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.

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.

New ‘Instructions’ Could Let Dementia Patients Refuse Spoon-Feeding

June marks the two-year anniversary of California’s End of Life Options Act (EOLA). Between June 9 and December 31, 2016, 111 patients were reported to have died following ingestion of aid-in-dying drugs prescribed under EOLA.

While controversial, the law has stringent controls

The law has been extremely controversial, opposed by many groups who argue that it creates too many opportunities for abuse. Yet the law, as it is structured, has stringent controls. Those with fatal, debilitating diseases who wish to take their own lives must get their doctor’s order and an opinion from a second doctor about the severity of their conditions. The act must be carried out within a certain time frame. The fact that there have been relatively few assisted suicides in California since the law was passed indicates to many that the law is fair and is working.

AHD: The legal document that allows people to detail how they want to die

At California Document Preparers, our Living Trust package includes an Advance Healthcare Directive (AHD). It is this document in which people can detail their final wishes about how they will die—if they want nursing care or prefer to die at home. If they want to be surrounded by their families or if they prefer to enlist the care of hospice and refuse artificial efforts to be kept alive. AHDs are the legal documents that record the ability to halt interventions, treat the patient’s pain and allow them to die as peacefully as possible. An AHD includes patients diagnosed with progressive dementia who can make end-of-life decisions before the disease robs them of their ability to sign legal documents. This practice has not included provisions to refuse food and fluids offered by hand—until now.

Washington state has new end-of-life guidelines for dementia patients

A Washington state agency, End of Life Washington (EOLWA), advocates for medical aid in dying and has created guidelines for dementia patients who don’t want to be spoon-fed at the end of life. The group helps people using the state’s 2009 Death with Dignity Act, recently posted new Instructions for Oral Feeding and Drinkingon its website.

The guidelines are directed at those with Alzheimer’s diseaseand other progressive forms of dementia. It instructs caregivers not to provide oral food or fluids under certain circumstances. “These instructions are groundbreaking for patients who fear losing control not only of their faculties but of their free will to live and die on their terms”, said Sally McLaughlin, executive director of EOLWA. “We get calls from people with concerns about their loved ones with dementia feeling like they’re being force-fed. Those with dementia understand that as they stop eating, they would like no one else to feed them.”

The new guidelines have both their critics and proponents

As with the death with dying law before it, these new guidelines have their share of critics who have concerns about potential mistreatment of vulnerable patients. They fear that these guidelines could be used essentially to starve the elderly or incapacitated. Proponents welcome the new guidelines, believing that they help define the uncertainties surrounding assisted feeding at the end of life.

Guidelines target those who show signs of not wanting food

The guidelines do not apply to people with dementia who still get hungry and thirsty and want to eat and drink, the authors note. “If I accept food and drink when they’re offered to me, I want them,” the document states. But if the person appears indifferent to eating, or shows other signs of not wanting food, turning away, spitting food out, coughing or choking, according to the guidelines, this is when attempts to feed should be stopped, and it’s at this point that caregivers should respect those actions.

“No matter what my condition appears to be, I do not want to be cajoled, harassed or forced to eat or drink,” the document states.

The new guidelines are not legally or ethically binding. It’s important to keep in mind that these are guidelines; they are neither legally nor ethically binding. They do, however, bring increased visibility to an issue that we likely will hear more about as the baby boomer population ages. Nearly two dozen states have laws that address assisted feeding, including many that prohibit withdrawing oral food and fluids from dying people.

An Advance Healthcare Directive is part of our Living Trust package

An AHDis part of our Living Trust package. If you need to create or update your Trust, contact California Document Preparersat one of our three Bay Area offices todayto schedule an appointment.Our dedicated team is helpful, compassionate and affordable.