Why is Grandma Twice as Likely to have Dementia as Grandpa?

Eight out of every ten of us will have some form of dementia before we die. Here’s another stat that most of us likely don’t know. Two-thirds of the 5.8 million people in the U.S. who have Alzheimer’s disease are women.

By 2050, that number will zoom to nearly 14 million—and 9 million of those will be women. This according to a new report from AARP. “People just don’t think about the fact that women are disproportionately affected by dementia,” says Kristine Yaffe, M.D., professor of psychiatry, neurology and epidemiology at UCSF.

Dementia: Not a disease so much as a group of symptoms

Dementia’s symptoms show a decline in memory and social abilities so that they interfere with the ability to function on a daily basis. Alzheimer’s disease is the most common cause of dementia. But there are other forms of dementia. Women shoulder a wildly disproportionate burden in every single one of these diseases, robbing them of independence, memories, and in many cases, their self-identity.

• Women’s lifetime risk of developing Alzheimer’s disease is twice that of men’s.
• They are more likely to be caregivers for loved ones with dementia, which takes a toll on their own financial, physical and mental wellbeing.
• Women make up more than 60% of dementia caregivers.

Why are women at greater risk for dementia? 

Experts assumed it was a consequence of women living longer than men—and of course it’s a factor, but not a reason. “The social and environmental influences on health play a huge role in brain health for women,” notes Sarah Lenz Lock, senior vice president for policy and brain health at AARP. “Women face more challenges due to lower educational levels. They have fewer economic resources, they provide more caregiving for their families and they experience more stress. All of these factors affect the risk of cognitive decline.”

Reproductive history plays a role

The age at which women get their first menstrual periods, how many successful pregnancies they have, childbearing and the decline in estrogen at menopause—all may be contributors, along with genetic factors, depression and anxiety.

Racial and ethnic disparities

Racial and ethnic disparities place women at a greater risk. Older African Americans are twice as likely to have Alzheimer’s as older whites; and older Hispanics have a 1.5 times higher risk than non-Hispanic whites. While there is little research to understand this disparity, lack of access to health care stands out as a contributing cause. Conditions such as heart disease, stress, hypertension, diabetes and obesity that disproportionately affect racial and ethnic minorities increase the risk of dementia.

What can women do to reduce their risk for dementia?

A mounting body of research suggests that a healthy lifestyle can reduce the risk of dementia by more than 33%.

Here are the key components of a brain-protective lifestyle:

• Exercise regularly. Cardio or aerobic exercise increases blood flow, reduces inflammation and stimulates the release of growth factors, stimulating brain health.
• Stimulate your brain. Puzzles, word games and challenging reading material help keep your brain in shape.
• Stay socially connected. Besides helping prevent isolation and loneliness, staying connected to people you care about provides a sense of purpose and support.
• Relieve stress. It’s women who juggle careers and family obligations. That’s a problem for brain health because ongoing stress and anxiety cause depression and increase the risk of Alzheimer’s. Work on decompressing through exercise, meditation, yoga, deep breathing, therapy, time with friends or whatever helps you relieve the pressure.
• Get plenty of good sleep. It’s remarkable what a good night’s sleep can do. The toxins, get cleared out.
• Eat a balanced diet. Fads come and go. A heart-healthy/Mediterranean-style diet still makes sense.
• Protect your head from injury. Traumatic brain injuries are an important risk factor for dementia, so be sure to wear helmets for biking or skiing.

Control chronic health conditions. “There’s a connection between heart health and brain health,” Yaffe says, “and hypertension, diabetes and obesity have big effects on the brain because of the vascular effects and other effects.” Take steps to prevent these health problems or keep them under tight control. “Taking care of themselves with short-term investments in their health and wellbeing will pay long-term benefits for women,” Lock says.

Many of CDP’s clients are retired or they’re thinking about retiring

Healthcare issues, particularly Alzheimer’s, are frequent topics—especially for those who may be caring for aging family members. If someone you love has been diagnosed with some form of dementia, it’s important to create a Trust while that person still has testamentary capacity.

