麻豆女优 Health News聽senior contributing editor Elisabeth Rosenthal discussed the cost of cancer care in the wake of James Van Der Beek’s death on ABC News’ ABC News Live on Feb. 12.

麻豆女优 Health News Southern California correspondent Claudia Boyd-Barrett discussed how families of detainees by the U.S. Immigration and Customs Enforcement agency are struggling to find those who have been hospitalized on KQED’s The California Report on Feb. 10.

• Read Boyd-Barrett’s “鈥�I Can’t Tell You’: Attorneys, Relatives Struggle To Find Hospitalized ICE Detainees.”

Céline Gounder, 麻豆女优 Health News’ editor-at-large for public health, discussed a new study linking daily coffee or caffeinated tea intake to lower dementia risk on CBS News’ CBS Mornings on Feb. 10.

麻豆女优 Health News senior correspondent Aneri Pattani discussed differing opinions within the addiction medicine community on WNO’s Louisiana Considered on Feb 6.

• Read Pattani’s “Inside the Battle for the Future of Addiction Medicine.”

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The most important reason for older adults to be vaccinated against the respiratory infection RSV is that their by almost 70% in the year they get the shot, and by nearly 60% over two years.

And the main reason to roll up a sleeve for an annual flu shot is that when people do get infected, it also reliably reduces the severity of illness, though its effectiveness varies by how well scientists have predicted which strain of influenza shows up.

But other reasons for older people to be vaccinated are emerging. They are known, in doctor-speak, as off-target benefits, meaning that the shots do good things beyond preventing the diseases they were designed to avert.

The list of off-target benefits is lengthening as “the research has accumulated and accelerated over the last 10 years,” said William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tennessee.

Some of these protections have been established by years of data; others are the subjects of more recent research, and the payoff is not yet as clear. The first RSV vaccines, for example, became available only in 2023.

Still, the findings “are really very consistent,” said Stefania Maggi, a geriatrician and senior fellow at the Institute of Neuroscience at the National Research Council in Padua, Italy.

She is the lead author of , published in the British journal Age and Ageing, that found reduced risks of dementia after vaccination for an array of diseases. Given those “downstream effects,” she said, vaccines “are key tools to promote healthy aging and prevent physical and cognitive decline.”

Yet too many older adults, whose weakening immune systems and high rates of chronic illness put them at higher risk of infectious diseases, have not taken advantage of vaccination.

The last week that about 31% of older adults had not yet received a flu shot. Only about 41% of adults 75 and older had ever been vaccinated against RSV, or respiratory syncytial virus, and about a third of seniors had received the most recent covid-19 vaccine.

The CDC recommends the one-and-done pneumococcal vaccine for adults 50 and older. An analysis in the American Journal of Preventive Medicine, however, from 2022, when new guidelines were issued, through 2024, only about 12% of those 67 to 74 received it, and about 8% of those 75 and older.

The strongest evidence for off-target benefits, dating back 25 years, shows reduced cardiovascular risk following flu shots.

Healthy older adults vaccinated against flu have substantially , as well as for pneumonia and other respiratory infections. Vaccination against influenza has also been associated with and .

Moreover, many of these studies predate the more potent flu vaccines now recommended for older adults.

Could the RSV vaccine, protective against another respiratory illness, have similar cardiovascular effects? A recent large found a nearly 10% decline in cardiorespiratory hospitalizations 鈥� involving the heart and lungs 鈥� among the vaccinated versus a control group, a significant decrease.

Lowered rates of cardiovascular hospitalizations and stroke did not reach statistical significance, however. That may reflect a short follow-up period or inadequate diagnostic testing, cautioned Helen Chu, an infectious disease specialist at the University of Washington and co-author of an in JAMA.

“I don’t think RSV behaves differently from flu,” Chu said. “It’s just too early to have the information for RSV, but I think it will show the same effect, maybe even more so.”

Vaccination against still another dangerous respiratory disease, covid, has been linked to a , with its damaging effects on physical and mental health.

Probably the most provocative findings concern vaccination against shingles, aka herpes zoster. Researchers made headlines last year when they documented an association between shingles vaccination and lower rates of dementia 鈥� even with the less effective vaccine that has since been replaced by Shingrix, approved in 2017.

Nearly all studies of off-target benefits are observational, because scientists cannot ethically withhold a safe, effective vaccine from a control group whose members could then become infected with the disease.

That means such studies are subject to “healthy volunteer bias,” because vaccinated patients may also practice other healthy habits, differentiating them from those not vaccinated.

Although researchers try to control for a variety of potentially confounding differences, from age and sex to health and education, “we can only say there’s a strong association, not a cause and effect,” Maggi said.

But Stanford researchers seized on in 2013, when the first shingles vaccine, Zostavax, became available to older people who had not yet turned 80. Anyone who had was ineligible.

Over seven years, dementia rates in participants who had been eligible for vaccination declined by 20% 鈥� even though only half had actually received the vaccine 鈥� compared with those who narrowly missed the cutoff.

“There are no reasons people born one week before were different from those born a few days later,” Maggi said. Studies and have also found reductions in the odds of dementia following shingles shots.

In fact, in the meta-analysis Maggi and her team published, several other childhood and adult vaccinations appeared to have such effects. “We now know that many infections are associated with the onset of dementia, both Alzheimer’s and vascular,” she said.

In 21 studies involving more than 104 million participants in Europe, Asia, and North America, vaccination against shingles was associated with a 24% reduction in the risk of developing dementia. Flu vaccination was linked to a 13% reduction. Those vaccinated against pneumococcal disease had a 36% reduction in Alzheimer’s risk.

The Tdap vaccine against tetanus, diphtheria, and pertussis (whooping cough) is recommended for adults every 10 years, with vaccination among older adults often prompted by the birth of a grandchild, who cannot be fully vaccinated for months. It was associated with a one-third decline in dementia.

Other researchers are investigating the effects of and of .

What causes such vaccine bonuses? Most hypotheses focus on the inflammation that arises when the immune system mobilizes to fight off an infection. “You have damage to the surrounding environment” in the body, “and that takes time to calm down,” Chu said.

The effects of inflammation can far outlast the initial illness. It may allow other infections to take hold, or cause heart attacks and strokes when clots form in narrowed blood vessels. “If you prevent the infection, you prevent this other damage,” Chu said.

Hospitalization itself, during which older patients can become deconditioned or develop delirium, is a risk factor for dementia, among other health problems. Vaccines that reduce hospitalization might therefore delay or ward off cognitive decline.

Health officials in the Trump administration have assailed childhood vaccines more than adult ones, but their vocal opposition may be contributing to inadequate vaccination among older Americans, too.

Many will not only miss out on the emerging off-target benefits but will remain vulnerable to the diseases the vaccines prevent or diminish.

“The current national policy on vaccination is at best uncertain, and in instances appears anti-vaccine,” said Schaffner, a former member of the CDC’s Advisory Committee on Immunization Practices. “All of us in public health are very, very distressed.”

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Both patients, a man and a woman, had agreed to donate their brains after they died for further research. “An amazing gift,” said Edward Lee, the neuropathologist who directs the at the university’s Perelman School of Medicine. “They were both very dedicated to helping us understand Alzheimer’s disease.”

The man, who died at 83 with dementia, had lived in the Center City neighborhood of Philadelphia with hired caregivers. The autopsy showed large amounts of amyloid plaques and tau tangles, the proteins associated with Alzheimer’s disease, spreading through his brain.

Researchers also found infarcts, small spots of damaged tissue, indicating that he had suffered several strokes.

By contrast, the woman, who was 84 when she died of brain cancer, “had barely any Alzheimer’s pathology,” Lee said. “We had tested her year after year, and she had no cognitive issues at all.”

The man had lived a few blocks from Interstate 676, which slices through downtown Philadelphia. The woman had lived a few miles away in the suburb of Gladwyne, Pennsylvania, surrounded by woods and a country club.

The amount of air pollution she was exposed to 鈥� specifically, the level of fine particulate matter called PM2.5 鈥� was less than half that of his exposure. Was it a coincidence that he had developed severe Alzheimer’s while she had remained cognitively normal?

With increasing evidence that chronic exposure to PM2.5, a neurotoxin, not only damages lungs and hearts but is also associated with dementia, probably not.

“The quality of the air you live in affects your cognition,” said Lee, the senior author of a recent , one of several large studies in the past few months to demonstrate an association between PM2.5 and dementia.

Scientists have been tracking the connection for at least a decade. In 2020, the influential Lancet Commission to its list of modifiable risk factors for dementia, along with common problems like hearing loss, diabetes, smoking, and high blood pressure.

Yet such findings are emerging when the federal government is dismantling efforts by previous administrations to continue reducing air pollution by shifting from fossil fuels to renewable energy sources.

“鈥楧rill, baby, drill’ is totally the wrong approach,” said John Balmes, a spokesperson for the American Lung Association who researches the effects of air pollution on health at the University of California-San Francisco.

“All these actions are going to decrease air quality and lead to increasing mortality and illness, dementia being one of those outcomes,” Balmes said, referring to recent environmental moves by the White House.

Many factors contribute to dementia, of course. But the role of particulates 鈥� microscopic solids or droplets in the air 鈥� is drawing closer scrutiny.

Particulates arise from many sources: emissions from power plants and home heating, factory fumes, motor vehicle exhaust, and, increasingly, wildfire smoke.

Of the several particulate sizes, PM2.5 “seems to be the most damaging to human health,” Lee said, because it is among the smallest. Easily inhaled, the particles enter the bloodstream and circulate through the body; they can also travel directly from the nose to the brain.

The research at the University of Pennsylvania, the largest autopsy study to date of people with dementia, included more than 600 brains donated over two decades.

Previous research on pollution and dementia mostly relied on epidemiological studies to establish an association. Now, “we’re linking what we actually see in the brain with exposure to pollutants,” Lee said, adding, “We’re able to do a deeper dive.”

The study participants had undergone years of cognitive testing at Penn Memory. With an environmental database, the researchers were able to calculate their PM2.5 exposure based on their home addresses.

The scientists also devised a matrix to measure how severely Alzheimer’s and other dementias had damaged donors’ brains.

Lee’s team concluded that “the higher the exposure to PM2.5, the greater the extent of Alzheimer’s disease,” he said. The odds of more severe Alzheimer’s pathology at autopsy were almost 20% greater among donors who had lived where PM2.5 levels were high.

Another research team recently between PM2.5 exposure and Lewy body dementia, which includes dementia related to Parkinson’s disease. Generally considered the second most common type after Alzheimer’s, Lewy body accounts for an estimated 5% to 15% of dementia cases.

In what the researchers believe is the largest epidemiological study to date of pollution and dementia, they analyzed records from more than 56 million beneficiaries with traditional Medicare from 2000 to 2014, comparing their initial hospitalizations for neurodegenerative diseases with their exposure to PM2.5 by ZIP codes.

“Chronic PM2.5 exposure was linked to hospitalization for Lewy body dementia,” said Xiao Wu, an author of the study and a biostatistician at the Mailman School of Public Health at Columbia University.

After controlling for socioeconomic and other differences, the researchers found that the rate of Lewy body hospitalizations was 12% higher in U.S. counties with the worst concentrations of PM2.5 than in those with the lowest.

To help verify their findings, the researchers nasally administered PM2.5 to laboratory mice, which after 10 months showed “clear dementia-like deficits,” senior author Xiaobo Mao, a neuroscientist at the Johns Hopkins School of Medicine, wrote in an email.

The mice got lost in mazes that they had previously dashed through. They had earlier built nests quickly and compactly; now their efforts were sloppy, disorganized. At autopsy, Mao said, their brains had atrophied and contained accumulations of the protein associated with Lewy bodies in human brains, called alpha-synuclein.

A , published this summer in The Lancet, included 32 studies conducted in Europe, North America, Asia, and Australia. It also found “a dementia diagnosis to be significantly associated with long-term exposure to PM2.5” and to certain other pollutants.

Whether so-called ambient air pollution 鈥� the outdoor kind 鈥� increases dementia because of inflammation or other physiological causes awaits the next round of research.

Although air pollution has declined in the United States over two decades, scientists are calling for still stronger policies to promote cleaner air. “People argue that air quality is expensive,” Lee said. “So is dementia care.”

President Donald Trump, however, reentered office vowing to increase and to block the transition to renewable energy. His administration for solar installations and electric vehicles, Balmes noted, adding, “They’re encouraging continuing to burn coal for power generation.”

The administration has , announced in the Arctic National Wildlife Refuge in Alaska, and moved to stop to transition to electric cars by 2035. (The state has challenged that action in court.)

“If policy goes in the opposite direction, with more air pollution, that’s a big health risk for older adults,” Wu said.

Last year, under the Biden administration, the Environmental Protection Agency for PM2.5, noting that “the available scientific evidence and technical information indicate that the current standards may not be adequate to protect public health and welfare, as required by the Clean Air Act.”

In March, the EPA’s that the agency would be “revisiting” those stricter standards.

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Her doctor and several pharmacies turned her down because she was below the recommended age at the time, which was 60. So, in 2016, she celebrated her 60th birthday at her local CVS.

“I was there when they opened,” Beckham recalled. After getting her Zostavax shot, she said, “I felt really relieved.” She has since received the newer, more effective shingles vaccine, as well as a pneumonia shot, an RSV vaccine to guard against respiratory syncytial virus, annual flu shots and all recommended covid-19 vaccinations.

Some older people are really eager to be vaccinated.

