Newsweek had an article about a new study finding evidence to suggest that Alzheimer’s begins in childhood, with babies younger than a year old displaying signs of the disease. The research emphasized that earlier intervention is necessary to prevent the disease and addressing air pollution may play a key role.

Researchers examined the autopsies of 203 residents of Mexico City and published their findings online in Environmental Research. The bodies ranged in age from 11 months to 40 years old.

The researchers specifically looked at levels of two abnormal proteins associated with Alzheimer’s—hyperphosphorylated tau and beta amyloid. Many of the bodies displayed heightened levels of these two proteins in the brain, even in children less than a year old. Evidence of early signs of Alzheimer’s disease was found in 99.5 percent of the subjects examined.

The study theorized that exposure to air pollution may be behind these heightened abnormal protein levels in young brains. Children exposed to cleaner air performed better in various categories, including cognitive performance, lead study researcher Dr. Lilian Calderón-Garcidueñas, a professor in the department of biomedical and pharmaceutical sciences at the University of Montana, told Newsweek. Calderón-Garcidueñas, who also collaborates with Universidad del Valle de Mexico, compared children by age, gender, socioeconomic status, the IQ of their mother, nutrition and education.

See article about the tragic and preventable death of a long time nursing home resident.  Mark Billiter died as a result of the nursing home’s failure to realize and communicate to police that he was missing from the nursing home.  Billiter suffered from a heart attack-induced dementia which made him confused and wander away from the nursing home.  Police reports  indicate he used the elevator security code and walked out while following another patient’s visitor.  A nursing home staff member ushered them both out, the reports show.The nursing home is required to supervise him to keep him safe.

Billiter had slipped out the care facility where he had lived for years. Billiter had not been reported missing by the time a Canton police officer encountered him hours later.  The police found him but no one informed them he was missing from a nursing home.  They drove him to the city limits. National Weather Service records show the temperature dropped to 32 degrees and was below freezing Monday into Tuesday with a wind chill consistently in the 20s.  He was found dead there two days later.

“This is a person who has obviously lived in a sheltered care facility for three years and is now outside …,” said Tracey Laslo, the family’s attorney. “He lacks cognition to live outside of a nursing facility. This was supposed to be a safe harbor and a place of protection for him.  He was a known risk. That’s the reason he was in a secured unit,” she said.

“If the nursing facility had reported this to the family and to police, this tragic ending would not have happened. The police would’ve been able to secure him and return him, and Mark would’ve been OK at this point. The travesty in this case is the nursing home did not follow (its) own policy. There should’ve been an immediate perimeter check of the facility by the staff, the family should have then been contacted so that they could assist and the police should’ve been contacted.”

Kathryn Price’s blog had an article on the use of anti-psychotics in nursing homes despite the FDA’s black box warnings.  Human Rights Watch, a nonprofit, nongovernmental human rights organization, released a report this year that shows nursing homes are overprescribing antipsychotic drugs to manage the behavior of dementia patients even though anti-psychotic drugs are not FDA approved as treatment for dementia.

The FDA mandates that a black box warning appear on anti-psychotic medications, which cautions that they may lead to an increased risk of death for dementia patients. Additionally, research exists supporting the idea that anti-psychotics can be harmful when used for behavioral reasons alone on dementia patients, including an increased risk of deathfalls, and reduced cognitive functioning.

The federal government does have regulations aimed at preventing this. One such regulation appears in a 2016 revision to the Centers for Medicare & Medicaid Services’ (CMS) regulations for Medicare and Medicaid certified nursing facilities. The regulations state that “Residents who have not used psychotropic drugs are not given these drugs unless the medication is necessary to treat a specific condition as diagnosed and documented in the clinical record.”

According to federal regulations, patients and/or their guardians have a right to understand the purpose of their prescribed medical treatment prior to administering, which is vital to preventing the prescription of unnecessary anti-psychotic drugs.