During this health crisis, many are feeling an urgency to create a Living Trust 

Our Trust package includes a Will, Power of Attorney, an Advance Healthcare Directive and Incapacity Planning. We guide you through the process and prepare the legal documents. At California Document Preparers, for most of our services, we charge one flat fee. We’re helpful, compassionate and affordable. Schedule an appointment today at one of our three Bay Area offices in Dublin, Walnut Creek or Oakland. 

Note that our offices are open and we’ve instituted stringent sanitation procedures. We can also provide our services virtually.

We service the entire East Bay and North Bay areas

Berkeley, El Cerrito, Richmond, Pinole, Alameda, San Leandro, Castro Valley Newark, San Lorenzo, Concord, Alamo, Danville, Lafayette, Orinda, Moraga, Pleasant Hill, Martinez, Pittsburg, Antioch, Brentwood, Oakley, Discovery Bay, Pleasanton, San Ramon, Livermore, Tracy and Fremont. Our clients also live in the Napa Valley, Benicia, Vallejo, Martinez, Fairfield.

This story is based on a story from the AARP, Dementia’s Gender Disparity: Report Uncovers Unique Challenges Facing Women, by Stacey Colino.

Prescription Drugs to Fight Aging—Entirely Experimental

Meet Dr. Alan Green. He has a tiny but lucrative practice in Queens. His patients travel from around the country to get prescriptions to drugs they believe will fight aging. Who are his patients? An estimated 5% are fellow doctors. Others have backgrounds in science or are in the upper-income bracket. He charges $350 for an initial visit and doesn’t accept insurance. Many fly to their appointments in their own airplanes. One 85-year old drove through a Midwest snowstorm to keep her appointment. Dr. Green is 76 and has been taking the drugs for three years himself.

Taking off-label drugs to fight aging

Green is among a small but growing number of doctors who prescribe drugs “off-label” for their possible anti-aging effects. In this case, the drugs are metformin, commonly prescribed for diabetes; the other drug is rapamycin, prescribed to prevent organ rejection. Now these drugs are being prescribed for their anti-aging powers, though there’s little evidence to support their premise.

Taking these drugs is entirely experimental

Patients get the drugs legally off-label or illegally from a foreign supplier. This methodology is much easier than it is for researchers to launch clinical trials. To date, no rigorous, large-scale clinical trials have been conducted for aging. Pharmaceutical companies have little incentive to fund costly, large-scale trials because aging is systemic—there is an infinite number of ways that aging takes place—and metformin and rapamycin are generic, cheap and accessible for seniors.

The National Instititue for Health (NIH) rejected a $77 million grant proposal by a prominent group of researchers to determine whether metformin could target multiple age-related diseases at once. It was the second rejection of the ambitious but unorthodox bid.

Advocate for rapamycin and Alzheimer’s study

Studies show that rapamycin extends animal life spans. It also has been shown in such studies to stave off age-related diseases, from cancer to cardiovascular diseases to cognitive diseases. “There should have been a clinical trial for rapamycin and Alzheimer’s disease years ago,” said Matt Kaeberlein a professor of pathology at the University of Washington medical school, who has publicly urged the NIH to use a historic boost in Alzheimer’s funding to study the drug’s effects. But clinical trials are expensive and difficult to fund.

Changing the model: Tackling aging as a whole rather than as one disease at a time

Alexander Fleming, a former FDA official and advocate for the metformin proposal, said he believed it was difficult for regulators and funders to grasp that aging can be tackled as a whole — not just one disease at a time.

In fact, NIH reviewers who rejected the metformin proposal cited problems with the project’s aim of testing multiple age-related diseases at once. The researchers considered appealing the decision, asserting those reviewers were biased against studying aging as a whole. The NIH, which declined to comment, discouraged the attempt.

Researchers have moved ahead with clinical trials focused on specific age-related conditions

• Researchers have shown that a “cousin” of rapamycin boosts the effectiveness of flu shots and lowers the incidence of upper respiratory infections in seniors by up to 30%.
• This group has licensed it from Novartis and is now working on getting approval to target Parkinson’s disease.
• At a recent forum on aging, a NIH researcher asked the 300 people in attendance to raise their hands if they were already taking metformin for aging. “Half the audience raised their hands,” recalled Nir Barzilai,director of the Institute for Aging Research at the Albert Einstein College of Medicine. “And a pharmaceutical rep estimated that metformin sales are up 20%.”