Robin Wolaner, 71, a retired publisher in Sausalito, California, has been known to badger friends who delay getting recommended shots, sending them relevant medical studies. “I’m sort of hectoring,” she acknowledged.

Deana Hendrickson, 66, who provides daily care for three young grandsons in Los Angeles, sought an additional MMR shot, though she was vaccinated against measles, mumps, and rubella as a child, in case her immunity to measles had waned.

For older adults who express more confidence in vaccine safety than younger groups, the past few months have brought welcome research. Studies have found important benefits from a newer vaccine and enhanced versions of older ones, and one vaccine may confer a major bonus that nobody foresaw.

The new studies are coming at a fraught political moment. The nation’s health secretary, Robert F. Kennedy Jr., has long disparaged certain vaccines, calling them unsafe and saying that the government officials who regulate them are compromised and corrupt.

On June 9, Kennedy fired a panel of scientific advisers to the Centers for Disease Control and Prevention, and later replaced them with some who have been skeptical of vaccines. But so far, Kennedy has not tried to curb access to the shots for older Americans.

The evidence that vaccines are beneficial remains overwhelming.

The phrase “Vaccines are ” has become a favorite for William Schaffner, an infectious diseases specialist at Vanderbilt University Medical Center.

“The population over 65, which often suffers the worst impact of respiratory viruses and others, now has the benefit of vaccines that can prevent much of that serious illness,” he said.

Take influenza, which annually sends from 140,000 to 710,000 people to hospitals, most of them seniors, and is fatal to 10% of hospitalized older adults. 

For about 15 years, the CDC has approved several enhanced flu vaccines for people 65 and older. More effective than the standard formulation, they either contain higher levels of the antigen that builds protection against the virus or incorporate an adjuvant that creates a stronger immune response. Or they’re recombinant vaccines, developed through a different method, with higher antigen levels.

In a meta-analysis in the Journal of the American Geriatrics Society, “all the enhanced vaccine products were superior to the standard dose for preventing hospitalizations,” said Rebecca Morgan, a health research methodologist at Case Western Reserve University and an author of the study.

Compared with the standard flu shot, the from the flu in older adults, by at least 11% and up to 18%. The CDC advises , as many already do.

More good news: Vaccines to prevent respiratory syncytial virus in people 60 and older are performing admirably.

RSV is the most common cause of hospitalization for infants, and it also poses significant risks to older people. “Season in and season out,” Schaffner said, “it produces outbreaks of serious respiratory illness that rivals influenza.”

Because the FDA first approved an RSV vaccine in 2023, the 2023-24 season provided “the first opportunity to see it in a real-world context,” said Pauline Terebuh, an epidemiologist at Case Western Reserve School of Medicine and an author of a in the journal JAMA Network Open.

In analyzing electronic health records for almost 800,000 patients, the researchers found the vaccines to be 75% effective against acute infection, meaning illness that was serious enough to send a patient to a health care provider.

The vaccines were 75% effective in preventing emergency room or urgent care visits, and 75% effective against hospitalization, both among those ages 60 to 74 and those older.

Immunocompromised patients, despite having a somewhat lower level of protection from the vaccine, will also benefit from it, Terebuh said. As for adverse effects, the study found a very low risk for Guillain-Barré syndrome, a rare condition that causes muscle weakness and that typically follows an infection, in about 11 cases per 1 million doses of vaccine. That, she said, “shouldn’t dissuade people.”

The CDC now recommends RSV vaccination for people 75 and older, and for those 60 to 74 if they’re at higher risk of severe illness (from, say, heart disease).

As data from the 2024-25 season becomes available, researchers hope to determine whether the vaccine will remain a one-and-done, or whether immunity will require repeated vaccination.

People 65 and up express the greatest confidence in vaccine safety of any adult group, a 麻豆女优 survey found in April. More than 80% said they were “very “or “somewhat confident” about MMR, shingles, pneumonia, and flu shots.

Although the covid vaccine drew lower support among all adults, more than two-thirds of older adults expressed confidence in its safety.

Even skeptics might become excited about one possible benefit of the shingles vaccine: This spring, Stanford researchers reported that over seven years, vaccination against shingles , a finding that made headlines.

Biases often undermine observational studies that compare vaccinated with unvaccinated groups. “People who are healthier and more health-motivated are the ones who get vaccinated,” said Pascal Geldsetzer, an epidemiologist at the Knight Initiative for Brain Resilience at Stanford and lead author of the study.

“It’s hard to know whether this is cause and effect,” he said, “or whether they’re less likely to develop dementia anyway.”

So the Stanford team took advantage of a “natural experiment” when the first shingles vaccine, Zostavax, was introduced in Wales. Health officials set a strict age cutoff: People who turned 80 on or before Sept. 1, 2013, weren’t eligible for vaccination, but those even slightly younger were eligible.

In the sample of nearly 300,000 adults whose birthdays fell close to either side of that date, almost half of the eligible group received the vaccine, but virtually nobody in the older group did.

“Just as in a randomized trial, these comparison groups should be similar in every way,” Geldsetzer explained. A substantial reduction in dementia diagnoses in the vaccine-eligible group, with a much stronger protective effect in women, therefore constitutes “more powerful and convincing evidence,” he said.

The team also found reduced rates of dementia after shingles vaccines were and other countries. “We keep seeing this in one dataset after another,” Geldsetzer said.

In the United States, where a more potent vaccine, Shingrix, became available in 2017 and supplanted Zostavax, Oxford investigators found .

By matching almost 104,000 older Americans who received a first dose of the new vaccine (full immunization requires two) with a group that had received the earlier formulation, they found delayed onset of dementia in the Shingrix group.

How a shingles vaccine might reduce dementia remains unexplained. Scientists have suggested that viruses themselves may contribute to dementia, so suppressing them could protect the brain. Perhaps the vaccine revs up the immune system in general or affects inflammation.

“I don’t think anybody knows,” said Paul Harrison, a psychiatrist at Oxford and a senior author of the study. But, he added, “I’m now convinced there’s something real here.”

Shingrix, now recommended for adults over 50, in preventing shingles and the lingering nerve pain that can result. In 2021, however, had received one dose of either shingles vaccine.

A connection to dementia will require further research, and Geldsetzer is trying to raise philanthropic funding for a clinical trial.

And “if you needed another reason to get this vaccine,” Schaffner said, “here it is.”

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The room, decorated with an under-the-sea theme, had a balloon arch decked out with streamers meant to look like jellyfish and a cloud of clear balloons mimicking ocean bubbles.

Kennedy comes to this memory cafe twice a month since being diagnosed with early onset Alzheimer’s disease in his late 50s.

Everyone here has a degree of memory loss or is a caregiver for someone with memory loss.

Attendees colored on worksheets with an underwater theme. They drank coffee and returned to the breakfast bar for seconds on pastries.

A quick round of trivia got everyone’s minds working.

“We start out with just little trivia 鈥� many of us cannot answer any of the questions,” Kennedy said with a laugh.

“We all have a good time going around,” he added. “You know, we all try to make it fun.”

The northeastern Pennsylvania memory cafe Kennedy attends is one of around the country, according to Dementia Friendly America. The gatherings for people with cognitive impairment and their caregivers are relatively cheap and easy to run 鈥� often the only expense is a small rental fee for the space.

As state and local health departments nationwide try to make sense of what the potential loss of will mean for the services they can offer their communities, memory cafe organizers believe their work may become even more important.

Losing Memory, and Other Things, Too

Kennedy’s diagnosis led him to retire, ending a decades-long career as a at the .

He recommends memory cafes to other people with dementia and their families.

“If they’re not coming to a place like this, they’re doing themselves a disservice. You got to get out there and see people that are laughing.”

The memory cafes he attends happen twice a month. They have given him purpose, Kennedy said, and help him cope with negative emotions around his diagnosis.

“I came in and I was miserable,” Kennedy said. “I come in now and it’s like, it’s family, it’s a big, extended family. I get to meet them. I get to meet their partners. I get to meet their children. So, it’s really nice.”

in the U.S. have been diagnosed with some form of dementia. The diagnosis can be burdensome on relationships, particularly with family members who are the primary caregivers.

A new report from the found that 70% of caregivers reported that coordinating care is stressful. Socializing can also become more difficult after diagnosis.

“One thing I have heard again and again from people who come to our memory cafe is 鈥榓ll of our friends disappeared,’” said , a social worker at , where she directs the Alzheimer’s and related dementia family support program.

The inclusion of caregivers is what distinguishes memory cafes from other programs that serve people with cognitive impairment, like adult day care. Memory cafes don’t offer formal therapies. At a memory cafe, having fun together and being social supports the well-being of participants. And that support is for the patient and their caregiver 鈥� because both can experience social isolation and distress after a diagnosis.

A 2021 study published in indicated that even online memory cafes during the pandemic provided social support for both patients and their family members.

“A memory cafe is a cafe which recognizes that some of the clients here may have cognitive impairment, some may not,” said , a geriatrics professor at the University of Pennsylvania’s Perelman School of Medicine and the co-director of the .

Karlawish regularly recommends memory cafes to his patients, in part because they benefit caregivers as well.

“The caregiver-patient dyad, I find often, has achieved some degree of connection and enjoyment in doing things together,” Karlawish said. “For many, that’s a very gratifying experience, because dementia does reshape relationships.”

“That socialization really does help ease the stress that they feel from being a caregiver,” said , a neurologist who also teaches at Penn’s Perelman School of Medicine. “We know that patients have better quality of life when their caregivers are under less stress.”

An Affordable Way To Address a Growing Problem

As the population grows older, the number of available family caregivers is decreasing, according to the The report found that the number of potential caregivers for an individual 80 or older will decrease significantly by 2050.

In 2024, the Alzheimer’s Association issued a in dementia cases in the U.S. from an estimated 6.9 million people age 65 or older currently living with Alzheimer’s disease to 13.8 million people by 2060. It attributed this increase primarily to the aging of the baby boom generation, or those born between .

As cases of memory loss are projected to rise, the Trump administration is attempting to cut billions in health spending. Since memory cafes don’t rely on federal dollars, they may become an even more important part of the continuum of care for people with memory loss and their loved ones.

“We’re fighting off some pretty significant Medicaid cuts at the congressional level,” said , director of Medicaid policy for , a national nonprofit network of services for people as they age. “Medicaid is a program that doesn’t necessarily pay for memory cafes, but thinking about ensuring that the long-term care continuum and the funding mechanisms that support it are robust and remain available for folks is going to be key.”

The nonprofit operates two memory cafes in Toledo, Ohio. They’re virtually free to operate, because they take place in venues that don’t require payment, according to , the executive director.

“That really helps from a cost standpoint, from a funding standpoint,” Bollin said.

One of the memory cafes takes place once a month at a local coffee shop. The other meets at the Toledo Museum of Art. MemoryLane Care Services provides the museum employees with training in dementia sensitivity so they can lead tours for the memory cafe participants.

The memory cafe that Rob Kennedy attends in Pennsylvania costs about $150 a month to run, according to the host organization, .

“This is a labor of love,” said board member , referring to the volunteers who run the memory cafe. “The fact that they’re giving up time 鈥� they recognize that this is important.”

The monthly budget goes toward crafts, books, coffee, snacks, and some utilities for the two-hour meetings. Local foundations provide grants that help cover those costs.

Even though memory cafes are inexpensive and not dependent on federal funding, they could face indirect obstacles because of the Trump administration’s recent funding cuts.

Organizers worry the loss of federal funds could negatively affect the host institutions, such as libraries and other community spaces.

Memory Cafe Hot Spot: Wisconsin

At least 39 states have hosted memory cafes recently, according to Wisconsin has the most 鈥� more than 100.

The state has a strong infrastructure focused on memory care, which should keep its memory cafes running regardless of what is happening at the federal level, according to , a professor emerita of psychology at the . She co-founded the , which oversees .

“They’ve operated on the grassroots, they’ve operated on pretty small budgets and a lot of goodwill,” she said.

Since 2013, Wisconsin has also had a unique network for dementia care, with state-funded for each county and federally recognized tribe in Wisconsin. The specialists help connect individuals with cognitive impairment to community resources, bolstering memory cafe attendance.

McFadden first heard about memory cafes in 2011, before they were popular in the United States. She was conducting research on memory and teaching courses on aging.

McFadden reached out to memory cafes in the United Kingdom, where the model was already popular and well connected. Memory cafe organizers invited her to visit and observe them in person, so she planned a trip overseas with her husband.

Their tour skipped over the typical tourist hot spots, taking them to more humble settings.

“We saw church basements and senior center dining rooms and assisted living dining rooms,” she said. “That, to me, is really the core of memory cafes. It’s hospitality. It’s reaching out to people you don’t know and welcoming them, and that’s what they did for us.”

After her trip, McFadden started applying for grants and scouting locations that could host memory cafes in Wisconsin.

She opened her first one in Appleton, Wisconsin, in 2012, just over a year after her transformative trip to the U.K.

These days, she points interested people to a national directory of memory cafes hosted by . The organization’s also offers training modules 鈥� developed by McFadden and her colleague 鈥� to help people establish cafes in their own communities, wherever they are.

“They’re not so hard to set up; they’re not expensive,” McFadden said. “It doesn’t require an act of the legislature to do a memory cafe. It takes community engagement.”

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Sara Stewart was talking at the dining room table with her mother, Barbara Cole, 86 at the time, in Bar Harbor, Maine. Stewart, then 59, a lawyer, was making one of her extended visits from out of state.

Two or three years earlier, Cole had begun showing troubling signs of dementia, probably from a series of small strokes. “I didn’t want to yank her out of her home,” Stewart said.

