A simple blood test can check for Alzheimer’s disease before symptoms emerge

Alzheimer’s disease is becoming more prevalent among aging Americans, and there are more aging Americans than ever before. Alzheimer’s disease has three typical biomarkers: plaques of beta-amyloid protein, tangles of tau protein, and loss of connections in the synapses that communicate information between brain cells. Now a simple blood test may be able to detect early signs of Alzheimer’s years before any symptoms, like memory and thinking decline, become apparent. The test involves the identification of changes in levels of NfL a neurofilament light chain protein found in the brain. This protein is part of the internal skeleton and resides inside neurons and brain cells, but when damaged or dying NfL leaks into the cerebrospinal fluid (CSF), it becomes circulated into the bloodstream.  CSF provides essential mechanical and immunological protection to the brain inside of the skull.

Prior testing to determine elevated levels of NfL in the cerebrospinal fluid involved a lumbar puncture or a spinal tap which is a procedure many people are reluctant to undergo. Still, this raised level of NfL is a reliable indicator that brain damage has occurred and that the person is at an elevated risk of Alzheimer’s presymptomatic stages. Testing of NfL “…could be,” says co-first study author Stephanie A. Schultz, who is a graduate student at Washington University, “a good preclinical biomarker to identify those who will go on to develop clinical symptoms.”

Recent data from the National Institute on Aging Alzheimer’s disease fact sheet estimates Alzheimer’s may rank as the third leading cause of death for older people following heart disease and cancer. It is also the most common form of dementia among seniors aged 65 or more. A simple blood test can detect the future state of you and Alzheimer’s but do you want to know? Currently, there is no cure for the disease, and depending on the levels of optimism an individual displays, knowing their NfL status could be a blessing or a curse.

The blood test gives pre-diagnosis years ahead of the onset of symptoms. There is a percentage of seniors who would find this information disheartening and feel burdensome and full of worry for what is about to come. These individuals can receive protection from knowing at their request if the information would make them fearful and angst-ridden. Other seniors might want to have a pre-diagnosis to relish the time that they have left with full faculties. They may want to get their affairs in order, handling day to day living choices and extension of life choices when they are no longer mentally competent to do so. Many components divide the two camps of thought; wanting or not wanting to know. Family structure, faith, financial independence, education level, and general health and well being typically play a factor in the decision.

What of the family who may want or may need to know of the future advent of Alzheimer’s to plan for the care of their spouse or parent? As a spouse and as a child, it is crucial that medical directives be in place for when their loved one can no longer make a sound decision but can be comforted by the fact that they participated in the planning years before. A spouse must prepare when their loved one enters a full-time care facility they may no longer recall their marriage and their spouse and unknowingly, may strike up a “relationship” with another resident. Retired Supreme Court Justice Sandra Day O’Connor encountered this with her husband and famously became involved in raising awareness of Alzheimer’s disease. Subsequently, she was diagnosed with Alzheimer’s disease in 2018 and retired from public life.

Outside of the emotional realm of not having an Alzheimer’s stricken spouse or parent recognize who you are there is a substantial financial component to caring for individuals with Alzheimer’s. For practical and economic reasons, a family should be able to establish the biomarker for a loved one’s likelihood to develop the disease through this simple blood test. To that end, health information is private and protected by law. To ascertain your spouse or parents’ risk of Alzheimer’s requires conversation, acceptance of the blood test, and careful planning with elder counsel for proper legal documentation.

Contact our office today and schedule an appointment to discuss how we can help you with your planning.

Health and Financial Questions to Understand Before Turning 65

In the United States, turning 65 years of age is a milestone on many levels, but before this birthday, there is a hefty checklist that you need to address to continue aging successfully. Overall the most crucial thing to do before turning 65 is to invest your time wisely crafting the best approach possible for your health and financial security well-being. 

Can you afford to retire? Are you married? Estimate your total annual spending, including a cushion for periodic or unforeseen expenses like home repairs or dental work. Total all of your potential retirement-income sources and understand the tax implications associated with their spending. Run through several scenarios where you change what year you claim social security benefits to see if you should defer collecting it to a later age. Be realistic and start adhering to a modest budget today. Very few Americans can withdraw a lot from personal savings and investments without risking running out of money too soon. As you start to gather your assessments in general about how you view your retirement, find a qualified retirement planning expert that can help you with projections that are based on realistic assumptions.