To be successful, clinical trials are necessary

Barzilai contends that researchers in the longevity field first need to set up a framework for testing in clinical trials. Even if metformin doesn’t pan out as the most effective drug, he asserts a model like the metformin proposal is needed for any major clinical trial to proceed. His group is now trying to secure about half the amount of funding it requested from NIH from a mix of nonprofit and private investment.

Proceeding with caution

While Dr. Green plans to continue prescribing his drugs, other doctors who may be open to prescribing metformin are holding off on rapamycin due to side effects in higher doses. Meanwhile, we’re a society obsessed with youth, and supplements with purported anti-aging effects routinely enter the market with little scrutiny and less evidence. There will be more on this one.

Many of our clients are seniors who come in to our offices to create their Living Trusts

The result is numerous conversations on a wide range of topics related to health, healthcare and end-of-life planning–and a Trust is an important part of this planning process. Our dedicated team has assisted hundreds of families in creating their Living Trusts. Our comprehensive Living Trust package includes a Power of Attorney and an Advance Healthcare Directive. We’re responsive and available throughout the process. We’re helpful, compassionate and affordable.

Who Will Care for the Caretakers?

Many of us are caring for–or know someone who is caring for–a family member, often an aging parent. With 10,000 baby boomers turning 70 every day, caring for this demographic is a growing health care matter, and it’s only time before it becomes a political issue. Let’s take a look at three women and the impact this has had on their lives.

• Aisha Adkins graduated from college with goals, dreams and a bright future. Ten years later, she’s still living at home. No job or car, no savings or the advanced degree she needs to be competitive in her field. Her mother was diagnosed with early onset dementia and cannot be left alone. For the last decade, Aisha has held the demanding role of caretaker for her mother. Aisha takes care of the house, shops and cooks dinner, then retires to her room around 10pm, when her father gets home. She’s had three dates in three years; she’s completely missing those exciting post-college years when young adults really start to find themselves.
• Heather Oglesby is a project officer for the Centers for Disease Control and Prevention in Atlanta.She was 42 when her mother received a dementia diagnosis four years ago. Caring for her mother has stunted her career prospects and weighed on her marriage. She has taken money from her pension plan and refinanced her home to cover her mother’s expenses. “Caregivers are physically, mentally and financially dying,” she told me. “They are a health care crisis in the making.”
• Heather Boldon dropped her demanding paralegal job nine years ago to take care of her mother. Since then, she has moved in and out of lesser-paying jobs, unable to build financial security. “I’m almost 52, and I’m starting from scratch,” said Ms. Boldon, whose mother has Alzheimer’s disease. “I’ve lost ten years of my life. What’s going to happen to me?”

Aisha and her father understand that her mother will need full-time professional care at some point. But they have no idea how they will pay for it. The Adkinses’ situation may be extreme, stemming from an early onset dementia diagnosis. But even for caregivers who keep a foothold in the labor force, the economic cost can be substantial.

The burden of care is profoundly reshaping lives

Unfortunately, stories about these three women aren’t uncommon. This burden of care is reshaping the lives of millions of Americans. About 15% women and 13% of men 25-54 years old spend time caring for an older relative, according to the Labor Department. For those 55 to 64, the share rises to one in five Americans. Some 20% of these caregivers also have children at home.

Demand for care is growing: Blame it on the boomers

“The boomer generation is living longer than when the safety net was put in place,” said Ai-jen Poo, a co-director of Caring Across Generations, a coalition of advocacy groups. Her organization is pushing to add a benefit to cover care — for older adults, children and sick family members — to the nation’s safety net, alongside Social Security and Medicare.

While men are being forced to step up, Ms. Poo noted that “women, in particular, are bearing the brunt of the burden.” By knocking many women in their prime earning years from the work force, the growing strain from care is weighing down the American economy.

For many, leaving the labor force is not an option

More than 60% of the people caring for an older person work, too; 45% of the caregivers work fulltime. Altogether, American families forgo at least $28.9 billion per year in wages when they take time off to take care of their children or sick relatives, according to a study issued in 2016 by the liberal Center for American Progress.