So with a squadron of helpers 鈥� a housekeeper, regular family visitors, a watchful neighbor, and a meal delivery service 鈥� Cole remained in the house she and her late husband had built 30-odd years earlier.

She was managing, and she usually seemed cheerful and chatty. But this conversation in 2014 took a different turn.

“She said to me: 鈥楴ow, where is it we know each other from? Was it from school?’” her daughter and firstborn recalled. “I felt like I’d been kicked.”

Stewart remembers thinking, “In the natural course of things, you were supposed to die before me. But you were never supposed to forget who I am.” Later, alone, she wept.

People with advancing dementia do regularly fail to recognize beloved spouses, partners, children, and siblings. By the time Stewart and her youngest brother moved Cole into a memory-care facility a year later, she had almost completely lost the ability to remember their names or their relationship to her.

“It’s pretty universal at the later stages” of the disease, said Alison Lynn, director of social work at the Penn Memory Center, who has led support groups for dementia caregivers for a decade.

She has heard many variations of this account, a moment described with grief, anger, frustration, relief, or some combination thereof.

These caregivers “see a lot of losses, reverse milestones, and this is one of those benchmarks, a fundamental shift” in a close relationship, she said. “It can throw people into an existential crisis.”

It’s hard to determine what people with dementia 鈥� a category that includes Alzheimer’s disease and many other cognitive disorders 鈥� know or feel. “We don’t have a way of asking the person or looking at an MRI,” Lynn noted. “It’s all deductive.”

But researchers are starting to investigate how family members respond when a loved one no longer appears to know them. A qualitative study in the journal Dementia analyzed in-depth interviews with adult children caring for mothers with dementia who, at least once, did not recognize them.

“It’s very destabilizing,” said Kristie Wood, a clinical research psychologist at the University of Colorado Anschutz Medical Campus and co-author of the study. “Recognition affirms identity, and when it’s gone, people feel like they’ve lost part of themselves.”

Although they understood that nonrecognition was not rejection but a symptom of their mothers’ disease, she added, some adult children nevertheless blamed themselves.

“They questioned their role. 鈥榃as I not important enough to remember?’” Wood said. They might withdraw or visit less often.

Pauline Boss, the family therapist who developed the theory of “” decades ago, points out that it can involve physical absence 鈥� as when a soldier is missing in action 鈥� or psychological absence, including nonrecognition because of dementia.

Society has no way to acknowledge the transition when “a person is physically present but psychologically absent,” Boss said. There is “no death certificate, no ritual where friends and neighbors come sit with you and comfort you.”

“People feel guilty if they grieve for someone who’s still alive,” she continued. “But while it’s not the same as a verified death, it is a real loss and it just keeps coming.”

Nonrecognition takes different forms. Some relatives report that while a loved one with dementia can no longer retrieve a name or an exact relationship, they still seem happy to see them.

“She stopped knowing who I was in the narrative sense, that I was her daughter Janet,” Janet Keller, 69, an actress in Port Townsend, Washington, said in an email about her late mother, diagnosed with Alzheimer’s. “But she always knew that I was someone she liked and wanted to laugh with and hold hands with.”

It comforts caregivers to still feel a sense of connection. But one of the respondents in the Dementia study reported that her mother felt like a stranger and that the relationship no longer provided any emotional reward.

“I might as well be visiting the mailman,” she told the interviewer.

Larry Levine, 67, a retired health care administrator in Rockville, Maryland, watched his husband’s ability to recognize him shift unpredictably.

He and Arthur Windreich, a couple for 43 years, had married when Washington, D.C., legalized same-sex marriage in 2010. The following year, Windreich received a diagnosis of early-onset Alzheimer’s.

Levine became his caregiver until his death at 70, in late 2023.

“His condition sort of zigzagged,” Levine said. Windreich had moved into a memory-care unit. “One day, he’d call me 鈥榯he nice man who comes to visit’,” Levine said. “The next day he’d call me by name.”

Even in his final years when, like many dementia patients, Windreich became largely nonverbal, “there was some acknowledgment,” his husband said. “Sometimes you could see it in his eyes, this sparkle instead of the blank expression he usually wore.”

At other times, however, “there was no affect at all.” Levine often left the facility in tears.

He sought help from his therapist and his sisters, and recently joined a support group for LGBTQ+ dementia caregivers even though his husband has died. Support groups, in person or online, “are medicine for the caregiver,” Boss said. “It’s important not to stay isolated.”

Lynn encourages participants in her groups to also find personal rituals to mark the loss of recognition and other reverse milestones. “Maybe they light a candle. Maybe they say a prayer,” she said.

Someone who would sit shiva, part of the Jewish mourning ritual, might gather a small group of friends or family to reminisce and share stories, even though the loved one with dementia hasn’t died.

“To have someone else participate can be very validating,” Lynn said. “It says, 鈥業 see the pain you’re going through.’”

Once in a while, the fog of dementia seems to lift briefly.

Researchers at Penn and elsewhere have pointed to a startling phenomenon called “.” Someone with severe dementia, after being noncommunicative for months or years, suddenly regains alertness and may come up with a name, say a few appropriate words, crack a joke, make eye contact, or sing along with a radio.

Though common, these episodes generally last only seconds and don’t mark a real change in the person’s decline. Efforts to recreate the experiences tend to fail.

“It’s a blip,” Lynn said. But caregivers often respond with shock and joy; some interpret the episode as evidence that despite deepening dementia, they are not truly forgotten.

Stewart encountered such a blip a few months before her mother died. She was in her mother’s apartment when a nurse asked her to come down the hall.

“As I left the room, my mother called out my name,” she said. Though Cole usually seemed pleased to see her, “she hadn’t used my name for as long as I could remember.”

It didn’t happen again, but that didn’t matter. “It was wonderful,” Stewart said.

The New Old Age is produced through a partnership with .

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Relating to Relatives of Lonely Dementia Patients

I was sent the article by Judith Graham on older adults with dementia living alone (“,” Oct. 15). I appreciate this article. My mom lives alone with dementia. My son lives next door and checks on her, and my daughter comes when she is able to vacuum floors and to scrub the kitchen and bathroom. I handle the bills, clean and change her clothes, wash her clothes, search for mail, and bring in groceries. She refused to allow the home health aide in, which complicates the care schedule. Neighbors watch out for her, including police at the station across the street. It is complex and complicated for caregivers. Applying for Medicaid is a nightmare, as is searching for memory care facilities. The thought of actually moving her is heartbreaking and so stressful. Again: Thank you for sharing that others with dementia are living on their own.

— Gail Daniels, Washington, D.C.

On the social platform X, a reader drew on her own experience:

Having cared for my mom toward the end of her journey with dementia, this is terrifying.

For many elders, there is no family to cushion the insults of dementia and cognitive decline.

— Shava Nerad – @shava23@bluesky 🌻 (@shava23)

— Shava Nerad, Arlington, Massachusetts

Bonding — To the Letter

Thanks a million! I read your article “” (Sept. 17) in the and related to it on a major level. As a senior living alone, I am experiencing some of the same “social isolation” expressed by your interviewees. Since I love to write, I thought it would be interesting to involve some of the persons mentioned in a nationwide pen pal association. This would place very little demand on their budget (other than postage and stationery), on their time, and with little or no travel involved.

It is breathtakingly exhilarating to receive a letter from a friend or relative, a package from anywhere, and experience the reward of sitting down and reading good news from afar.

I appreciate our advances in technology and I use it rather sparingly. However, I come from a generation that writes in cursive, knows the five elements of letter writing, and understands what a return address is and where it’s positioned on an envelope.

— Gloria Rankin, Las Vegas

A specialist in health economics and policy tweeted praise:

Historic Numbers of Americans Live by Themselves as They Age

Important, impactful story by superb

— Paul Hughes-Cromwick (Pooge) (@cromwick)

—  Paul Hughes-Cromwick (Pooge), Ann Arbor, Michigan

On X, a group of interdisciplinary faculty representing Johns Hopkins University shared 麻豆女优 Health News’ coverage about racial bias in the development and use of pulse oximeters:

In a article, BDP @iwashyna explains how we move forward from the racial bias of our current pulse oximeters.

— Bloomberg Distinguished Professors (@JHU_BDPs)

A Slap on the Wrist for Pulse Oximeters

Between 1983 and 1988, I had four sons at Stanford Hospital. I was friends with Eben Kermit, who was a bioengineer. He was developing the original pulse oximeter on babies in the neonatal intensive care unit (“: ,” Oct. 7). He tested only white babies. That is because white parents could come to the NICU in the daytime, which is when Eben was at work in the NICU. Black parents could come only at night because their work wouldn’t give them time off to care for a very sick baby. Since no one was there to sign consent forms, at night, with the Black parents, no Black children were included. Discrimination against Black parents by their employers is continuing to cascade through the Black community through the exclusion of Black people from the development of medical technology.

— Zoe Joyner Danielson, a toxicology biologist, Woodland, California

This X post came from a consulting and training firm that focuses on health equity issues:

Reforms are needed ASAP—these devices have harmed so many patients.

FDA’s Promised Guidance on Pulse Oximeters Unlikely To End Decades of Racial Bias by CC: @iwashyna

— HealthBegins (@HealthBegins)

What’s All This Fuss About Fluoride?

No one seems to address the fact that not everyone drinks water from public water systems (“,” Nov. 18). I see many people buying bottled water by the trunkful, or have a water fountain at home with 5-gallon bottles of purified drinking water, or have reverse osmosis water filtration systems installed at their sink.

So even if RFK Jr. removes fluoride from public water systems, I can’t see that there would be a drastic increase in dental issues. Also, when you get your teeth cleaned at the dentist, they give you a fluoride treatment (unless you opt out). So on this issue of removing fluoride, would this be a drastic issue knowing that many now are not getting fluoridated water?

— Suzann Lebda, Sun Lakes, Arizona

Hitting the Paywall

Why does your newsletter link to articles with paywalls? As an example:

The Oct. 18 aggregation “” links to Stat News, where the article cannot be read without a subscription. If you are doing this as a means to provide subscribers to them, too bad.

In any case, this practice does not represent your organization well since it supports the trend that only those who can afford it get to be informed. I hope you reconsider this practice.

The financial barriers to accessing important information are hurting us as individuals and as a society. It is expensive for most people to have access to a mainstream publication, but it gets cost-prohibitive to have access to multiple points of view, to learn, reason, and make up our own minds. In most cases, the only alternative available is to get “bites of information” from the “free” social media. The results are as one would expect: We become less aware of what is really going on as we are guided into silos of ignorance.

Thank you.

— Carl Loben, Bellevue, Washington

On X, a technology journalist in Spain shared the article about pregnant people being asked by their providers to pay out-of-pocket fees earlier than expected:

Pay first, deliver later: Some pregnant people are being asked to prepay for their baby

— José María López (@gilead1984)

— José María López, Badalona, Spain

A New Generation of Health Plans Overdue

The recent article “” (Nov. 15) effectively highlights the emotional and financial uncertainty facing providers and patients. I commend the author for capturing how this uncertainty, rooted in empathy and fairness, must be better understood and addressed.

I write to draw attention to market trends and federal legislation aimed at alleviating this issue. Until recently, health plans considered the out-of-pocket experience as definitionally out-of-scope, leaving patients, and providers, to manage this growing uncertainty on their own.

The evidence shows that it is possible to build a more pragmatic and empathic out-of-pocket experience into a health plan, improving care accessibility and affordability without removing patient responsibility. This approach has been proven, across thousands of employer health plans, to feel better and financially benefit everyone — patients, providers, and plans (employers/insurers).

On Oct. 15, 2024, the Medicare Prescription Payment Plan launched, offering nearly 54 million Americans the option to have their insurer pay their out-of-pocket expenses upfront at the point of service giving members time to review and repay the balance — without interest or fees. If the patient in the article had a health plan with this capability, her OB-GYN would have been paid, on her behalf, by her insurer. She would have received a simple monthly statement to repay in full or over time from the comfort of her home. Everyone benefits and it is a better member experience.

This new, bipartisan, commonsense improvement to one of health care’s most acute pain points is rapidly expanding as employers and insurers realize there is significant actuarial value, provider savings, and member behavior change caused by improving a person’s ability to pay for care.

Brian Whorley, Columbia, Missouri

An associate professor in the health care leadership program at Rockhurst University’s Helzberg School of Management also shared the article on X:

Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby via

— Prof. Jim Dockins (@DrDockins)

— Jim Dockins, Kansas City, Missouri

On Hospital Gatekeepers and Tolls

In regards to the article “” (Nov. 15): Back in 1992, the hospital where my son was going to be delivered required that the projected copay be paid to them one month before the delivery date or my wife would not be admitted (a Catholic hospital, very charitable).

My wife was born at the same hospital in 1963; at that time, my father-in-law was informed by the hospital that he could not take her home until the bill was paid in full. He contacted a friend who was an attorney who told him to let the hospital know that would be considered kidnapping and that he would be calling the police if they didn’t release her.

— Andrew McGovern, Great River, New York

Taken Advantage Of?

I belong to a Blue Cross Blue Shield Medicare Advantage plan and, for the past several years, it has offered a home assessment with a reward of $25. I have participated in the program in the past but declined this year since I didn’t think there was much value to the program. I am a retired registered nurse, and I felt that the nurse who did my assessment did not do an especially thorough job, and any questions I asked of her, she could not answer. The nurse was also from out of state.