Familiarize yourself with Medicare and its associated program variations. If you are retiring, you will approach Medicare differently than if you continue to work and have health care available through your employer. If you no longer will have health care through an employer, learn about Medigap supplemental insurance policies as Medicare will not cover all of your health care. Health insurance becomes quite complicated and varies widely depending on your overall health and personal financial situation. The National Council on Aging (NCOA), in partnership with private companies Aon Retiree Health Exchange™ and Via Benefits™, provides a checklist and timeline that can guide you through the process of enrolling in Medicare and assessing how you will cover the cost of prescription medication. If your income is low, you may qualify to enroll in Medicaid, which covers more expenses than Medicare. If you have already begun to take your social security benefits, then you will automatically be enrolled in Medicare. A packet entitled “Welcome to Medicare” will be sent to your address three months before turning 65. There are essential actions to take and deadlines associated with this packet, so read through the material carefully and meet those deadlines.

There are resources available to help you understand what your options are and the best way for you to proceed. As you approach the age of 65 many private insurance companies will lobby for your insurance dollars that will be spent on supplemental insurance. Finding a retirement planning company with insurance brokers that can sell you policies from many different insurance companies is more advantageous than locking into a group that will only sell plans that are associated with their company. A reputable insurance broker should not charge for helping you to assess your situation as they make commissions from the insurance company providing the policy to you. Check with the Better Business Bureau (BBB) online where you can plug in the name of an insurance group or retirement counselor and find out how long they have been in business, their accreditation, BBB rating, and customer reviews and complaints.

If you are over the age of 50, you can contribute an extra 1,000 dollars annually to your IRAs and an additional 6,000 dollars to 401(k)s up until the age of 65, according to Kiplinger. If you are still working, this is an excellent way to boost your retirement spending money. Before 65, you need to explore the option of a long-term care insurance policy, which helps to pay for any assisted living care needs you may require in the future. Long-term care policies can be expensive. If you do not enroll in a long-term care plan before the age of 65, the policies will become practically unaffordable.

Before turning 65, you should also come to terms with your will, advance medical directives, trusts, and the difficult conversation with your spouse or children about your end of life wishes and any funeral arrangements. Take heart, turning 65 is far from a death sentence as many Americans are living long and active lives well beyond the age of 65; however, meeting with an elder counsel attorney can save you and your heirs’ plenty of money and heartache. Do not wait until an adverse medical event forces your family or loved on to act on your behalf financially or medically. Decisions made under duress do not provide the best outcomes. Beyond your will, power of attorney and power of medical attorney, consider a dementia directive as well. Projections for the aging US population indicate an ever-increasing number of seniors who have Alzheimer’s and other forms of dementia. Your elder counsel attorney can guide you through your options. Some states even have working templates for dementia directives. As you age, you can review your legal strategies from time to time and make adjustments as you deem necessary. It isn’t easy to discuss your end of life scenario, but once you have had the discussions and put proper legal documents into place, you can move forward with a sense of relief. It is freeing to make decisions and act on your future behalf, knowing you can always revisit your choices.

Now for the fun stuff; get excited about the senior discount. While it is true that there are discounts available as early as 55 and 62, nothing beats the senior discount at age 65. You can check off that bucket list of yours with deals on restaurant meals and travel excursions, clubs, retail stores, hotels, cinemas, smartphone plans, AARP membership discounts, and more. If you do not see an offering for a 65 senior discount posted, by all means, ask.

Beyond Medicare eligibility, you can get a onetime free physical exam if you have Medicare Part B insurance coverage. Gyms and community programs offer discounted or free physical fitness programs so that you can keep yourself moving and as healthy as possible. If you have Medicare, check out your eligibility for SilverSneakers for a 65+ fitness program. Your local senior center can keep you socially active and connected to people your age. Making friends and enjoying the simple act of conversation is known to have many benefits for your cognition and staves off isolation and depression issues.

If you retire from your job at 65, you can finally begin to collect on your pension plan or 401(k). That in itself is worth a celebration after many decades of hard work. You might also opt to collect your social security benefits, but it is generally advisable to wait until you reach full retirement age.

Homestead benefits and property tax exemptions are a considerable benefit for those who already own or plan to own a home or property. Benefits vary by state, so you will need to see what you can qualify for where you live. Your local comptrollers’ office can provide information about offers regarding homestead benefits. For property tax exemptions, you must contact your local comptroller or tax assessor’s office for exemption information.

