, uninsured rates are estimated to fall below 14 percent when the Affordable Care Act is fully implemented: in Texas, the uninsured rate is expected to drop from 30.3 percent in 2009-10 to 11.6 percent; in Florida from 26.2 percent to 9.9 percent; in Arkansas from 25.3 percent to 6.8 percent; in New Mexico from 25.3 percent to 13.3 percent; and in Nevada from 25.2 percent to 13.1 percent.
The report finds that women will also benefit from provisions in the law that will prevent insurers from charging women higher premiums because of their gender or health. More affordable reproductive and preventive health care and a strengthening of primary care services will also benefit women.
The report’s authors note that continued implementation of the Affordable Care Act reforms will be essential to ensuring the future affordability of health care for women and households.
“We are on the cusp of a remarkable feat – providing comprehensive, affordable health insurance to almost all American women,” said Commonwealth Fund President Karen Davis. “It is crucial that states actively work to implement the reform law and take full advantage of all the benefits the Affordable Care Act stands to offer to their residents so that all American families are able to benefit from the law’s potential.”
In a recent Journal of Biological Chemistry “Paper of the Week,” research led by Ayae Kinoshita at the Kyoto University Graduate School of Medicine in Japan reveals the benefits of exercise in combating Alzheimer’s disease.
The most common cause of dementia, Alzheimer’s disease results in the loss of cognitive faculty. In the majority of cases, Alzheimer’s disease occurs after age 65, and factors such as diet and exercise appear to play a role in its development, with high-fat diets as a risk factor.
Kinoshita’s research compared the effects of 1) diet control, 2) voluntary exercise and 3) diet control plus exercise in an Alzheimer’s disease mouse model.
The results showed that exercise was more beneficial than diet control in reducing β-amyloid formation (a defining characteristic of Alzheimer’s disease) and restoring memory loss induced by a high-fat diet in these mice.
Moreover, Kinoshita’s team found that the effect of diet control plus exercise was not significantly different than exercise alone.
They attribute the positive effects of exercise to increased degradation of β-amyloid deposits in the brain.
“Based on the results in this research,” Kinoshita suggests, “exercise should be given priority to prevent Alzheimer’s disease.”
From the article: “Exercise is more effective than diet control in preventing high fat diet-induced β-amyloid deposition and memory deficit in amyloid precursor protein transgenic mice.”