After reading your article on “” (Sept. 30), the reasons for the assessment seem to be more than improving the beneficiary’s health and well-being, which is what I believed. I am relatively healthy and active, so it would not appear that BCBS found any new diagnoses that it could bill Medicare for, but I assume that that is not the case with other seniors.

— Bruce Gilman, Millis, Massachusetts

An economist in Florida had this to say on social media:

Thank you  for pointing out the failed bureaucracy I’ve been talking about for years. You can’t read this and not conclude DC bureaucrats are “captured” and policy makers are beholden to Medicare Advantage lobby money.

— Luke Neumann (@pglukeneumann)

— Luke Neumann, St. Petersburg, Florida

In Defense of Deloitte

On March 12, 2024, in good faith and with respect for 麻豆女优 Health News, Deloitte’s health and human services practice leader provided a 90-minute interview with two reporters for a story they said was about “problems with Deloitte’s eligibility systems across the country.”

We agreed to the interview because we had heard from several of our state clients that they, too, had been contacted, and that the questions being raised showed a misunderstanding of integrated eligibility systems, the technology that sustains them, and the complexity of the health and human services programs they support.

The eligibility systems are owned by the states, not Deloitte; they are uniquely built for each state (in some cases, by other vendors decades ago); and we work at the direction of our clients to maintain and enhance these systems to comply with state-specific policies, rules, and processes, and evolving federal regulations.

Two stories subsequently ran: “” (June 24) and “” (Sept. 5).

Many of the issues reported as “widespread” are isolated to specific situations or involve sensitive data that cannot be refuted by Deloitte due to client confidentiality obligations. That said, there are many reasons why someone may lose coverage or no longer be eligible for a benefit they once received.

Not every “issue” a constituent faces is the result of a system “error,” and challenges with individual cases in individual systems are not due to some fundamental problem in the way Deloitte supports state Medicaid programs.

On the issue of contract changes, Deloitte rejected the claim in March that our state clients send us a “change request … when a fix is needed.” We said that was inaccurate and explained that when there are policy or rule changes — or a global pandemic — that require modifications to a state’s technology, change orders are not only necessary but appropriate.

They do not represent errors in a system that need to be fixed.

Throughout the unwinding of the covid-19 public health emergency — as technologies evolved and policies changed — Deloitte worked closely with states to minimize challenges for those going through the Medicaid redetermination process. The innovations and human-centered design processes we helped our clients implement enhanced the digital experience for their constituents and made it easier for caseworkers, staff, and community partners to support the 34 million people in their care.

Our clients understand that large system implementations are challenging due to the complexity of the programs they support, and that all IT systems require ongoing maintenance, periodic enhancements and upgrades to software and hardware, and database management.

That is why so many states continue to select Deloitte to help them maintain their mission-critical systems, and why industry analysts like Forrester and Gartner consistently rank Deloitte as a leader in system integration and business transformation.

— Karen L. Walsh, Government & Public Services, Deloitte Consulting LLP, Harrisburg, Pennsylvania

[Editor’s note: 麻豆女优 Health News stands by its reporting on Deloitte and the state eligibility determination systems that Deloitte supports.]

An assistant professor at Harvard voiced her opinion on X:

This is such a grim summary of the state of Medicaid eligibility and enrollment systems

— Adrianna McIntyre (@adrianna.bsky.social) (@onceuponA)

— Adrianna McIntyre, Boston

Far Less Than Meets the Eye

I read your article about the new $2,000 limit for out-of-pocket payments for Medicare Part D (“ Oct. 21). As someone with very high drug costs, I was very excited about this change. However, once I researched the different drug plans available for me and my husband, I realized that the money we spend on drugs that are prescribed by a doctor but not covered by our plan will not count toward the $2,000 limit. Therefore, our cost for necessary drugs will continue to be exorbitant.

I think that there are many seniors who will be very disappointed once they realize this.

— Pia Stampe, Eureka, California

In sharing the article on X, a Florida attorney simply shared their contact information:

“Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More:” 
Grady H. Williams, Jr., LL.M., Attorneys at Law P.A.
1543 Kingsley Avenue, Building 5
Orange Park, FL 32073
Tel: 904-264-8800 • Fax: 904-264-0155

— Grady H. Williams (@floridaelder)

— Grady H. Williams, Orange Park, Florida

Shedding Light on Fluorescence in Dental Care

Congratulations on a highly impactful publication (“,” Nov. 1). The facts presented are harrowing for a retired practitioner with multiple specialties who tried a lifetime to preserve teeth and promote human health.

As you might know, oral biofilm is the biggest enemy of oral health and even general health. Dental clinicians have not been able to visualize and identify the presence of pathogenic oral microbiome until recently. Pathogenic oral bacteria are among the significant generators of hard and soft tissue deterioration, such as tooth decay, gum diseases, and even infection of dental implants. The most trusted and used diagnosis procedure is still the X-ray.

X-rays can identify only established diseases. Unfortunately, radiologic diagnosis is still the most trusted diagnostic tool used and taught in dental education.

Microbiology, the microbiome science, utilizes fluorescence as its major identification procedure. Some of the most aggressive oral bacteria, generators of caries, gum diseases, etc., generate so-called porphyrins, which, once excited by a specific wavelength, emit light at a different wavelength. Highly reliable and simple-to-use technologies have been created recently to support direct visualization and point-of-care identification of this pathogenic bacteria through the above-described procedure. These devices support the diagnostic process and help the dental clinician by guiding the treatment execution and identifying when the treatment goal has been achieved. Dental treatment protocols utilizing “Fluorescence-Enhanced Theragnosis” have become reliable and less invasive.

The high loss of human lives in the ICUs during the pandemic due to ventilator-associated pneumonia could have been dramatically reduced using the above protocol.

Wound-care science has already implemented fluorescence and is undergoing a tremendous protocol change. Tumor surgery celebrates fluorescence-guided surgery as a milestone in its development.

Academic dental education is due for an urgent renewal. We must open the doors and facilitate science translation to benefit humankind!

— Liviu Steier, Needham, Massachusetts

A reader who manages a website predicting the collapse of the American health care system commented on X:

🙄😠👎Technically, American dentistry was once ranked as the best in the world. Unfortunately, It has a history of mismanagement and negligence. It’s a “reputational good” that’s been flooded with scams. Now it’s payback time. It’s demonstrating the…

— Francis Anthony Toto (@francisatoto)

— Francis Anthony Toto, San Diego

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It seemed clear they had some type of cognitive impairment. Yet they were living alone.

Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing?

When she reviewed the research literature more than a decade ago, there was little there. “I realized this is a largely invisible population,” she said.

Portacolone got to work and now leads the at UCSF. The project that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States.

About half have trouble with daily activities such as bathing, eating, cooking, shopping, taking medications, and managing money, according to their research. But only 1 in 3 received help with at least one such activity.

Compared with other older adults who live by themselves, people living alone with cognitive impairment are older, more likely to be women, and disproportionately Black or Latino, with lower levels of education, wealth, and homeownership. Yet for publicly funded programs such as Medicaid that pay for aides to provide services in the home.

In a health care system that assumes older adults have family caregivers to help them, “we realized this population is destined to fall through the cracks,” Portacolone said.

Imagine what this means. As memory and thinking problems accelerate, these seniors can lose track of bills, have their electricity shut off, or be threatened with eviction. They might stop shopping (it’s too overwhelming) or cooking (it’s too hard to follow recipes). Or they might be unable to communicate clearly or navigate automated phone systems.

A variety of other problems can ensue, including social isolation, malnutrition, self-neglect, and susceptibility to scams. Without someone to watch over them, older adults on their own may experience worsening health without anyone noticing or struggle with dementia without ever being diagnosed.

Should vulnerable seniors live this way?

For years, Portacolone and her collaborators nationwide have followed nearly 100 older adults with cognitive impairment who live alone. She listed some concerns people told researchers they worried most about: “Who do I trust? When is the next time I’m going to forget? If I think I need more help, where do I find it? How do I hide my forgetfulness?”

Jane Lowers, an assistant professor at the Emory University School of Medicine, has been studying “kinless” adults in the early stages of dementia 鈥� those without a live-in partner or children nearby. Their top priority, she told me, is “remaining independent for as long as possible.”

Seeking to learn more about these seniors’ experiences, I contacted the National Council of Dementia Minds. The organization last year started a biweekly online group for people living alone with dementia. Its staffers arranged a Zoom conversation with five people, all with early-to-moderate dementia.

One was Kathleen Healy, 60, who has significant memory problems and lives alone in Fresno, California.

“One of the biggest challenges is that people don’t really see what’s going on with you,” she said. “Let’s say my house is a mess or I’m sick or I’m losing track of my bills. If I can get myself together, I can walk out the door and nobody knows what’s going on.”

An administrator with the city of Fresno for 28 years, Healy said she had to retire in 2019 “because my brain stopped working.” With her pension, she’s able to cover her expenses, but she doesn’t have significant savings or assets.

Healy said she can’t rely on family members who have troubles of their own. (Her 83-year-old mother has dementia and lives with Healy’s sister.) The person who checks on her most frequently is an ex-boyfriend.

“I don’t really have anybody,” she said, choking up.

David West, 62, is a divorced former social worker with , which can impair thinking and concentration and cause hallucinations. He lives alone in an apartment in downtown Fort Worth, Texas.

“I will not survive this in the end 鈥� I know that 鈥� but I’m going to meet this with resilience,” he said when I spoke with him by phone in June.

Since his diagnosis nearly three years ago, West has filled his life with exercise and joined three dementia support groups. He spends up to 20 hours a week volunteering, at a restaurant, a food bank, a museum, and .

Still, West knows that his illness will progress and that this period of relative independence is limited. What will he do then? Although he has three adult children, he said, he can’t expect them to take him in and become dementia caregivers 鈥� an extraordinarily stressful, time-intensive, financially draining commitment.

“I don’t know how it’s going to work out,” he said.

Denise Baker, 80, a former CIA analyst, lives in a 100-year-old house in Asheville, North Carolina, with her dog, Yolo. She has cognitive problems related to a stroke 28 years ago, Alzheimer’s disease, and serious vision impairment that prevents her from driving. Her adult daughters live in Massachusetts and Colorado.

“I’m a very independent person, and I find that I want to do everything I possibly can for myself,” Baker told me, months before Asheville was ravaged by severe flooding. “It makes me feel better about myself.”

She was lucky in the aftermath of Hurricane Helene: Baker lives on a hill in West Asheville that was untouched by floodwaters. In the week immediately after the storm, she filled water jugs every day at an old well near her house and brought them back in a wheelbarrow.  Though her power was out, she had plenty of food and neighbors looked in on her. 

“I’m absolutely fine,” she told me on the phone in early October after a member of drove to Baker’s house to check in on her, upon my request. Baker is on the steering committee of that organization.

Baker once found it hard to ask for assistance, but these days she relies routinely on friends and hired help. A few examples: Elaine takes her grocery shopping every Monday. Roberta comes once a month to help with her mail and finances. Jack mows her lawn. Helen offers care management advice. Tom, a cab driver she connected with through Buncombe County’s transportation program for seniors, is her go-to guy for errands.

Her daughter Karen in Boston has the authority to make legal and health care decisions when Baker can no longer do so. When that day comes 鈥� and Baker knows it will 鈥� she expects her long-term care insurance policy to pay for home aides or memory care. Until then, “I plan to do as much as I can in the state I’m in,” she said.

Much can be done to better assist older adults with dementia who are on their own, said Elizabeth Gould, co-director of the National Alzheimer’s and Dementia Resource Center at RTI International, a nonprofit research institute. “If health care providers would just ask 鈥榃ho do you live with?’” she said, “that could open the door to identifying who might need more help.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit聽聽to submit your requests or tips.

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By the time their lives intersected at Canyon Creek Memory Care Community in Billings, Montana, both were deep in the grips of dementia and exhibiting some of the disease’s terrible traits.

Shively had been wandering lost in his neighborhood, having outbursts at home, and leaving the gas stove on. Dowd previously had been hospitalized for being confused, suicidal, and agitated, medical records filed in U.S. District Court in Billings show. When Dowd entered Canyon Creek, managers warned employees in a note later filed in court that he could be “physically/verbally abusive when frustrated.”

On Shively’s fourth day at Canyon Creek, carrying a knife and fork, he walked over to a dining room table where Dowd was sitting. Dowd told Shively to keep the knife away from his coffee, according to a witness statement filed in court. Shively, who at 5-foot-2 and 125 pounds was half Dowd’s weight and 10 inches shorter, turned to walk away, but Dowd stood up and shoved Shively so hard that when he hit the floor, his skull fractured and brain hemorrhaged, according to a lawsuit his family filed against Canyon Creek.

“The doctor said there’s not much they could do about it,” his son Casey Shively said in an interview.

Dan Shively died five days later at age 73.

Police did not charge Dowd, then 66. He stayed at Canyon Creek for nearly three more years, during which time he repeatedly clashed with residents, sometimes hitting male residents and groping female ones, according to facility records filed in the court case. His anger would flare quickly. “I’m literally scared to death of Jeff,” one nurse wrote in a filed statement describing Dowd’s dispute with another resident.

In court, Canyon Creek denied liability for Shively’s death. Its privately held corporate owner, Koelsch Communities, declined to answer questions from 麻豆女优 Health News. Chase Salyers, Koelsch’s director of marketing, said in an email to 麻豆女优 Health News that the company prioritizes “the health, well-being, safety, and security of our residents.”

Dowd’s relatives said in a statement via text they would not comment because they had no firsthand knowledge. “We were very pleased with the care Jeffrey received at Canyon Creek,” they added. Dowd was not named in the lawsuit and his current whereabouts could not be determined.