Burden of care only starting to seep into political conversations

The burden of care has not become a political concern with the urgency of health care policy; it is mostly absent from proposals by candidates for the Democratic presidential nomination. But it is seeping into the conversation. Senator Bernie Sanders’s Medicare for All proposal includes a benefit for long-term care. Senator Elizabeth Warren supports universal child care, which she has proposed to finance with a wealth tax. In 2016, Hillary Clinton made this part of her platform, by giving tax credits to those who were taking care of family members.

Ms. Poo argues that it is only a matter of time before care becomes a political priority. “There is no feasible way in this economy that people can manage care without more institutional support,” she said. It most likely will become a political issue and it will end up being a women’s issue.

Many of our clients are seniors who come in to our offices to create their Living Trusts

The result is numerous conversations on a wide range of topics related to health, healthcare and end-of-life planning. California Document Preparers assists our clients in the preparation of their Trusts, which include a Power of Attorney and Advance Healthcare Directive. Most are surprised at how easy it is. Schedule your appointment today by contacting us at one of our three Bay Area offices. Our dedicated team is helpful, compassionate and affordable.

An Emotional Journey for a Daughter, a Mother and the Memory Care Unit

While Marilyn Friedman had always dreamed that one day she and her mother would have a closer relationship, it was not to be. Her mother had dementia. She forgot the word for “dog.” She got lost on the way home from the grocery store. She experienced hallucinations of flashing lights at 2am and strangers in her bedroom. She stopped eating and lost 20 pounds in a month. She’d fallen several times, could no longer write a check or drive. When her doctors recommended 24-hour care, her mother rejected it. This is the story about a family, their mother’s dementia and the memory-care unit.

In a New York Times article, The Dementia Heist, Ms. Friedman tells the heartbreaking story of caring for her mother. In this story, Ms. Friedman and her sister resorted to tricking their mother to get her into the memory-care unit. They hid in the back of a car and watched a paramedic escort their mother into the facility.

She felt like the worst daughter ever, yet she was doing the most caring thing

Ms. Friedman reminded herself that her mother had had a hard life. At 27, she fell from a train, shattered her kneecap and nearly died from gangrene. Friedman’s parents had abandoned everything when they immigrated to the U.S. from Russia in 1964. Mother-daughter relationships are often complex, and they can be volatile and unpredictable. For the Friedmans, good moods meant blueberry blintzes and movies; bad moods resulted in an endless cycle of slaps.

The sisters toured memory-care facilities

“My sister worked hard to enable mom to remain at home, but she couldn’t juggle my mother’s multiplying needs with those of her own family. Our choices were to let her die alone from starvation or trick her into memory care.”

The sisters toured memory-care centers, where cost is based on the level of care. They found a facility with a B&B vibe and patient staff members who gave lots of hugs. They signed a 40-page contract making their mother liable if she injured another resident or destroyed property.

Next up: Getting mom admitted to the facility required “therapeutic lying”

The sisters had her admitted to the hospital, blaming her high blood pressure. Professionals call it “therapeutic lying” because honesty can increase anxiety. Once she was in memory care, the sisters couldn’t contact her for ten days—an effort to help her adapt. They did, however, get reports: Mom wouldn’t sleep in her room; rather, she parked herself in the lobby all night.

Their mother’s belligerent behavior continued in her new environment

She refused to eat. If she kept starving herself, she’d be sent to a more depressing, regular nursing home. She refused medication because the pills were making her lose her memory. The staff hid meds in her food, but she resisted her glaucoma drops, risking blindness. When finally allowed to visit, Ms. Friedman found her mother belligerent, insisting that her daughters take her home. They resisted for a number of reasons.

Understanding that the last chapter of her mother’s life would be painful

“We ate cake at a courtyard table beside a classic convertible. She complained that everyone there was crazy, so we changed topics–another strategy for dealing with dementia patients. This next chapter of her life would be painful. My only hope was that she’d become enveloped in a pleasant memory.”

Testamentary capacity is a growing legal concern

Testamentary capacityis the legal term defining a person’s legal and mental ability to make or alter a valid Will. With the increased occurrence of some kind of dementia, the matter of testamentary capacityis being raised more frequently when it comes to signing legal documents. In every case, capacity is specific to each time and situation. Legal capacity can fluctuate. In terms of the law, there is a presumption of capacity until it is disproved. If you have legal documents that need to be signed by someone who has been diagnosed with dementia, it’s important to do this as soon as possible. Most important are a Living Trust, a Power of Attorney and Advance Healthcare Directive.