There is a lot to discover, learn, and know about how to proceed in life at age 65 and beyond. With Social Security benefit determinations, health insurance policies, and legal documents in order, you can begin to enjoy being 65. Start your education about being 65 or more today. Stay vibrant and healthy and enjoy those things you dreamed of doing when you were your younger self.

Holding a Family Caregiving Meeting

A family caregiving meeting is an essential tool when dealing with the care of an aging loved one. These meetings are beneficial for helping to keep all family members abreast of decisions that need to be made, changes in diagnosis or prognosis, and helps to ensure that all family members feel that they have a voice. Family meetings can also help to keep caregiving responsibilities from falling solely on the shoulders of one family member. In addition, family caregiving meetings can foster cooperation among family members and lessen the stress associated with caring for an aging loved one.

Who should attend a family caregiving meeting?

There are a number of people who should be included in a family caregiving meeting. First and foremost, it is important to include the aging loved one in the meeting whenever possible. This helps the aging loved one to feel that they are being heard and that their opinions and thoughts are being considered. If a spouse is living, the spouse should be included, as well as any children and possibly siblings of the aging person. Some families may choose to include other family members, but this really varies from one family to another. Anyone else involved in care for the person should also be there. This could include paid caregivers, family friends, or neighbors. Depending on family dynamics, a facilitator can be helpful in running the meeting.

When should a family have a caregiving meeting?

First it is important to note that family caregiving meetings are not a one and done event. They must occur on a regular basis. The first family meeting can occur before an aging loved one actually needs care. This can give the person who may eventually need care more say in their future care, but often times this does not occur. Most families find that the initial meeting needs to occur when an aging loved when begins to show signs of needing care or when a diagnosis is given that determines care will soon be needed. In addition, meetings should be scheduled regular to discuss changes in diagnosis, prognosis, or general needs of the loved one or the caregivers.

How can a family hold a successful caregiving meeting?

The key to having a successful caregiving meeting is cooperation. This doesn’t mean that family members will agree on everything, but it is important that all family members are respectfully heard and considered. Families must be willing to compromise and seek the best plan for their aging loved one. Additionally, a smoothly run meeting should have an agenda and families should try to stay focused on the items included on the agenda. When holding a meeting, always put things in writing and be sure that all those involved get a copy of the important information and everyone’s responsibilities.

What challenges do families face in caregiving meetings?

One of the biggest challenges to family caregiving meetings is the family’s history. All families have their own dynamics that can cause problems in a caregiving meeting. There may be members of the family who are at odds with one another. This can become an obstacle to having a successful caregiving meeting. The role that each family member plays can be a challenge. Some members may be overbearing and demand control, while others are peacemakers and do not feel free to share their thoughts. Another challenge is that some family members may be in denial of the severity of an aging loved one’s needs. This may make it difficult to get a consensus for care.

Family caregiving meetings are beneficial and necessary when an aging loved one can no longer care for themselves. These meetings can help to divide the responsibilities of caregiving and reduce stress placed on the family members. It is important that families remember that the meetings are for the care of their loved one and cooperate with one another to help the process to run more smoothly and successfully.

If you have any questions about something you have read or would like additional information, please feel free to contact us.

3 Things to Consider When Your Special Needs Child Turns 18

Having a special needs child has many challenges. One of the toughest challenges faced by many parents is knowing how to best care for their special needs child as they reach adulthood. There are many areas that need consideration when planning for the transition of a special needs child to adulthood. Let’s take a look at some of these areas.

Education

During childhood, the public education system provides for the bulk of the care, structure, and services that a special needs child requires. However, once they are out of public education, this support and service abruptly come to an end. If parents don’t plan for this transition, it can be difficult for the child and the family. That is why the Individuals with Disabilities Education Act (IDEA) requires that at age 14, the student’s Individualized Education Plan (IEP) contain a plan with steps that will be taken to help the special needs student acquire skills that are necessary to transition from school to the workforce. Schools are required to monitor progress of the students as they acquire the specific skills. It is important for parents to understand their child’s rights and for parents of children with special needs to be advocates for their child as they turn 14 and enter this time of transition.

Employment

Special needs individuals if trained in skills specific to the workforce can find ways to have a job. For example, the local Walmart hired a young lady who has special needs to work as a cashier. The young lady while in school had an IEP. From the time the young lady was in elementary school, part of her IEP include life skills goals. These goals allowed her to learn necessary skills to get and keep a job as a cashier.