Violent altercations between residents in long-term care facilities are alarmingly common. Across the country, residents in nursing homes or assisted living centers have been killed by other residents who weaponized , shoved into a person’s mouth, or .

A in JAMA Network Open of 14 New York assisted living homes found that, within one month, 15% of residents experienced verbal, physical, or sexual resident-on-resident aggression. Another study found nearly engaged in physical aggression or abuse toward residents or staff members within one month. Dementia residents are to be involved in altercations because the parts of the brain affecting memory, language, reasoning, and social behavior.

More than with Alzheimer’s or other types of dementia reside in nursing homes and assisted living centers. Many of the most seriously impaired live in the roughly 5,000 facilities with locked dementia floors or wings or the 3,300 homes devoted exclusively to memory care. These places are mostly for-profit and often charge thousands of dollars extra a month, promising expertise in the disease and a safe environment.

Clashes can be spontaneous and too unpredictable to prevent. But the chance of an altercation increases when memory care homes admit and retain residents they can’t manage, according to a 麻豆女优 Health News examination of inspection and court records and interviews with researchers. Homes that have too few staffers or nonexistent or perfunctory training for employees have a harder time heading off resident conflicts. Homes also may fail to properly assess incoming residents or may keep them despite demonstrated threats to others.

“As much as long-term care providers in general do their best to provide competent, high-quality care, there is a real problem with endemic violence,” said Karl Pillemer, a gerontologist at Cornell University and lead author of the JAMA study.

“There needs to be much more of an effort to single out verbal and physical aggression that occurs in long-term care,” he said, “and begin to create a model of violence-free zones in the same way we have violence-free zones in the schools.”

A Danger to Others

The first signs of Shively’s emerged in 2011 as confusion, but the disease accelerated in 2016, according to interviews with his wife and children and his medical records. He began referring to mountains he knew well by the wrong name and forgot how to tie flies on his fishing line. “The decline was so slow at first we thought we could manage,” his wife, Tana Shively, said in an interview before this year.

As the disease progressed, his outbursts became hard to handle. He took a swing at one of his sons when upset about the temperature in the house. He refused to swallow his medications and fell repeatedly.

“He would start walking the neighborhood and get lost,” Casey said. “He would turn on the gas stove but not light the stove, and the room would start filling up with gas. He would put clothing in strange places. I found socks in a punch bowl. It got to the point where we couldn’t do this anymore.”

Dowd, meanwhile, had lived in a Santa Fe nursing home and had a long history of dementia with behavioral issues, major depressive disorder with psychotic features, and hypertension, according to medical records filed in court. Dowd entered Canyon Creek in October 2018 to be closer to his brother, who lived nearby in Wyoming, according to an admission notice the facility provided to employees that was included in the court record. The notice said Dowd suffered from .

Two months later, Shively moved in.

Montana licenses Canyon Creek, which has 67 beds, as a Level C assisted living facility, which permits it to house people with cognitive impairments so severe that they cannot express their needs or make basic care decisions. these facilities cannot admit or retain a resident who is “a danger to self or others.”

In the lawsuit, Shively’s family argued that, given that law, Canyon Creek never should have accepted or kept Dowd. The Shively family’s lawyer, Torger Oaas, noted in court papers that Canyon Creek’s intake assessment form for Dowd categorized his behavior as “physically and/or verbally abusive/aggressive 1x per month.” Oaas also wrote in court papers that in Dowd’s first weeks at Canyon Creek, he mocked and threatened to hit other residents and threw someone’s silverware to the ground during dinner.

In its defense filings in the lawsuit, Canyon Creek said the Montana statute was too broad to be the basis of a negligence claim and argued that all memory care residents are unpredictable. And while Dowd had yelled and cursed at other residents at Canyon Creek, he hadn’t had physical confrontations 鈥� or any conflicts with Shively, Canyon Creek said. “The accident was not reasonably foreseeable,” Canyon Creek argued.

In the days after Shively’s fall, nurses noted that Dowd was “more anxious, angry toward others.” Dowd yelled at a nurse to get off the phone and “do your job,” a nurse wrote in a logbook entry filed in court.

“He got into my face,” the nurse wrote. “It looked like he was going to hit me 鈥� he had his hand/fist raised.”

鈥楢s Bad as I’ve Ever Seen It’

People with dementia will lash out because they no longer have social inhibitions or because it’s the only way they can express pain, discomfort, fear, disagreement, or anxiety. Some 鈥� overstimulation from loud noises, a frenzied atmosphere, unfamiliar faces 鈥� are hallmarks of dementia care institutions.

“We can’t expect someone who is constantly and unfailingly disoriented to adapt to our environment anymore,” said , a licensed clinical social worker and dementia researcher in Florida. “We have to adapt to them.”

Eilon Caspi, a researcher, analyzed 105 fatal incidents involving dementia residents and found 44% were fatal falls in which one resident pushed another. “Some people are aggressive, and some are violent,” Caspi said, “but if you look closely, the vast majority are doing their best while living with a serious brain disease.”

Holly Harmon, a senior vice president at the American Health Care Association/National Center for Assisted Living, an industry trade group, said in a written statement that conflicts cannot always be averted despite facility operators’ best efforts. “If they do occur,” she said, “providers respond promptly with interventions to protect the residents and staff and prevent future occurrences.”

But Richard Mollot, executive director of the Long Term Care Community Coalition, a resident advocacy group, said many operators of assisted living centers, including memory care units, are driven by the bottom line. “The issue that we see quite often is that assisted living retains people they should not,” Mollot said. “They don’t have the staffing or the competency or the structure to provide safe care.” Conversely, he said, when facilities have enough rooms filled with paying customers, they are more likely to evict residents who require too much attention.

“They will kick them out if they’re too cumbersome,” Mollot said.

Teepa Snow, an occupational therapist who founded , a company that trains dementia caregivers, noted that the space inside many facilities, with double rooms, tight common areas, and restricted outdoor access, can fuel conflicts. She said the pandemic degraded conditions in long-term care, as dementia residents with limited social skills atrophied in isolation in their rooms and staffing grew even sparser.

“It’s as bad as I’ve ever seen it,” she said.

鈥榁ery Common Fits of Rage’

The following account of Dowd’s time at Canyon Creek is based on 44 pages of nurse’s notes, witness statements, and internal resident-on-resident altercation reports; all were contained in the facility’s records and filed as exhibits in the court case. After Shively’s death in December 2018, Dowd was given new prescriptions, although the court record is unclear if the change was because of Shively’s death. Still, the records show, Canyon Creek was unable to head off recurring altercations involving Dowd.

Some were verbal threats. Once, Dowd yelled at residents in the living room to shut up, called them “retards” and told them they should all die, a caregiver wrote in a witness statement. He grabbed one resident’s face and threatened to kill him, according to a nurse’s note. Another time, Dowd went up to a resident sitting on a sofa and grabbed his walker. Dowd shook it and told him to shut up. According to a witness statement, as a nurse took the resident to the bathroom, Dowd muttered under his breath: “Stuff his head in the toilet.”

Other conflicts were physical. Dowd shoved a resident “down on his back so hard his head bounced off the floor,” a nurse recorded in a note. In a different incident reported by a nurse, Dowd pushed a resident who had been agitated and cursing into a chair. On separate occasions, Dowd hit two residents on the head, once causing bleeding, according to two resident altercation reports.

The notes detail that Dowd was not always the initiator. Once, Dowd’s roommate scratched and punched him after Dowd told him to use the toilet rather than pee on the floor, resulting in a fight. Caregivers separated the two. Another day, a resident named Bill wandered into Dowd’s room and pulled Dowd’s hair and beard. Dowd told the nurses he “felt unsafe and VERY angry,” a nurse’s note said. The nurse led Bill out of Dowd’s room, but Dowd followed, yelling at Bill that he was “a fat bastard” and saying he was going to make Bill’s wife a widow.

“Jeff kept making a closed fist as tho he was going to hit Bill,” the nurse wrote in a witness statement. “I was legit scared because there was nothing I could do to defuse the situation. I’m literally scared to death of Jeff. I’m scared to approach him and talk to him when he gets into these very common fits of rage.”

Dowd ultimately went back to his room and a worker locked his door so no other resident would go in.

The records describe how Canyon Creek caregivers intervened after altercations began, often separating the fighting residents and updating Dowd’s brother on the clashes. Nurses would remove Dowd or the other resident from a room and discourage such acts. “Tried to explain it was inappropriate to hurt others,” one nurse wrote after one incident.

Salyers, the company marketing director, said in his email that the workers at Canyon Creek and other Koelsch facilities are “highly qualified” and “extensively trained.” He said the company’s memory care communities are “distinctively designed and staffed” for people with Alzheimer’s and other forms of dementia.

鈥業t’s Nice To Have a Girlfriend’

The nursing notes and statements in the court file suggest that incidents were frequent enough that nurses commented on Dowd’s occasional serenity. “No agitated or aggressive behaviors this shift,” one note said. Another nurse note said Dowd “continues to isolate at meals, sitting at a table by himself.” While Dowd enjoyed reading books and doing puzzles, he was overheard saying he was depressed and was “wondering if he wouldn’t be better off if he wasn’t around anymore.”

Nurses noted Dowd repeatedly exhibited sexual behavior that was either inappropriate 鈥� making “crude oral gestures while looking at younger females” 鈥� or ambiguous, such as placing his hand on a resident’s shoulder and commenting, “It’s nice to have a girlfriend.” Someone saw Dowd “grabbing on multiple residents[’] private areas,” a witness statement said. When nurses caught the behavior, they separated those involved and rebuked Dowd. A staff member wrote in a statement that Dowd was inappropriate throughout her shift, making sexual jokes and “trying to grab me.”

According to nursing notes, in summer 2021, Dowd told one female resident he wanted to see her genitals and later touched her breast. In August, a caregiver walked into Dowd’s room and found him touching the same resident under her shirt and pants. The caregiver told Dowd to “stop it and not ever do that again” and brought the woman out to meet her family, who had come to visit her.

After that incident, Canyon Creek sent Dowd to the emergency room at Montana State Hospital, a public psychiatric facility, according to a nurse administrator’s testimony in a deposition filed in court. The nurse testified Dowd was no longer at Canyon Creek. That is the last mention of Dowd’s whereabouts in the public record. A spokesperson for the Montana Department of Public Health and Human Services, which oversees the hospital, would not confirm whether he was a patient.

At a pretrial hearing, the judge excluded discussion about Dowd’s altercations after Shively’s death. In a court filing, Shively’s lawyer asked permission to share evidence with the jury that Canyon Creek gave its executive director a bonus any month when 90% or more of the beds were filled so he could argue Canyon Creek had a financial motivation to admit Dowd. But the judge also barred that information from the trial, which Canyon Creek said in a court filing was irrelevant.

The Shively case went to trial in 2022 before a federal civil jury in Billings. Despite the exclusions, the jury decided Canyon Creek’s negligence caused Shively’s death. It awarded the family $310,000.

“For us, the money wasn’t a huge factor,” said Spencer Shively, another of Dan Shively’s sons, who called the as to be a victory for Canyon Creek or its insurer. “At least they were negligent per se. But I don’t know it really changed anything. For me, I got some closure. I feel like these facilities are just continuing to do the same things they’re going to do because there hasn’t been systemic change.”

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Céline Gounder, 麻豆女优 Health News’ senior fellow and editor-at-large for public health, on “CBS Mornings” discussed new research that found the shingles vaccine may delay the onset of dementia. Gounder also discussed a covid-19 study that shows state mask and vaccine mandates save lives on CBS’ “CBS News 24/7.”

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麻豆女优 Health News聽senior contributing editor Elisabeth Rosenthal discussed the cost of cancer care in the wake of James Van Der Beek’s death on ABC News’ ABC News Live on Feb. 12.

麻豆女优 Health News Southern California correspondent Claudia Boyd-Barrett discussed how families of detainees by the U.S. Immigration and Customs Enforcement agency are struggling to find those who have been hospitalized on KQED’s The California Report on Feb. 10.

• Read Boyd-Barrett’s “鈥�I Can’t Tell You’: Attorneys, Relatives Struggle To Find Hospitalized ICE Detainees.”

Céline Gounder, 麻豆女优 Health News’ editor-at-large for public health, discussed a new study linking daily coffee or caffeinated tea intake to lower dementia risk on CBS News’ CBS Mornings on Feb. 10.

麻豆女优 Health News senior correspondent Aneri Pattani discussed differing opinions within the addiction medicine community on WNO’s Louisiana Considered on Feb 6.

• Read Pattani’s “Inside the Battle for the Future of Addiction Medicine.”

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The most important reason for older adults to be vaccinated against the respiratory infection RSV is that their by almost 70% in the year they get the shot, and by nearly 60% over two years.

And the main reason to roll up a sleeve for an annual flu shot is that when people do get infected, it also reliably reduces the severity of illness, though its effectiveness varies by how well scientists have predicted which strain of influenza shows up.

But other reasons for older people to be vaccinated are emerging. They are known, in doctor-speak, as off-target benefits, meaning that the shots do good things beyond preventing the diseases they were designed to avert.

The list of off-target benefits is lengthening as “the research has accumulated and accelerated over the last 10 years,” said William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville, Tennessee.

Some of these protections have been established by years of data; others are the subjects of more recent research, and the payoff is not yet as clear. The first RSV vaccines, for example, became available only in 2023.

Still, the findings “are really very consistent,” said Stefania Maggi, a geriatrician and senior fellow at the Institute of Neuroscience at the National Research Council in Padua, Italy.