Early Dementia Detection Helps Seniors Manage the Disease

In 2016 The New York Times devoted a special section to Alzheimer’s. It was a beautifully written story, Fraying at the Edges, by N.R. Kleinfield, that focused on Geri Taylor’s heroic journey with the disease. Ms. Taylor had become forgetful; mundane tasks often confused her. One day she got off the subway and had no idea why she was there. She tried to pass off increasingly frequent memory problems as inevitable infirmities of old age. But the day she looked in the mirror and didn’t recognize the face staring back at her was her come-to-Jesus moment. She knew she could no longer ignore what was happening to her mind.

Diagnosis: Mild cognitive impairment, a precursor to Alzheimer’s disease

Her doctor put her on Aricept, a drug designed to improve cognitive performance, and it seemed to sharpen her thinking. But as her doctor told her, she wasn’t just losing her memory, she was losing “executive function”— forgetting the sequence of steps in the processes of all the little things we do, the things we take for granted.

It’s important to get help sooner for people whose minds are slipping

Patients showing signs of mental decline or dementia should be getting checked during routine medical visits. Dementia is an uncomfortable topic for patients and their families. It’s also a difficult topic for their doctors, but family physicians need to do a thorough evaluation and share the diagnosis.

Patients and family members should push for an evaluation if they’re worried that symptoms might not be normal aging. We all laugh about misplacing our keys. But there’s a difference between occasionally misplacing keys and putting them in the freezer. By the time you’ve gone from misplacing your keys to forgetting what those keys are for, you’re too far gone to participate in your own care. It’s not just memory that suffers, but judgment, and sometimes it can be years before dementia is diagnosed.

The growing need for early diagnosis

• About 50 million people worldwide have dementia; Alzheimer’s is the most common form of the disease. In the U.S., nearly 6 million people have Alzheimer’s and an estsimated 12 million have mild cognitive impairment, a frequent precursor.
• In 2015, Alzheimer’s Association research using Medicare records suggested that only about half of those being treated for Alzheimer’s had been told by their health-care providers that they had been diagnosed with the disease.
• Physicians often hear of symptoms or memory complaints from patients or their spouses and say, “you know, you seem okay to me today, so check back in six months”. The consequences? Patients may end up hospitalized because they forgot to take their medications.

Medicare has begun covering mental assessments

Medicare recently started covering mental assessments as part of annual wellness visits, but doctors aren’t required to do it and there is no guidance on how to do it. In some cases, it might be as cursory as asking “how’s your memory?”

The guidelines do not recommend screening everyone

The Medicare guidelines outline what health care workers should do if people describe worrisome symptoms. It includes checking for risk factors that may contribute to dementia or other brain diseases, including family history, heart disease and head injuries. There are pen-and-pencil memory tests and imaging tests to detect small strokes or brain injuries that could be causing memory problems.

Doctors are trained to heal, when there is no cure for Alzheimer’s

Dr. Michael Sitorius, family medicine chairman at the University of Nebraska Medical Center, said dealing with mental decline adds to the challenge of caring for frail elderly patients. It’s a tough diagnosis to make for many doctors, he said, because medical training focuses on “trying to cure people, and Alzheimer’s and dementia are not curable.”

Dr. Sitorius gives his older patients mental tests at their annual checkups, but sometimes patients or their loved ones don’t want to hear the results. In those cases, Sitorius still addresses related issues including depression, safeguarding medication, nutrition and whether patients should continue driving. The new guidelines are a welcome reminder for family doctors to tackle these issues earlier. “We strongly encourage a full disclosure,” including diagnosis, stage and prognosis, he said.

Meet Anne Hunt, 81, who once ran a busy Chicago cooking school

At her daughter’s urging, Anne Hunt visited her family doctor in 2011 because of increasing forgetfulness. The 81-year-old now recalls struggling with memory tests involving letters and numbers that her doctor had her perform. The test results were inconclusive and there was no diagnosis.

“We didn’t do much about it,” said Bruce Hunt, Anne’s husband, until five years later, when her behavior was clearly worsening – more memory lapses, repeating herself and forgetting where to put things. She was diagnosed with Alzheimer’s after an imaging test showed brain changes associated with the disease.