Beyond preparing your child early for the workforce, it is helpful to research companies that hire people with special needs and determine the types of skills they will need to succeed. Then, parents or other caregivers, should seek out ways to develop those necessary skills in their child. The key to employment is being prepared to help your child both during and after school. Be patient with the process. Sometimes it takes time for a special needs adult to get hired. Many special needs people do not work because they are scared that they may lose benefits if they work.

Financial

Working can be a great way for special needs adults to earn some additional income. However, it is important to keep in mind that there are limits on the amount of money a special needs person can earn without affecting Social Security Insurance (SSI) and Social Security Disability Insurance (SSDI). Once a child reaches 18, these benefits are based on his or her own assets. Other ways to protect the assets of your special needs child is by creating a first or third-party trust. This way, your special needs child can draw benefits while also having assets.

If you are the parent of a special needs child, it is important to begin planning early for the future of your child. Don’t wait until your child is 18. The public education system can be a great resource but you will need to do some planning on your own. The good news is there are organizations that can help you and your child find the right employment opportunities to match their skills. An elder law attorney who specializes in adults with special needs can be very helpful in planning for the financial future of your child with special needs.

If you have any questions about something you have read or would like additional information, please feel free to contact us.

Seniors and Drug Abuse

Many seniors are from a generation that, on the whole, still scorn drug abuse and stigmatize those people who engage in such activities. However, as the baby boomer numbers increase in senior living environments, they bring with them a more freewheeling attitude about drug use and misuse rooted in the culture of the 1960s and onward. Many of the senior baby boomers have experienced illegal drugs first hand, and because of a sense of nostalgia, their views may be more tolerant to the overuse or abuse of drugs.

The opioid epidemic in America is now firmly rooted in the senior population. Statistics indicate that opioid addiction has been growing as fast or even faster among seniors compared to other age groups. The National Institute on Drug Abuse (NIDA) estimates 115 Americans die every day from overdosing on opioids and according to 2014 report by the government Agency for Healthcare Research and Quality, the rate of hospitalization for opioid overuse among those people 65 and older has increased over five-fold since 1993, and continues to worsen.

The crisis has grown mainly from doctors prescribing opioids like OxyContin much more frequently beginning in the mid-1990s under guidelines and assurances from pharmaceutical companies that opioid pain relievers were not as addictive as previously reported. However, this opioid class of drug is highly addictive, and many patients prescribed the medication end up abusing their prescriptions. Based on controversial research in 2009, the American Geriatric Society (AGS) announced that they were in favor of prescribing opioids, asking doctors to consider opioids for any senior with moderate or severe pain. Since seniors often have multiple chronic pain conditions, it is easy to see how addiction rates can skyrocket among the senior population. But, it is more than just opioids.

According to the Drug and Alcohol Dependence Journal, of the 63% of senior study participants who had an alcoholic drink over the course of one month, 13% had engaged in binge drinking, which is defined as having five or more drinks in a single session of imbibing. Bars and pubs are becoming one of the new normal amenities in life plan communities, and it can put seniors at significant risk. Stumbling and falling after having too much to drink or driving a small golf cart while impaired can have disastrous consequences. There is also a danger of mixing prescription medications with alcohol, which can be fatal.

Beyond opioids and alcohol, there is marijuana. As more and more states legalize medicinal (and recreational) marijuana and provide them in edible forms, more seniors are turning to pot as a painkiller and anti-nausea treatment. Contrary to what many believe it is not harmless, especially in a geriatric patient. The strains of marijuana available are potent and can create confusion, delirium, and even psychotic episodes in seniors and its interactions with legally prescribed medications are often hard to assess.

Professional staff in the aging services industry are trained to look for signs of drug misuse and abuse. The Center for Disease Control (CDC) is now recommending doctors to opt for short-term, fast-acting medications instead of long-lasting drugs and prescriptions.  But seniors who experience multiple, chronic pains may find this means they take more pills as their conditions are usually degenerative.

The best way to solve the problem is through education. As a senior, one should be aware of their medications and the proper doses to take. Encourage each doctor to prescribe the lowest necessary dose and look to alternative options to address pain. Never exceed the recommended dose as prescribed and follow the instructions given by the doctor.  Do not take prescription medication with alcohol. If a senior is having trouble understanding their medications or gets confused with the dosage, encourage them to talk to a trusted family member. Consider drafting a medical power of attorney document that will allow someone the senior trusts to be their advocate for a safe and happy senior life.  Contact our office today and schedule an appointment to discuss how we can help you with your planning.