She is the lead author of , published in the British journal Age and Ageing, that found reduced risks of dementia after vaccination for an array of diseases. Given those “downstream effects,” she said, vaccines “are key tools to promote healthy aging and prevent physical and cognitive decline.”

Yet too many older adults, whose weakening immune systems and high rates of chronic illness put them at higher risk of infectious diseases, have not taken advantage of vaccination.

The last week that about 31% of older adults had not yet received a flu shot. Only about 41% of adults 75 and older had ever been vaccinated against RSV, or respiratory syncytial virus, and about a third of seniors had received the most recent covid-19 vaccine.

The CDC recommends the one-and-done pneumococcal vaccine for adults 50 and older. An analysis in the American Journal of Preventive Medicine, however, from 2022, when new guidelines were issued, through 2024, only about 12% of those 67 to 74 received it, and about 8% of those 75 and older.

The strongest evidence for off-target benefits, dating back 25 years, shows reduced cardiovascular risk following flu shots.

Healthy older adults vaccinated against flu have substantially , as well as for pneumonia and other respiratory infections. Vaccination against influenza has also been associated with and .

Moreover, many of these studies predate the more potent flu vaccines now recommended for older adults.

Could the RSV vaccine, protective against another respiratory illness, have similar cardiovascular effects? A recent large found a nearly 10% decline in cardiorespiratory hospitalizations 鈥� involving the heart and lungs 鈥� among the vaccinated versus a control group, a significant decrease.

Lowered rates of cardiovascular hospitalizations and stroke did not reach statistical significance, however. That may reflect a short follow-up period or inadequate diagnostic testing, cautioned Helen Chu, an infectious disease specialist at the University of Washington and co-author of an in JAMA.

“I don’t think RSV behaves differently from flu,” Chu said. “It’s just too early to have the information for RSV, but I think it will show the same effect, maybe even more so.”

Vaccination against still another dangerous respiratory disease, covid, has been linked to a , with its damaging effects on physical and mental health.

Probably the most provocative findings concern vaccination against shingles, aka herpes zoster. Researchers made headlines last year when they documented an association between shingles vaccination and lower rates of dementia 鈥� even with the less effective vaccine that has since been replaced by Shingrix, approved in 2017.

Nearly all studies of off-target benefits are observational, because scientists cannot ethically withhold a safe, effective vaccine from a control group whose members could then become infected with the disease.

That means such studies are subject to “healthy volunteer bias,” because vaccinated patients may also practice other healthy habits, differentiating them from those not vaccinated.

Although researchers try to control for a variety of potentially confounding differences, from age and sex to health and education, “we can only say there’s a strong association, not a cause and effect,” Maggi said.

But Stanford researchers seized on in 2013, when the first shingles vaccine, Zostavax, became available to older people who had not yet turned 80. Anyone who had was ineligible.

Over seven years, dementia rates in participants who had been eligible for vaccination declined by 20% 鈥� even though only half had actually received the vaccine 鈥� compared with those who narrowly missed the cutoff.

“There are no reasons people born one week before were different from those born a few days later,” Maggi said. Studies and have also found reductions in the odds of dementia following shingles shots.

In fact, in the meta-analysis Maggi and her team published, several other childhood and adult vaccinations appeared to have such effects. “We now know that many infections are associated with the onset of dementia, both Alzheimer’s and vascular,” she said.

In 21 studies involving more than 104 million participants in Europe, Asia, and North America, vaccination against shingles was associated with a 24% reduction in the risk of developing dementia. Flu vaccination was linked to a 13% reduction. Those vaccinated against pneumococcal disease had a 36% reduction in Alzheimer’s risk.

The Tdap vaccine against tetanus, diphtheria, and pertussis (whooping cough) is recommended for adults every 10 years, with vaccination among older adults often prompted by the birth of a grandchild, who cannot be fully vaccinated for months. It was associated with a one-third decline in dementia.

Other researchers are investigating the effects of and of .

What causes such vaccine bonuses? Most hypotheses focus on the inflammation that arises when the immune system mobilizes to fight off an infection. “You have damage to the surrounding environment” in the body, “and that takes time to calm down,” Chu said.

The effects of inflammation can far outlast the initial illness. It may allow other infections to take hold, or cause heart attacks and strokes when clots form in narrowed blood vessels. “If you prevent the infection, you prevent this other damage,” Chu said.

Hospitalization itself, during which older patients can become deconditioned or develop delirium, is a risk factor for dementia, among other health problems. Vaccines that reduce hospitalization might therefore delay or ward off cognitive decline.

Health officials in the Trump administration have assailed childhood vaccines more than adult ones, but their vocal opposition may be contributing to inadequate vaccination among older Americans, too.

Many will not only miss out on the emerging off-target benefits but will remain vulnerable to the diseases the vaccines prevent or diminish.

“The current national policy on vaccination is at best uncertain, and in instances appears anti-vaccine,” said Schaffner, a former member of the CDC’s Advisory Committee on Immunization Practices. “All of us in public health are very, very distressed.”

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Both patients, a man and a woman, had agreed to donate their brains after they died for further research. “An amazing gift,” said Edward Lee, the neuropathologist who directs the at the university’s Perelman School of Medicine. “They were both very dedicated to helping us understand Alzheimer’s disease.”

The man, who died at 83 with dementia, had lived in the Center City neighborhood of Philadelphia with hired caregivers. The autopsy showed large amounts of amyloid plaques and tau tangles, the proteins associated with Alzheimer’s disease, spreading through his brain.

Researchers also found infarcts, small spots of damaged tissue, indicating that he had suffered several strokes.

By contrast, the woman, who was 84 when she died of brain cancer, “had barely any Alzheimer’s pathology,” Lee said. “We had tested her year after year, and she had no cognitive issues at all.”

The man had lived a few blocks from Interstate 676, which slices through downtown Philadelphia. The woman had lived a few miles away in the suburb of Gladwyne, Pennsylvania, surrounded by woods and a country club.

The amount of air pollution she was exposed to 鈥� specifically, the level of fine particulate matter called PM2.5 鈥� was less than half that of his exposure. Was it a coincidence that he had developed severe Alzheimer’s while she had remained cognitively normal?

With increasing evidence that chronic exposure to PM2.5, a neurotoxin, not only damages lungs and hearts but is also associated with dementia, probably not.

“The quality of the air you live in affects your cognition,” said Lee, the senior author of a recent , one of several large studies in the past few months to demonstrate an association between PM2.5 and dementia.

Scientists have been tracking the connection for at least a decade. In 2020, the influential Lancet Commission to its list of modifiable risk factors for dementia, along with common problems like hearing loss, diabetes, smoking, and high blood pressure.

Yet such findings are emerging when the federal government is dismantling efforts by previous administrations to continue reducing air pollution by shifting from fossil fuels to renewable energy sources.

“鈥楧rill, baby, drill’ is totally the wrong approach,” said John Balmes, a spokesperson for the American Lung Association who researches the effects of air pollution on health at the University of California-San Francisco.

“All these actions are going to decrease air quality and lead to increasing mortality and illness, dementia being one of those outcomes,” Balmes said, referring to recent environmental moves by the White House.

Many factors contribute to dementia, of course. But the role of particulates 鈥� microscopic solids or droplets in the air 鈥� is drawing closer scrutiny.

Particulates arise from many sources: emissions from power plants and home heating, factory fumes, motor vehicle exhaust, and, increasingly, wildfire smoke.

Of the several particulate sizes, PM2.5 “seems to be the most damaging to human health,” Lee said, because it is among the smallest. Easily inhaled, the particles enter the bloodstream and circulate through the body; they can also travel directly from the nose to the brain.

The research at the University of Pennsylvania, the largest autopsy study to date of people with dementia, included more than 600 brains donated over two decades.

Previous research on pollution and dementia mostly relied on epidemiological studies to establish an association. Now, “we’re linking what we actually see in the brain with exposure to pollutants,” Lee said, adding, “We’re able to do a deeper dive.”

The study participants had undergone years of cognitive testing at Penn Memory. With an environmental database, the researchers were able to calculate their PM2.5 exposure based on their home addresses.

The scientists also devised a matrix to measure how severely Alzheimer’s and other dementias had damaged donors’ brains.

Lee’s team concluded that “the higher the exposure to PM2.5, the greater the extent of Alzheimer’s disease,” he said. The odds of more severe Alzheimer’s pathology at autopsy were almost 20% greater among donors who had lived where PM2.5 levels were high.

Another research team recently between PM2.5 exposure and Lewy body dementia, which includes dementia related to Parkinson’s disease. Generally considered the second most common type after Alzheimer’s, Lewy body accounts for an estimated 5% to 15% of dementia cases.

In what the researchers believe is the largest epidemiological study to date of pollution and dementia, they analyzed records from more than 56 million beneficiaries with traditional Medicare from 2000 to 2014, comparing their initial hospitalizations for neurodegenerative diseases with their exposure to PM2.5 by ZIP codes.

“Chronic PM2.5 exposure was linked to hospitalization for Lewy body dementia,” said Xiao Wu, an author of the study and a biostatistician at the Mailman School of Public Health at Columbia University.

After controlling for socioeconomic and other differences, the researchers found that the rate of Lewy body hospitalizations was 12% higher in U.S. counties with the worst concentrations of PM2.5 than in those with the lowest.

To help verify their findings, the researchers nasally administered PM2.5 to laboratory mice, which after 10 months showed “clear dementia-like deficits,” senior author Xiaobo Mao, a neuroscientist at the Johns Hopkins School of Medicine, wrote in an email.

The mice got lost in mazes that they had previously dashed through. They had earlier built nests quickly and compactly; now their efforts were sloppy, disorganized. At autopsy, Mao said, their brains had atrophied and contained accumulations of the protein associated with Lewy bodies in human brains, called alpha-synuclein.

A , published this summer in The Lancet, included 32 studies conducted in Europe, North America, Asia, and Australia. It also found “a dementia diagnosis to be significantly associated with long-term exposure to PM2.5” and to certain other pollutants.

Whether so-called ambient air pollution 鈥� the outdoor kind 鈥� increases dementia because of inflammation or other physiological causes awaits the next round of research.

Although air pollution has declined in the United States over two decades, scientists are calling for still stronger policies to promote cleaner air. “People argue that air quality is expensive,” Lee said. “So is dementia care.”

President Donald Trump, however, reentered office vowing to increase and to block the transition to renewable energy. His administration for solar installations and electric vehicles, Balmes noted, adding, “They’re encouraging continuing to burn coal for power generation.”

The administration has , announced in the Arctic National Wildlife Refuge in Alaska, and moved to stop to transition to electric cars by 2035. (The state has challenged that action in court.)

“If policy goes in the opposite direction, with more air pollution, that’s a big health risk for older adults,” Wu said.

Last year, under the Biden administration, the Environmental Protection Agency for PM2.5, noting that “the available scientific evidence and technical information indicate that the current standards may not be adequate to protect public health and welfare, as required by the Clean Air Act.”

In March, the EPA’s that the agency would be “revisiting” those stricter standards.

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Her doctor and several pharmacies turned her down because she was below the recommended age at the time, which was 60. So, in 2016, she celebrated her 60th birthday at her local CVS.

“I was there when they opened,” Beckham recalled. After getting her Zostavax shot, she said, “I felt really relieved.” She has since received the newer, more effective shingles vaccine, as well as a pneumonia shot, an RSV vaccine to guard against respiratory syncytial virus, annual flu shots and all recommended covid-19 vaccinations.

Some older people are really eager to be vaccinated.

Robin Wolaner, 71, a retired publisher in Sausalito, California, has been known to badger friends who delay getting recommended shots, sending them relevant medical studies. “I’m sort of hectoring,” she acknowledged.

Deana Hendrickson, 66, who provides daily care for three young grandsons in Los Angeles, sought an additional MMR shot, though she was vaccinated against measles, mumps, and rubella as a child, in case her immunity to measles had waned.

For older adults who express more confidence in vaccine safety than younger groups, the past few months have brought welcome research. Studies have found important benefits from a newer vaccine and enhanced versions of older ones, and one vaccine may confer a major bonus that nobody foresaw.

The new studies are coming at a fraught political moment. The nation’s health secretary, Robert F. Kennedy Jr., has long disparaged certain vaccines, calling them unsafe and saying that the government officials who regulate them are compromised and corrupt.

On June 9, Kennedy fired a panel of scientific advisers to the Centers for Disease Control and Prevention, and later replaced them with some who have been skeptical of vaccines. But so far, Kennedy has not tried to curb access to the shots for older Americans.

The evidence that vaccines are beneficial remains overwhelming.

The phrase “Vaccines are ” has become a favorite for William Schaffner, an infectious diseases specialist at Vanderbilt University Medical Center.

“The population over 65, which often suffers the worst impact of respiratory viruses and others, now has the benefit of vaccines that can prevent much of that serious illness,” he said.

Take influenza, which annually sends from 140,000 to 710,000 people to hospitals, most of them seniors, and is fatal to 10% of hospitalized older adults. 

For about 15 years, the CDC has approved several enhanced flu vaccines for people 65 and older. More effective than the standard formulation, they either contain higher levels of the antigen that builds protection against the virus or incorporate an adjuvant that creates a stronger immune response. Or they’re recombinant vaccines, developed through a different method, with higher antigen levels.

In a meta-analysis in the Journal of the American Geriatrics Society, “all the enhanced vaccine products were superior to the standard dose for preventing hospitalizations,” said Rebecca Morgan, a health research methodologist at Case Western Reserve University and an author of the study.