Despite these regulations, the report maintains that anti-psychotic drugs are still used to treat behavioral concerns in dementia patients due to a lack of enforcement. A 2014 NPR report indicates the penalties that exist for unnecessary prescriptions are rarely used and of the infractions reported only 2 percent were severe enough to warrant a fine.

CMS launched a program in 2012 to combat the improper usage of antipsychotic drugs in nursing homes and by late 2016, CMS announced that it met its goal of reducing the national prevalence of antipsychotic use in long-stay nursing home residents by 30 percent.

 

 

Advance directives are legally recognized documents that specify care if a person is incapacitated. They can confirm that a patient doesn’t want to be resuscitated or kept on mechanical life support, such as a ventilator or feeding tube, if they have a terminal condition from which they’re not likely to recover.

The National Review had an interesting article discussing an NPR story on “aggressive advance directive” that would force nursing homes to starve dementia patients — even if they are willing and able to eat — when they reach a specified stage of cognitive decline. The directive, finalized by the board for End Of Life Choices New York, aims to provide patients a way to hasten death in late-stage dementia, if they choose.

The document offers two options. One option is a request for “comfort feeding” — providing oral food and water if a patient appears to enjoy or allows it during the final stages of the disease. Another alternative would halt all assisted eating and drinking, even if a patient seems willing to accept it.  The options would be invoked only when a patient is diagnosed with moderate or severe dementia, defined as Stages 6 or 7 of a widely used test known as the Functional Assessment Staging Tool (FAST). At those stages, patients would be unable to feed themselves or make health care decisions.

 

The Fresno Bee reported on the nursing home resident of Bella Vista Memory Care Community who contends that he had to have his right eye removed after staff at the nursing home allowed him to be attacked twice by his roommate.  Josh Dansby Jr. is seeking compensation for injuries suffered as a result of the facilities failure to protect him.  The lawsuit says Bella Vista is understaffed and has a history of being issued deficiencies by the California Department of Social Services.

Sierra Meadows Senior Living, LLC runs Bella Vista and has called the lawsuit a “shakedown”.

The lawsuit states that Dansby suffers from Alzheimer’s and dementia and has a history of strokes and heart attacks. Around February 2017 he became a resident of the nursing home.  Bella Vista placed Dansby with a roommate who had a known history of aggressive propensities and physical assault.  In September, the roommate attacked Dansby.

After this assault, Dansby’s family complained to the Bella Vista staff, asking that Dansby be protected from the roommate including moving rooms or changing roommates. Bella Vista refused to make any changes.

Dansby was attacked by his roommate again in December. After the attack, Bella Vista staff did not provide Dansby with care for days. He was later taken to Saint Agnes Medical Center’s emergency room, where he was determined to have suffered a corneal detachment. Doctors removed Dansby’s right eye.

 

 

Newsweek reported that a new study published online in Acta Neuropathologica suggests that eight young adults who developed serious brain plaque buildup may have been “infected” with amyloid proteins via dirty medical instruments during brain surgeries in their youth.

Brain plaque buildup is one of the most recognized characteristics of Alzheimer’s disease, as well as other neurodegenerative diseases, such as Creutzfeldt-Jakob Disease (CJD), also known as “human” mad-cow disease, New Scientist reported. Eight patients in England experienced brain plaque buildup caused by excessive amyloid proteins so severe it caused blood vessels in their brain to burst.

Researchers from University College London reviewed the cases of eight young patients who had experienced cerebral amyloid angiopathy (CAA), a condition where amyloid proteins build up in blood vessels in the brain. Not only are both CAA and Alzheimer’s disease both characterized by brain plaque buildup, but both illnesses are also found in much older patients. All eight patients were under 60-years-old, therefore not yet at risk for brain plaque buildup. In addition, none of the patients were at predisposed genetic risk for this disease, New Scientist reported. Instead, the researchers found these patients shared one salient common factor: brain surgery during adolescence.