The benefits of early diagnosis

“There’s no pill they can take to make it go away, so some people think there’s no point to getting a diagnosis,” but that’s being short-sighted, the National Institute of Aging’s Silverberg said. “It really does offer an opportunity to plan.” Alzheimer’s medication such as Aricept and Namenda can ease symptoms. Other benefits include a chance to join experiments testing treatments, opportunities to resolve finances, find caregivers, make homes safer and use memory aids and calendars to promote independent living. The diagnosis energized the Hunts. They joined support groups and a singing ensemble, finding new things to help them cope.

For many, the biggest fear is the unknown. Dementia can be a slow-moving disease. Receiving a diagnosis helps many Alzheimer’s patients make the most of the time they have left.

A big part of end-of-life planning is creating a Living Trust. Make an appointment today by contacting us at one of our three Bay Area offices. Our dedicated team is helpful, compassionate and affordable.

Grandma and Guns: Families Confront Dementia and Firearms

Dee Hill begged the 911 dispatcher for help. “My husband accidentally shot me in the stomach". A few feet away, her 76-year old husband, Darrell, a former police chief and county sheriff, sat in his wheelchair with a discharged Glock on the table in front of him, completely unaware that he’d nearly killed his wife of nearly 60 years. Darrell had been diagnosed two years earlier with a form of progressive dementia that had quickly stripped him of reasoning and memory. His wife needed 30 pints of blood, three surgeries and seven weeks in the hospital to survive.

Shesold her husband's car when it became too dangerous for him to drive, yet never removed his guns

Many of us these days are helping our aging parents with a wide range of issues, and a troubling problem that's getting more attention is aging gun owners with dementia. This scenario describes a disturbing situation that may be more common than we think. Gun owners steadfastly refuse to part with their weapons, even as they lose the ability to reason and make sound decisions. 

Darrell Hill was unaware that he'd nearly killed his wife

“He was almost obsessive about seeing and caring for his guns." Darrell accidentally knocked the pouch that had held the revolver to the floor. When Dee bent to pick it up, he grabbed the Glock and fired. “My concern had been that someone was going to get hurt. I didn’t in my wildest dreams think it was going to be me.” The incident was classified as an assault. Dee was outraged at the suggestion she consider pressing charges. Gun advocates insist that guns are not to blame. 

America's tragedy of gun violence kills 96 people/day 

There's a vast cache of firearms in the homes of aging Americans with impaired/declining mental faculties. When Darrell Hill died in 2016, he joined the estimated 9 percent of Americans 65 and older diagnosed with dementia, many of whom are gun owners and fierce supporters of Second Amendment rights.A 2017 Pew Research Center survey shows that 45% of people 65 and older have guns in their homes. 

No one tracks the potentially deadly intersection of these groups

A four-month Kaiser Health News investigation uncovered more than 100 cases across the U.S. in which people with dementia used guns to kill or injure themselves or others. Kaiser's research found 15 homicides and more than 95 suicides since 2012.The shooters often acted during bouts of confusion, paranoia, delusion or aggression — common symptoms of dementia. They killed people closest to them--their caregivers, wives, sons or daughters. They shot at people they happened to encounter--the mailman, a police officer.

Keep in mind that these statistics do not begin to tally incidents in which a person with dementia waves a gun at an unsuspecting neighbor or a terrified home-health aide.

Few topics are as polarizing as gun control and second amendment rights

Gun control is a politically polarizing topic. Only five states have laws allowing families to petition a court to temporarily seize guns from people who exhibit dangerous behavior. 

What families can do: Take a gun owner to court to evaluate competency

Federal law prohibits people who are not mentally competent to make their own decisions, including those with advanced dementia, from buying or owning firearms. Unfortunately, a diagnosis of dementia does not disqualify someone from owning a gun. If a gun owner were reluctant to give up his/her arsenal, the family would typically have to take that person to court to evaluate competency.

We’re seeing a small change. Since February's school shooting in Parkland, Fla., more states are taking action to make it easier for families to remove guns from their homes. 

Changes ahead for the NRA?