Compared with the standard flu shot, the from the flu in older adults, by at least 11% and up to 18%. The CDC advises , as many already do.

More good news: Vaccines to prevent respiratory syncytial virus in people 60 and older are performing admirably.

RSV is the most common cause of hospitalization for infants, and it also poses significant risks to older people. “Season in and season out,” Schaffner said, “it produces outbreaks of serious respiratory illness that rivals influenza.”

Because the FDA first approved an RSV vaccine in 2023, the 2023-24 season provided “the first opportunity to see it in a real-world context,” said Pauline Terebuh, an epidemiologist at Case Western Reserve School of Medicine and an author of a in the journal JAMA Network Open.

In analyzing electronic health records for almost 800,000 patients, the researchers found the vaccines to be 75% effective against acute infection, meaning illness that was serious enough to send a patient to a health care provider.

The vaccines were 75% effective in preventing emergency room or urgent care visits, and 75% effective against hospitalization, both among those ages 60 to 74 and those older.

Immunocompromised patients, despite having a somewhat lower level of protection from the vaccine, will also benefit from it, Terebuh said. As for adverse effects, the study found a very low risk for Guillain-Barré syndrome, a rare condition that causes muscle weakness and that typically follows an infection, in about 11 cases per 1 million doses of vaccine. That, she said, “shouldn’t dissuade people.”

The CDC now recommends RSV vaccination for people 75 and older, and for those 60 to 74 if they’re at higher risk of severe illness (from, say, heart disease).

As data from the 2024-25 season becomes available, researchers hope to determine whether the vaccine will remain a one-and-done, or whether immunity will require repeated vaccination.

People 65 and up express the greatest confidence in vaccine safety of any adult group, a 麻豆女优 survey found in April. More than 80% said they were “very “or “somewhat confident” about MMR, shingles, pneumonia, and flu shots.

Although the covid vaccine drew lower support among all adults, more than two-thirds of older adults expressed confidence in its safety.

Even skeptics might become excited about one possible benefit of the shingles vaccine: This spring, Stanford researchers reported that over seven years, vaccination against shingles , a finding that made headlines.

Biases often undermine observational studies that compare vaccinated with unvaccinated groups. “People who are healthier and more health-motivated are the ones who get vaccinated,” said Pascal Geldsetzer, an epidemiologist at the Knight Initiative for Brain Resilience at Stanford and lead author of the study.

“It’s hard to know whether this is cause and effect,” he said, “or whether they’re less likely to develop dementia anyway.”

So the Stanford team took advantage of a “natural experiment” when the first shingles vaccine, Zostavax, was introduced in Wales. Health officials set a strict age cutoff: People who turned 80 on or before Sept. 1, 2013, weren’t eligible for vaccination, but those even slightly younger were eligible.

In the sample of nearly 300,000 adults whose birthdays fell close to either side of that date, almost half of the eligible group received the vaccine, but virtually nobody in the older group did.

“Just as in a randomized trial, these comparison groups should be similar in every way,” Geldsetzer explained. A substantial reduction in dementia diagnoses in the vaccine-eligible group, with a much stronger protective effect in women, therefore constitutes “more powerful and convincing evidence,” he said.

The team also found reduced rates of dementia after shingles vaccines were and other countries. “We keep seeing this in one dataset after another,” Geldsetzer said.

In the United States, where a more potent vaccine, Shingrix, became available in 2017 and supplanted Zostavax, Oxford investigators found .

By matching almost 104,000 older Americans who received a first dose of the new vaccine (full immunization requires two) with a group that had received the earlier formulation, they found delayed onset of dementia in the Shingrix group.

How a shingles vaccine might reduce dementia remains unexplained. Scientists have suggested that viruses themselves may contribute to dementia, so suppressing them could protect the brain. Perhaps the vaccine revs up the immune system in general or affects inflammation.

“I don’t think anybody knows,” said Paul Harrison, a psychiatrist at Oxford and a senior author of the study. But, he added, “I’m now convinced there’s something real here.”

Shingrix, now recommended for adults over 50, in preventing shingles and the lingering nerve pain that can result. In 2021, however, had received one dose of either shingles vaccine.

A connection to dementia will require further research, and Geldsetzer is trying to raise philanthropic funding for a clinical trial.

And “if you needed another reason to get this vaccine,” Schaffner said, “here it is.”

The New Old Age is produced through a partnership with .

This <a target="_blank" href="/aging/vaccines-perceptions-benefits-older-people-aging-column/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

The room, decorated with an under-the-sea theme, had a balloon arch decked out with streamers meant to look like jellyfish and a cloud of clear balloons mimicking ocean bubbles.

Kennedy comes to this memory cafe twice a month since being diagnosed with early onset Alzheimer’s disease in his late 50s.

Everyone here has a degree of memory loss or is a caregiver for someone with memory loss.

Attendees colored on worksheets with an underwater theme. They drank coffee and returned to the breakfast bar for seconds on pastries.

A quick round of trivia got everyone’s minds working.

“We start out with just little trivia 鈥� many of us cannot answer any of the questions,” Kennedy said with a laugh.

“We all have a good time going around,” he added. “You know, we all try to make it fun.”

The northeastern Pennsylvania memory cafe Kennedy attends is one of around the country, according to Dementia Friendly America. The gatherings for people with cognitive impairment and their caregivers are relatively cheap and easy to run 鈥� often the only expense is a small rental fee for the space.

As state and local health departments nationwide try to make sense of what the potential loss of will mean for the services they can offer their communities, memory cafe organizers believe their work may become even more important.

Losing Memory, and Other Things, Too

Kennedy’s diagnosis led him to retire, ending a decades-long career as a at the .

He recommends memory cafes to other people with dementia and their families.

“If they’re not coming to a place like this, they’re doing themselves a disservice. You got to get out there and see people that are laughing.”

The memory cafes he attends happen twice a month. They have given him purpose, Kennedy said, and help him cope with negative emotions around his diagnosis.

“I came in and I was miserable,” Kennedy said. “I come in now and it’s like, it’s family, it’s a big, extended family. I get to meet them. I get to meet their partners. I get to meet their children. So, it’s really nice.”

in the U.S. have been diagnosed with some form of dementia. The diagnosis can be burdensome on relationships, particularly with family members who are the primary caregivers.

A new report from the found that 70% of caregivers reported that coordinating care is stressful. Socializing can also become more difficult after diagnosis.

“One thing I have heard again and again from people who come to our memory cafe is 鈥榓ll of our friends disappeared,’” said , a social worker at , where she directs the Alzheimer’s and related dementia family support program.

The inclusion of caregivers is what distinguishes memory cafes from other programs that serve people with cognitive impairment, like adult day care. Memory cafes don’t offer formal therapies. At a memory cafe, having fun together and being social supports the well-being of participants. And that support is for the patient and their caregiver 鈥� because both can experience social isolation and distress after a diagnosis.

A 2021 study published in indicated that even online memory cafes during the pandemic provided social support for both patients and their family members.

“A memory cafe is a cafe which recognizes that some of the clients here may have cognitive impairment, some may not,” said , a geriatrics professor at the University of Pennsylvania’s Perelman School of Medicine and the co-director of the .

Karlawish regularly recommends memory cafes to his patients, in part because they benefit caregivers as well.

“The caregiver-patient dyad, I find often, has achieved some degree of connection and enjoyment in doing things together,” Karlawish said. “For many, that’s a very gratifying experience, because dementia does reshape relationships.”

“That socialization really does help ease the stress that they feel from being a caregiver,” said , a neurologist who also teaches at Penn’s Perelman School of Medicine. “We know that patients have better quality of life when their caregivers are under less stress.”

An Affordable Way To Address a Growing Problem

As the population grows older, the number of available family caregivers is decreasing, according to the The report found that the number of potential caregivers for an individual 80 or older will decrease significantly by 2050.

In 2024, the Alzheimer’s Association issued a in dementia cases in the U.S. from an estimated 6.9 million people age 65 or older currently living with Alzheimer’s disease to 13.8 million people by 2060. It attributed this increase primarily to the aging of the baby boom generation, or those born between .

As cases of memory loss are projected to rise, the Trump administration is attempting to cut billions in health spending. Since memory cafes don’t rely on federal dollars, they may become an even more important part of the continuum of care for people with memory loss and their loved ones.

“We’re fighting off some pretty significant Medicaid cuts at the congressional level,” said , director of Medicaid policy for , a national nonprofit network of services for people as they age. “Medicaid is a program that doesn’t necessarily pay for memory cafes, but thinking about ensuring that the long-term care continuum and the funding mechanisms that support it are robust and remain available for folks is going to be key.”

The nonprofit operates two memory cafes in Toledo, Ohio. They’re virtually free to operate, because they take place in venues that don’t require payment, according to , the executive director.

“That really helps from a cost standpoint, from a funding standpoint,” Bollin said.

One of the memory cafes takes place once a month at a local coffee shop. The other meets at the Toledo Museum of Art. MemoryLane Care Services provides the museum employees with training in dementia sensitivity so they can lead tours for the memory cafe participants.

The memory cafe that Rob Kennedy attends in Pennsylvania costs about $150 a month to run, according to the host organization, .

“This is a labor of love,” said board member , referring to the volunteers who run the memory cafe. “The fact that they’re giving up time 鈥� they recognize that this is important.”

The monthly budget goes toward crafts, books, coffee, snacks, and some utilities for the two-hour meetings. Local foundations provide grants that help cover those costs.

Even though memory cafes are inexpensive and not dependent on federal funding, they could face indirect obstacles because of the Trump administration’s recent funding cuts.

Organizers worry the loss of federal funds could negatively affect the host institutions, such as libraries and other community spaces.

Memory Cafe Hot Spot: Wisconsin

At least 39 states have hosted memory cafes recently, according to Wisconsin has the most 鈥� more than 100.

The state has a strong infrastructure focused on memory care, which should keep its memory cafes running regardless of what is happening at the federal level, according to , a professor emerita of psychology at the . She co-founded the , which oversees .

“They’ve operated on the grassroots, they’ve operated on pretty small budgets and a lot of goodwill,” she said.

Since 2013, Wisconsin has also had a unique network for dementia care, with state-funded for each county and federally recognized tribe in Wisconsin. The specialists help connect individuals with cognitive impairment to community resources, bolstering memory cafe attendance.

McFadden first heard about memory cafes in 2011, before they were popular in the United States. She was conducting research on memory and teaching courses on aging.

McFadden reached out to memory cafes in the United Kingdom, where the model was already popular and well connected. Memory cafe organizers invited her to visit and observe them in person, so she planned a trip overseas with her husband.

Their tour skipped over the typical tourist hot spots, taking them to more humble settings.

“We saw church basements and senior center dining rooms and assisted living dining rooms,” she said. “That, to me, is really the core of memory cafes. It’s hospitality. It’s reaching out to people you don’t know and welcoming them, and that’s what they did for us.”

After her trip, McFadden started applying for grants and scouting locations that could host memory cafes in Wisconsin.

She opened her first one in Appleton, Wisconsin, in 2012, just over a year after her transformative trip to the U.K.

These days, she points interested people to a national directory of memory cafes hosted by . The organization’s also offers training modules 鈥� developed by McFadden and her colleague 鈥� to help people establish cafes in their own communities, wherever they are.

“They’re not so hard to set up; they’re not expensive,” McFadden said. “It doesn’t require an act of the legislature to do a memory cafe. It takes community engagement.”

This article is part of a partnership with and .

This <a target="_blank" href="/aging/memory-cafe-federal-health-grants-dementia-caregiver-wisconsin-pennsylvania/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Sara Stewart was talking at the dining room table with her mother, Barbara Cole, 86 at the time, in Bar Harbor, Maine. Stewart, then 59, a lawyer, was making one of her extended visits from out of state.

Two or three years earlier, Cole had begun showing troubling signs of dementia, probably from a series of small strokes. “I didn’t want to yank her out of her home,” Stewart said.

So with a squadron of helpers 鈥� a housekeeper, regular family visitors, a watchful neighbor, and a meal delivery service 鈥� Cole remained in the house she and her late husband had built 30-odd years earlier.

She was managing, and she usually seemed cheerful and chatty. But this conversation in 2014 took a different turn.

“She said to me: 鈥楴ow, where is it we know each other from? Was it from school?’” her daughter and firstborn recalled. “I felt like I’d been kicked.”

Stewart remembers thinking, “In the natural course of things, you were supposed to die before me. But you were never supposed to forget who I am.” Later, alone, she wept.

People with advancing dementia do regularly fail to recognize beloved spouses, partners, children, and siblings. By the time Stewart and her youngest brother moved Cole into a memory-care facility a year later, she had almost completely lost the ability to remember their names or their relationship to her.

“It’s pretty universal at the later stages” of the disease, said Alison Lynn, director of social work at the Penn Memory Center, who has led support groups for dementia caregivers for a decade.

She has heard many variations of this account, a moment described with grief, anger, frustration, relief, or some combination thereof.

These caregivers “see a lot of losses, reverse milestones, and this is one of those benchmarks, a fundamental shift” in a close relationship, she said. “It can throw people into an existential crisis.”

It’s hard to determine what people with dementia 鈥� a category that includes Alzheimer’s disease and many other cognitive disorders 鈥� know or feel. “We don’t have a way of asking the person or looking at an MRI,” Lynn noted. “It’s all deductive.”

But researchers are starting to investigate how family members respond when a loved one no longer appears to know them. A qualitative study in the journal Dementia analyzed in-depth interviews with adult children caring for mothers with dementia who, at least once, did not recognize them.

