New Help for Dealing With Aggression in People With Dementia

Published

6 months ago

May 28, 2024

admin

Caring for older adults with dementia is stressful, especially when they become physically or verbally aggressive, wander away from home, develop paranoia or hallucinations, engage in inappropriate or repetitive behaviors, or refuse to let caregivers help them.

This story also ran on The Washington Post. It can be republished for free.

Upward of 95% of patients experience these neuropsychiatric symptoms of dementia, which tend to fluctuate over time and vary in intensity. Theyre the primary reasons people with dementia end up in assisted living facilities or nursing homes. At some point, families and friends trying to help at home simply cant manage.

When people think about dementia, they usually think about forgetfulness and memory impairment, said Mary Blazek, director of the geriatric psychiatry clinic at the University of Michigan. But its behavioral and psychological disturbances that are most disruptive to patients and caregivers lives. About ‘Navigating Aging’

Navigating Agingfocuses on medical issues and advice associated with aging and end-of-life care, helping Americas 45 million seniors and their families navigate the health care system.

To contact Judith Graham with a question or comment,click here.Read More Columns

Now, help is available from a first-of-its-kind website created by prominent experts in this field. It offers free training in a comprehensive approach to managing neuropsychiatric symptoms of dementia a method known as DICE based on several decades of scientific research as well as extensive clinical practice.

The websites goal is to give people tools to better manage often-distressing situations, said Helen Kales, chair of the Department of Psychiatry and Behavioral Sciences at UC Davis Health in Sacramento, California, and one of DICEs creators. Users learn that neuropsychiatric symptoms are caused by changes in the brain that increase peoples vulnerability. Nine video modules and two simulations provide comprehensive information and problem-solving techniques.

More than 16 million unpaid caregivers primarily family members and friends help people with dementia live at home. (An estimated 20% of patients live in institutional settings.) The most common form of dementia, Alzheimers disease, affects nearly 7 million Americans 65 and older.

DICE is also designed to help avoid the knee-jerk prescribing of psychoactive medications that have potentially serious side effects, Kales said. Several medical organizations recommend that non-pharmaceutical approaches to troublesome behaviors be tried before drug therapy, but, in practice, this doesnt routinely happen. Email Sign-Up

Subscribe to KFF Health News' free Weekly Edition. Your Email Address Sign Up

Drugs prescribed for dementia include antipsychotic medications, such as Risperidone, which carry a black-box warning noting an increased risk of sooner-than-expected death in elderly patients; anticonvulsants, such as gabapentin, for which use has been on the rise despite concerns about safety; benzodiazepines, such as Ativan, which are associated with an increased risk of falls and, thus, fractures; and Celexa and other such antidepressants that have limited data supporting their effectiveness in easing dementia symptoms.

DICE is a mnemonic a pattern of letters meant to serve as a memory aid that stands for Describe, Investigate, Create, and Evaluate, the four pillars of this approach. At its core is an assumption people with dementia engage in disturbing behaviors for often-unrecognized reasons that can be addressed once they are understood.

Take an example on the website featuring Jennifer, a 55-year-old caregiver for her mother, Betty, 85, whom she tries to bathe daily in the late afternoon. When Betty resists getting into the tub, Jennifer insists, Lets go! I have things to do. Betty responds by smacking her and shouting, Leave me alone. It hurts.

DICE asks caregivers to step back from the heat of the moment and examine issues from three perspectives: the person with dementia, the caregiver, and the environment. All can contribute to distressing situations and all need to be considered in fashioning a response.

Examining the problem by using a who, what, when, how, why prompt can reveal several potential issues: The patient. Betty has arthritis and may experience pain getting in and out of the tub. She may feel tired and overwhelmed in the late afternoon. The caregiver. Jennifer may become easily frustrated when she encounters resistance adopting a scolding and commanding tone rather than breaking down what Betty needs to do in simple steps. The environment. The bathroom tends to be cold, with overly bright lights, tepid bathwater, and no grab bars around the tub.

Some possible solutions discussed on the website: Offer Betty an over-the-counter pain reliever before her bath. Try baths in the morning, not the afternoon. Relax expectations that shell have a daily bath and offer sponge baths several times a week. Install grab bars around the tub, and make sure the water temperature is comfortable. Use a nicely scented soap and play music to help Betty relax. Speak calmly, making simple statements.

These embody strategies shown to improve neuropsychiatric symptoms associated with dementia: recognizing and addressing underlying medical issues such as pain, infections, or delirium; simplifying the tasks a person with dementia is expected to perform; and establishing daily routines that give structure to the day.

Other important steps: Engage the person in activities that are meaningful to them, including social interactions. Reduce clutter and the potential for overstimulation in the environment. Make sure the person is using hearing or vision aids, if needed. Get them outside and exposed to light.

If safety, psychosis, or major depression are urgent concerns, then consider using psychoactive medications after consulting a physician.

Of course, this isnt a comprehensive list of recommendations. Nor is it prescriptive. What works for one person with dementia may not work for another.