The NRA, traditionally one of the most powerful lobbies in Washington, is experiencing tougher times. Many big brands are severing ties with the company. If the Democrats take back the House and Senate in the midterm elections, gun reform well may become a reality. 

Can California lead the way? 

California has some of the most stringent gun laws in the country and is intent on eliminating severely restricted weapons by making their transfer nearly impossible. 

Anyone found by the courts to be mentally defective or those committed to a mental institution cannot own firearms. 

This includes those deemed by a court to be a danger to others, mentally disordered sex offenders and those found not guilty of a crime by reason of insanity or found mentally incompetent to stand trial. 

It also includes those in custody because they present a danger to themselves or others, individuals undergoing intensive treatment for mental illness and those placed in a conservatorship.

Ultimately, it's up to every family to take away the guns

In my own family, it was the car keys. Our stepfather was a terrible driver and had been for years. Some of us wouldn't ride with him. Yet none of us would stand up to him and take away the keys. We could have found a way, but we didn't want to create an incident. In retrospect, a family fight is nothing compared to the chaos and tragedy of an accident. 

Helping family members with end-of-life planning is a challenge for many Bay Area families.

California Document Preparers assists families with our comprehensive Living Trust package that includes a Power of Attorneyand an Advanced Healthcare Directive. Contact California Document Preparers at one of our three Bay Area offices to schedule an appointment or find out how we work with our clients. We’re helpful, compassionate and affordable. 

New Healthcare Directive: Facing Dementia with a Plan

Dr. Barak Gaster is a Seattle internist who spent three years working with specialists in geriatrics, neurology, palliative care and psychiatry to create a dementia-specific advance directive. The document maps out the stages of dementia: mild, moderate and severe; it asks patients to specify which medical interventions they would want at each phase of the illness.

Identifying end-of-life care while still able to make decisions

“Patients stumble into the advanced stage of dementia before anyone identifies it and talks to them about what’s happening,” said Dr. Gaster. “At what point would they not want medical interventions to keep them alive longer?” Dr. Gaster wants his patients to respond to his directive before the disease has left them unable to make choices.

Ann Vandervelde, 71, is an abstract painter who was familiar with dementia. Her father had died of dementia and, as a hospice volunteer, she had spent time with dementia patients. She also was well aware of the family conflicts that can accompany critical medical decisions.

Not all experts are convinced that another directive is needed

But as Dr. Gaster and his co-authors argue in the JAMA, the current directive doesn’t address dementia and the disease’s progressive nature. Dementia progresses slowly, and in the early stages, patients can still enjoy a high quality of life and are able to make decisions about their care.

An estimated 20%-30% of us will at some point develop dementia

Last year, the journal Demography estimated that for someone born in 1940, the lifetime risk of having some form of dementia at age 70 was 30.8% for men and 37% percent for women. Dr. Gaster has offered his directive to patients qualifying for Medicare. Not surprisingly, those families who have experienced dementia are most responsive to the more comprehensive directive.

Highlights of Dr. Gaster’s directive include the following:

• For each stage of dementia, the patient can choose among four options, from full efforts to prolong life to comfort care only.
• Patients can opt for lifesaving treatments.
• They can opt to receive care where they live but avoid hospitalization, which can be frightening for a dementia patient.

Doctors and nurses are concerned that these end-of-life documents get filed away—it’s not uncommon for documents to be unavailable when it’s time to make critical decisions.

Healthcare professionals are trained to save lives—not allow patients to die

One of the problems with directives is that healthcare professionals are trained to save lives, not necessarily to administer palliative care that will allow their patients to die. It’s not uncommon for family members to ignore the wishes of their loved ones and keep someone alive against their documented wishes.

The takeaway: Families need to get involved

We need to be discussing quality of life issues with our families and healthcare teams–identifying what we find acceptable or unacceptable, what interventions we agree to. The decisions should be documented and shared with family, friends and doctors. For Ann Vandervelde, knowing that she had carefully detailed her end-of-life wishes and shared them with her family gave her a sense of calm. She trusted that the people she loved and trusted would carry out her final wishes.

A Power of Attorney and an Advanced Healthcare Directive are included in our Living Trust package. Contact California Document Preparers at one of our three Bay Area offices today to schedule an appointment to create or update your Trust. Our dedicated team is helpful, compassionate and affordable.