Lead researcher Sebastian Brandner, a professor of neuropathology at University City London and his UCL team, hypothesized that the amyloid proteins may have been transferred into the patients’ brains during surgery by hitching a ride on surgical instruments that had not been cleaned well enough, New Scientist reported.

The theory is that medical instruments previously used on Alzheimer’s patients were then used on these young adults. If the tools were not properly cleaned, amyloid proteins from the Alzheimer’s patients could then be transferred to other patients operated on with the same tools.

Brandner told Newsweek that there are no other risk factors that can explain such early onset CAA, and this suggests that transfer of proteins via medical tools is likely why these patients developed the disease so young.

“Brain surgery is so far the most likely cause,” said Brandner. “In theory other routes are thinkable, but we have no evidence.”

This is not the first time researchers have proposed that brain proteins can be transferred from patient to patient via surgery. A 2015 study also led by Brandner also suggested that fragments of sticky amyloid proteins spread among patients through contaminated surgical tools, The Guardian reported.

Brain protein buildup in young people is rare but not completely unheard of. Another study from 2015 suggested that plaque buildup in young people could simply be a sign that the “resource” and “machinery” needed to make these protein clumps already exist in young people.

“The implication appears to be that if we want to prevent these clumps from forming when a person becomes old, we may need to intervene much earlier than we have thought, to try and get rid of amyloid very early in life,” the 2015 study co-author Changiz Geula, a professor at the Northwestern University Feinberg School of Medicine in Chicago who focuses on Alzheimer’s disease, told CBS News.

CNN had a great article on the new Human Rights Watch report, “‘They want docile:’ How Nursing Homes in the United States Overmedicate People with Dementia.”  “Children complained about parents who were robbed of their personalities and turned into zombies. Residents remembered slurring their words and being unable to think or stay awake. Former administrators admitted doling out drugs without having appropriate diagnoses, securing informed consent or divulging risks.”  The under-staffing of nursing homes is a major factor of such over-medication.

The 157-page report estimates that each week more than 179,000 people living in US nursing facilities are given antipsychotic medications, even though they don’t have the approved psychiatric diagnoses — like schizophrenia — to warrant use of the drugs. Most of these residents are older and have dementia, and researchers say the antipsychotic medications are administered as a cost-effective “chemical restraint” to suppress behaviors and ease the load on overwhelmed staff.
What’s revealed in this report echoes the findings of a CNN investigation published in October. The CNN story described how one little red pill, Nuedexta, was being misused and overprescribed in nursing homes. What’s more, CNN learned that this overuse benefited the drugmaker to a tune of hundreds of millions of dollars, largely at the expense of the US government. The CNN report prompted an investigation into a California-based pharmaceutical company.
The Food and Drug Administration has not deemed antipsychotic drugs an effective or safe way to treat symptoms associated with dementia — including dementia-related psychosis, for which there is no approved drug. In fact, the FDA cautions that these drugs pose dangers for elderly patients with dementia, even doubling the risk of death, the report shows. Other possible side effects outlined in the report include an onset of nervous system problems that may cause “severe muscular rigidity” or “jerking movements,” as well as low blood pressure, high blood sugar, blood clots and other problems.
There are plenty of ways to deal with dementia-related symptoms or behaviors that don’t involve pharmaceuticals, the report lays out. Improvements can be achieved through providing activities, reducing loneliness, creating routines, encouraging relationships with familiar staff members, offering exercise and promoting programs like music therapy and pet therapy.
The government has long-recognized the problem of overusing antipsychotic medications and is required to monitor the use of such drugs, the report shows. In fact, in 2012, the Centers for Medicare & Medicaid Services established the National Partnership to Improve Dementia Care in Nursing Homes in acknowledgement of this issue.  “The US government pays nursing homes tens of billions of dollars per year to provide safe and appropriate care for residents,” said Hannah Flamm, a New York University Law fellow at Human Rights Watch. “Officials have a duty to ensure that these often vulnerable people are protected rather than abused.”