Using DICE is an iterative process that involves creativity and frequent evaluation to assess whether strategies are working, Kales said. If not, new interventions should be tried.

Although this is the first time family caregivers can access the DICE toolkit, the program has been available to health care professionals for a while. Notably, all of Wisconsins dementia care specialists have been trained in DICE over the past few years (every county in that state has a specialist who helps families with dementia).

Its a really pragmatic approach thats put together in a very thoughtful fashion, said Art Walaszek, a professor of psychiatry and medicine at the University of Wisconsin School of Medicine and Public Health whos been involved in that effort.

Other dementia training programs are available, some of which review behavioral and psychiatric symptoms in less depth, and they, too, are increasingly available online. Another valuable resource, Best Programs for Caregiving, launched in March, lists evidence-based programs across the country and their availability. Enter a ZIP code to find information that previously hasnt been assembled in one place. This site, too, is very much worth consulting.

Were eager to hear from readers about questions youd like answered, problems youve been having with your care, and advice you need in dealing with the health care system. Visitkffhealthnews.org/columniststo submit your requests or tips.

Judith Graham: khn.navigatingaging@gmail.com, @judith_graham Related Topics Aging Navigating Aging Caregiving Dementia Nursing Homes Contact Us Submit a Story Tip

Entertainment

Sean ‘Diddy’ Combs attempting to obstruct justice from jail, prosecutors say

Published

1 hour ago

November 18, 2024

admin

Sean 'Diddy' Combs attempting to obstruct justice from jail, prosecutors say

Sean “Diddy” Combs has attempted to contact prospective witnesses from jail in a bid to sway public opinion ahead of his upcoming sex trafficking trial, prosecutors have claimed.

The accusations were made in a Manhattan federal court filing in which the prosecution opposes the 55-year-old rapper‘s latest $50m (£39m) bail proposal. A bail hearing is scheduled for next week.

Combs pleaded not guilty to charges that he coerced and abused women for years with the aid of a network of associates and employees, while silencing victims through blackmail and violence, including kidnapping, arson and physical beatings.

He says his sexual relationships were consensual, and strenuously denies all wrongdoing.

In the latest step of the ongoing case, prosecutors say a review of recorded jail calls made by Combs shows he has asked family members to reach out to potential victims and witnesses and has urged them to create “narratives” to influence the jury pool.

They say he has also encouraged marketing strategies to influence public opinion.

The filing said: “The defendant has shown repeatedly – even while in custody – that he will flagrantly and repeatedly flout rules in order to improperly impact the outcome of his case.

“The defendant has shown, in other words, that he cannot be trusted to abide by rules or conditions.”

Prosecutors wrote that it could be inferred from his behaviour that Combs wants to blackmail victims and witnesses into silence or into providing testimony helpful to his defence.

Read more: What is Sean Combs charged with?

It is alleged that Combs began breaking rules almost as soon as he was detained at the Metropolitan Detention Center in Brooklyn, New York City, after his arrest in September.

Two judges have concluded he is a danger to the community and at risk of fleeing, rejecting two previous bail requests.

In Combs’s latest request, his lawyers cited changed circumstances, including new evidence, which they said made it sensible to release him ahead of his trial next year.

But prosecutors said defence lawyers created their latest bail proposal using some evidence prosecutors turned over to them, and the new material was already known to defence lawyers when they made previous bail applications.

In their submission to a judge, prosecutors said Combs’s behaviour in jail shows he must remain locked up.

They cited examples including Combs enlisting family members to plan and carry out a social media campaign around his birthday earlier this month, “with the intention of influencing the potential jury in this criminal proceeding”.

They say he encouraged his seven children to post a video to their social media accounts showing them gathered to celebrate his birthday.

Afterwards, they say he allegedly monitored the analytics, including audience engagement, from inside the jail and “explicitly discussed with his family how to ensure that the video had his desired effect on potential jury members in this case”.

Prosecutors also alleged Combs made clear his intention to anonymously publish information that he thought would help his defence team.

“The defendant’s efforts to obstruct the integrity of this proceeding also includes relentless efforts to contact potential witnesses, including victims of his abuse who could provide powerful testimony against him,” they wrote.

Sky News has contacted Combs’s lawyer for comment.

Combs is currently in custody in Manhattan. His criminal trial is scheduled for 5 May 2025.

Politics

Row over how many farms will be affected by inheritance tax policy – as PM doubles down ahead of farmers protest

Published

1 hour ago

November 18, 2024

admin

Row over how many farms will be affected by inheritance tax policy - as PM doubles down ahead of farmers protest

Sir Keir Starmer has insisted the “vast majority of farmers” will not be affected by changes to Inheritance Tax (IHT) ahead of a protest outside parliament on Tuesday.

It follows Chancellor Rachel Reeves announcing a 20% inheritance tax that will apply to farms worth more than £1m from April 2026, where they were previously exempt.

But the prime minister looked to quell fears as he resisted calls to change course.