USA today reported that Phyllis Campbell, a nursing home resident with dementia and a history of wandering off, was outside in temperatures hovering around zero for about eight hours before staff members noticed she was missing and found her dead from hypothermia, a state investigation found.

The state’s findings say Campbell had wandered into the courtyard twice during the week before she died and that she got out of her room several times that day and said, “I’m going home.”

The woman told a nurse’s aide she was going home.  She went through a door into a courtyard even though she was wearing a monitor that should have set off alarms, the report said.  Tests later showed the sensors did not always work, the state’s report said. Staff members also told investigators the device didn’t always work.

Two aides told investigators they did not do scheduled checks that night even though they were marked as completed, according to the Ohio Department of Health investigation.  She was found in the courtyard about 30 feet from its doors the morning of Jan. 7.

The Star Tribune reported on the tragic and preventable death of Delores Rowan.  Rowan suffocated and died on May 31, according to the Ramsey County medical examiner’s office. The woman’s injuries included fresh bruising on her neck, the autopsy found.  The facility is at fault for allowing Rowan’s head to become trapped between the mattress and the bed’s grab bar.

Langton Place, which is operated by Presbyterian Homes, “had no policy, procedure or system to ensure the proper sizing of mattresses, the fit of the grab bars [or the proper] space between the mattresses and the grab bar device to reduce the risk of entrapment,” according to a state Health Department report released last week.  The report said a nurse saw the resident on her back and asleep about 4 a.m. In a routine check 90 minutes later, the woman was discovered with her head wedged between the mattress and a grab bar. Resuscitation efforts failed.

Her husband, Michael Rowan, said that his wife’s suffocation “wasn’t the only problem we had with that place.”  Langton Place one day ran out of the liquid nutrition she was fed through a tube. He also said she came down with cellulitis, a bacterial skin infection, and needed to be hospitalized. He said he also found caked feces in his wife’s pubic area.

CNN had an article with a video showing a resident assaulting another resident for several minutes before staff intervened.  The video is tough to watch.  The beating, which was first reported by the Gainesville Sun, lasted on and off for nearly 2 minutes. The beating occurred October 3 in a secure unit of Good Samaritan, a 45-bed assisted living facility.  It occurred in a common area of a secured unit within the facility while other residents ate and watched television mere feet away. The video of a resident beating another resident raises new questions about the safety of the elderly in places meant to protect and care for them.

In the video, a 52-year-old resident is seen punching an 86-year-old resident with dementia more than 50 times as the older man lay curled up on the floor. The younger resident accused the older resident of eating his cupcake, according to law enforcement.  At the time the beating took place, there was no staff member attending to residents in the unit, and no one had been assigned to monitor the unit’s video surveillance, according to official reports.
The video was taken by the facility’s closed circuit surveillance system in October and later turned over to the police, who shared it with CNN.
The facility — the Good Samaritan Retirement Home in Williston — had a history of violations, and more sanctions in the past five years than any other assisted living facility in Florida. In December, two administrators were arrested in connection with separate incidents on charges of neglect of the elderly.  One of the facility’s administrators, Nenita Alfonso Sudeall, later broke down and cried as she told police she was “overwhelmed” at the facility, which she said was short-staffed and had poorly trained employees, according to a police report.
The elderly resident was hospitalized with bruising and swelling to his face, as well as hip pain, according to the police report.
Also earlier this year, a CNN report found that the federal government has cited more than 1,000 nursing homes for mishandling or failing to prevent alleged cases of rape, sexual assault and sexual abuse at their facilities between 2013 and 2016.
“There are far too many cases of abuse and neglect happening in nursing homes and assisted living facilities,” said Brian Lee, executive director of Families for Better Care, a national advocacy organization for residents and their families. “We’ve been seeing cases for decades. This one incident in Florida shows how bad the problem can be.”