Speaking from the G20 summit in Brazil, he said: “If you take a typical case of a couple wanting to pass a family farm down to one of their children, which would be a very typical example, with all of the thresholds in place, that’s £3m before any inheritance tax is paid.”

Politics latest: No 10 insists chancellor has been ‘straight’ about her CV

The comments come as thousands of farmers, including celebrity farmer Jeremy Clarkson, are due to descend on Whitehall on Tuesday to protest the change.

And 1,800 more will take part in a “mass lobby” where members of the National Farmers’ Union (NFU) will meet their MPs in parliament to urge them to ask Ms Reeves to reconsider the policy.

Speaking to broadcasters, Sir Keir insisted the government is supportive of farmers, pointing to a £5bn investment announced for them in the budget.

He said: “I’m confident that the vast majority of farms and farmers will not be affected at all by that aspect of the budget.

“They will be affected by the £5bn that we’re putting into farming. And I’m very happy to work with farmers on that.”

Sir Keir’s spokesman made a similar argument earlier on Monday, saying the government expects 73% of farms to not be affected by the change.

Environment, Farming and Rural Affairs Secretary Steve Reed said only about 500 out of the UK’s 209,000 farms would be affected, according to Treasury calculations.

However, that number has been questioned by several farming groups and the Conservatives.

Government figures ‘misleading’

The NFU said the real number is about two-thirds, with its president Tom Bradshaw calling the government’s figures “misleading” and accusing it of not understanding the sector.

The Country Land and Business Association (CLA) said the policy could affect 70,000 farms.

Conservative shadow farming minister Robbie Moore accused the government last week of “regurgitating” figures that represent “past claimants of agricultural property relief, not combined with business property relief” because he said the Treasury does not have that data.

Agricultural property relief (APR) currently provides farmers 100% relief from paying inheritance tax on agricultural land or pasture used for rearing livestock or fish, and can include woodland and buildings, such as farmhouses, if they are necessary for that land to function.

Farmers can also claim business property relief (BPR), providing 50% or 100% relief on assets used by a trading business, which for farmers could include land, buildings, plant or machinery used by the business, farm shops and holiday cottages.

APR and BPR can often apply to the same asset, especially farmed land, but APR should be the priority, however BPR can be claimed in addition if APR does not cover the full value (e.g. if the land has development value above its agricultural value).

Mr Moore said the Department for the Environment, Farming and Rural Affairs (DEFRA) and the Treasury have disagreed on how many farms will be impacted “by as much as 40%” due to the lack of data on farmers using BPR.

Lib Dem MP Tim Farron said last week1,400 farmers in Cumbria, where he is an MP, will be affected and will not be able to afford to pay the tax as many are on less than the minimum wage despite being asset rich.

Politics

Cabinet split over assisted dying as Education Secretary Bridget Phillipson latest to reveal she will vote against bill

Published

1 hour ago

November 18, 2024

admin

Cabinet split over assisted dying as Education Secretary Bridget Phillipson latest to reveal she will vote against bill

A split is emerging in the cabinet, with Education Secretary Bridget Phillipson revealing she will join several of her colleagues and vote against the bill to legalise assisted dying.

Ms Phillipson told Sky News she will vote against the proposed legislation at the end of this month, which would give terminally ill people with six months to live the option to end their lives.

She voted against assisted dying in 2015 and said: “I haven’t changed my mind.

“I continue to think about this deeply. But my position hasn’t changed since 2015.”

Politics latest: Starmer on Ukraine as he attends Rio G20

MPs will be given a free vote on the bill, so they will not be told how to vote by their party.

The topic has seen a split in the cabinet – however, Prime Minister Sir Keir Starmer has yet to reveal how he will vote on 29 November.

Ms Phillipson joins some other big names who have publicly said they are voting against the bill

These include Deputy PM Angela Rayner, Health Secretary Wes Streeting, Justice Secretary Shabana Mahmood and Business Secretary Jonathan Reynolds.

Border security minister Angela Eagle is also voting against the bill.

Senior cabinet members voting in favour of assisted dying include Energy Secretary Ed Miliband, Science Secretary Peter Kyle, Work and Pensions Secretary Liz Kendall, Culture Secretary Lisa Nandy, Northern Ireland Secretary Hilary Benn, Transport Secretary Louise Haigh and Welsh Secretary Jo Stevens.

The split over the issue is said to be causing friction within government, with Sir Keir rebuking the health secretary for repeatedly saying he is against the bill and for ordering officials to review the costs of implementing any changes in the law.

Sky News’ deputy political editor Sam Coates has been told Morgan McSweeney, the PM’s chief of staff, is concerned about the politics of the bill passing.

He is understood to be worried the issue will dominate the agenda next year and, while he is not taking a view on the bill, he can see it taking over the national conversation and distracting from core government priorities like the economy and borders.

Details of the bill were published last week and include people wanting to end their life having to self-administer the medicine.

It would only be allowed for terminally ill people who have been given six months to live.

Two independent doctors would have to confirm a patient is eligible for assisted dying and a High Court judge would have to give their approval before it could go ahead.