“It’s very destabilizing,” said Kristie Wood, a clinical research psychologist at the University of Colorado Anschutz Medical Campus and co-author of the study. “Recognition affirms identity, and when it’s gone, people feel like they’ve lost part of themselves.”

Although they understood that nonrecognition was not rejection but a symptom of their mothers’ disease, she added, some adult children nevertheless blamed themselves.

“They questioned their role. 鈥榃as I not important enough to remember?’” Wood said. They might withdraw or visit less often.

Pauline Boss, the family therapist who developed the theory of “” decades ago, points out that it can involve physical absence 鈥� as when a soldier is missing in action 鈥� or psychological absence, including nonrecognition because of dementia.

Society has no way to acknowledge the transition when “a person is physically present but psychologically absent,” Boss said. There is “no death certificate, no ritual where friends and neighbors come sit with you and comfort you.”

“People feel guilty if they grieve for someone who’s still alive,” she continued. “But while it’s not the same as a verified death, it is a real loss and it just keeps coming.”

Nonrecognition takes different forms. Some relatives report that while a loved one with dementia can no longer retrieve a name or an exact relationship, they still seem happy to see them.

“She stopped knowing who I was in the narrative sense, that I was her daughter Janet,” Janet Keller, 69, an actress in Port Townsend, Washington, said in an email about her late mother, diagnosed with Alzheimer’s. “But she always knew that I was someone she liked and wanted to laugh with and hold hands with.”

It comforts caregivers to still feel a sense of connection. But one of the respondents in the Dementia study reported that her mother felt like a stranger and that the relationship no longer provided any emotional reward.

“I might as well be visiting the mailman,” she told the interviewer.

Larry Levine, 67, a retired health care administrator in Rockville, Maryland, watched his husband’s ability to recognize him shift unpredictably.

He and Arthur Windreich, a couple for 43 years, had married when Washington, D.C., legalized same-sex marriage in 2010. The following year, Windreich received a diagnosis of early-onset Alzheimer’s.

Levine became his caregiver until his death at 70, in late 2023.

“His condition sort of zigzagged,” Levine said. Windreich had moved into a memory-care unit. “One day, he’d call me 鈥榯he nice man who comes to visit’,” Levine said. “The next day he’d call me by name.”

Even in his final years when, like many dementia patients, Windreich became largely nonverbal, “there was some acknowledgment,” his husband said. “Sometimes you could see it in his eyes, this sparkle instead of the blank expression he usually wore.”

At other times, however, “there was no affect at all.” Levine often left the facility in tears.

He sought help from his therapist and his sisters, and recently joined a support group for LGBTQ+ dementia caregivers even though his husband has died. Support groups, in person or online, “are medicine for the caregiver,” Boss said. “It’s important not to stay isolated.”

Lynn encourages participants in her groups to also find personal rituals to mark the loss of recognition and other reverse milestones. “Maybe they light a candle. Maybe they say a prayer,” she said.

Someone who would sit shiva, part of the Jewish mourning ritual, might gather a small group of friends or family to reminisce and share stories, even though the loved one with dementia hasn’t died.

“To have someone else participate can be very validating,” Lynn said. “It says, 鈥業 see the pain you’re going through.’”

Once in a while, the fog of dementia seems to lift briefly.

Researchers at Penn and elsewhere have pointed to a startling phenomenon called “.” Someone with severe dementia, after being noncommunicative for months or years, suddenly regains alertness and may come up with a name, say a few appropriate words, crack a joke, make eye contact, or sing along with a radio.

Though common, these episodes generally last only seconds and don’t mark a real change in the person’s decline. Efforts to recreate the experiences tend to fail.

“It’s a blip,” Lynn said. But caregivers often respond with shock and joy; some interpret the episode as evidence that despite deepening dementia, they are not truly forgotten.

Stewart encountered such a blip a few months before her mother died. She was in her mother’s apartment when a nurse asked her to come down the hall.

“As I left the room, my mother called out my name,” she said. Though Cole usually seemed pleased to see her, “she hadn’t used my name for as long as I could remember.”

It didn’t happen again, but that didn’t matter. “It was wonderful,” Stewart said.

The New Old Age is produced through a partnership with .

This <a target="_blank" href="/aging/new-old-age-paula-span-dementia-alzheimers-family-members-forget-recognize-grief/">article</a&gt; first appeared on <a target="_blank" href="">麻豆女优 Health News</a> and is republished here under a <a target="_blank" href=" Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src="/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style="width:1em;height:1em;margin-left:10px;">

Relating to Relatives of Lonely Dementia Patients

I was sent the article by Judith Graham on older adults with dementia living alone (“,” Oct. 15). I appreciate this article. My mom lives alone with dementia. My son lives next door and checks on her, and my daughter comes when she is able to vacuum floors and to scrub the kitchen and bathroom. I handle the bills, clean and change her clothes, wash her clothes, search for mail, and bring in groceries. She refused to allow the home health aide in, which complicates the care schedule. Neighbors watch out for her, including police at the station across the street. It is complex and complicated for caregivers. Applying for Medicaid is a nightmare, as is searching for memory care facilities. The thought of actually moving her is heartbreaking and so stressful. Again: Thank you for sharing that others with dementia are living on their own.

— Gail Daniels, Washington, D.C.

On the social platform X, a reader drew on her own experience:

Having cared for my mom toward the end of her journey with dementia, this is terrifying.

For many elders, there is no family to cushion the insults of dementia and cognitive decline.

— Shava Nerad – @shava23@bluesky 🌻 (@shava23)

— Shava Nerad, Arlington, Massachusetts

Bonding — To the Letter

Thanks a million! I read your article “” (Sept. 17) in the and related to it on a major level. As a senior living alone, I am experiencing some of the same “social isolation” expressed by your interviewees. Since I love to write, I thought it would be interesting to involve some of the persons mentioned in a nationwide pen pal association. This would place very little demand on their budget (other than postage and stationery), on their time, and with little or no travel involved.

It is breathtakingly exhilarating to receive a letter from a friend or relative, a package from anywhere, and experience the reward of sitting down and reading good news from afar.

I appreciate our advances in technology and I use it rather sparingly. However, I come from a generation that writes in cursive, knows the five elements of letter writing, and understands what a return address is and where it’s positioned on an envelope.

— Gloria Rankin, Las Vegas

A specialist in health economics and policy tweeted praise:

Historic Numbers of Americans Live by Themselves as They Age

Important, impactful story by superb

— Paul Hughes-Cromwick (Pooge) (@cromwick)

—  Paul Hughes-Cromwick (Pooge), Ann Arbor, Michigan

On X, a group of interdisciplinary faculty representing Johns Hopkins University shared 麻豆女优 Health News’ coverage about racial bias in the development and use of pulse oximeters:

In a article, BDP @iwashyna explains how we move forward from the racial bias of our current pulse oximeters.

— Bloomberg Distinguished Professors (@JHU_BDPs)

A Slap on the Wrist for Pulse Oximeters

Between 1983 and 1988, I had four sons at Stanford Hospital. I was friends with Eben Kermit, who was a bioengineer. He was developing the original pulse oximeter on babies in the neonatal intensive care unit (“: ,” Oct. 7). He tested only white babies. That is because white parents could come to the NICU in the daytime, which is when Eben was at work in the NICU. Black parents could come only at night because their work wouldn’t give them time off to care for a very sick baby. Since no one was there to sign consent forms, at night, with the Black parents, no Black children were included. Discrimination against Black parents by their employers is continuing to cascade through the Black community through the exclusion of Black people from the development of medical technology.

— Zoe Joyner Danielson, a toxicology biologist, Woodland, California

This X post came from a consulting and training firm that focuses on health equity issues:

Reforms are needed ASAP—these devices have harmed so many patients.

FDA’s Promised Guidance on Pulse Oximeters Unlikely To End Decades of Racial Bias by CC: @iwashyna

— HealthBegins (@HealthBegins)

What’s All This Fuss About Fluoride?

No one seems to address the fact that not everyone drinks water from public water systems (“,” Nov. 18). I see many people buying bottled water by the trunkful, or have a water fountain at home with 5-gallon bottles of purified drinking water, or have reverse osmosis water filtration systems installed at their sink.

So even if RFK Jr. removes fluoride from public water systems, I can’t see that there would be a drastic increase in dental issues. Also, when you get your teeth cleaned at the dentist, they give you a fluoride treatment (unless you opt out). So on this issue of removing fluoride, would this be a drastic issue knowing that many now are not getting fluoridated water?

— Suzann Lebda, Sun Lakes, Arizona

Hitting the Paywall

Why does your newsletter link to articles with paywalls? As an example:

The Oct. 18 aggregation “” links to Stat News, where the article cannot be read without a subscription. If you are doing this as a means to provide subscribers to them, too bad.

In any case, this practice does not represent your organization well since it supports the trend that only those who can afford it get to be informed. I hope you reconsider this practice.

The financial barriers to accessing important information are hurting us as individuals and as a society. It is expensive for most people to have access to a mainstream publication, but it gets cost-prohibitive to have access to multiple points of view, to learn, reason, and make up our own minds. In most cases, the only alternative available is to get “bites of information” from the “free” social media. The results are as one would expect: We become less aware of what is really going on as we are guided into silos of ignorance.

Thank you.

— Carl Loben, Bellevue, Washington

On X, a technology journalist in Spain shared the article about pregnant people being asked by their providers to pay out-of-pocket fees earlier than expected:

Pay first, deliver later: Some pregnant people are being asked to prepay for their baby

— José María López (@gilead1984)

— José María López, Badalona, Spain

A New Generation of Health Plans Overdue

The recent article “” (Nov. 15) effectively highlights the emotional and financial uncertainty facing providers and patients. I commend the author for capturing how this uncertainty, rooted in empathy and fairness, must be better understood and addressed.

I write to draw attention to market trends and federal legislation aimed at alleviating this issue. Until recently, health plans considered the out-of-pocket experience as definitionally out-of-scope, leaving patients, and providers, to manage this growing uncertainty on their own.

The evidence shows that it is possible to build a more pragmatic and empathic out-of-pocket experience into a health plan, improving care accessibility and affordability without removing patient responsibility. This approach has been proven, across thousands of employer health plans, to feel better and financially benefit everyone — patients, providers, and plans (employers/insurers).

On Oct. 15, 2024, the Medicare Prescription Payment Plan launched, offering nearly 54 million Americans the option to have their insurer pay their out-of-pocket expenses upfront at the point of service giving members time to review and repay the balance — without interest or fees. If the patient in the article had a health plan with this capability, her OB-GYN would have been paid, on her behalf, by her insurer. She would have received a simple monthly statement to repay in full or over time from the comfort of her home. Everyone benefits and it is a better member experience.

This new, bipartisan, commonsense improvement to one of health care’s most acute pain points is rapidly expanding as employers and insurers realize there is significant actuarial value, provider savings, and member behavior change caused by improving a person’s ability to pay for care.

Brian Whorley, Columbia, Missouri

An associate professor in the health care leadership program at Rockhurst University’s Helzberg School of Management also shared the article on X:

Pay First, Deliver Later: Some Women Are Being Asked To Prepay for Their Baby via

— Prof. Jim Dockins (@DrDockins)

— Jim Dockins, Kansas City, Missouri

On Hospital Gatekeepers and Tolls

In regards to the article “” (Nov. 15): Back in 1992, the hospital where my son was going to be delivered required that the projected copay be paid to them one month before the delivery date or my wife would not be admitted (a Catholic hospital, very charitable).

My wife was born at the same hospital in 1963; at that time, my father-in-law was informed by the hospital that he could not take her home until the bill was paid in full. He contacted a friend who was an attorney who told him to let the hospital know that would be considered kidnapping and that he would be calling the police if they didn’t release her.

— Andrew McGovern, Great River, New York

Taken Advantage Of?

I belong to a Blue Cross Blue Shield Medicare Advantage plan and, for the past several years, it has offered a home assessment with a reward of $25. I have participated in the program in the past but declined this year since I didn’t think there was much value to the program. I am a retired registered nurse, and I felt that the nurse who did my assessment did not do an especially thorough job, and any questions I asked of her, she could not answer. The nurse was also from out of state.

After reading your article on “” (Sept. 30), the reasons for the assessment seem to be more than improving the beneficiary’s health and well-being, which is what I believed. I am relatively healthy and active, so it would not appear that BCBS found any new diagnoses that it could bill Medicare for, but I assume that that is not the case with other seniors.

— Bruce Gilman, Millis, Massachusetts

An economist in Florida had this to say on social media:

Thank you  for pointing out the failed bureaucracy I’ve been talking about for years. You can’t read this and not conclude DC bureaucrats are “captured” and policy makers are beholden to Medicare Advantage lobby money.

— Luke Neumann (@pglukeneumann)

— Luke Neumann, St. Petersburg, Florida

In Defense of Deloitte

On March 12, 2024, in good faith and with respect for 麻豆女优 Health News, Deloitte’s health and human services practice leader provided a 90-minute interview with two reporters for a story they said was about “problems with Deloitte’s eligibility systems across the country.”

We agreed to the interview because we had heard from several of our state clients that they, too, had been contacted, and that the questions being raised showed a misunderstanding of integrated eligibility systems, the technology that sustains them, and the complexity of the health and human services programs they support.

The eligibility systems are owned by the states, not Deloitte; they are uniquely built for each state (in some cases, by other vendors decades ago); and we work at the direction of our clients to maintain and enhance these systems to comply with state-specific policies, rules, and processes, and evolving federal regulations.

Two stories subsequently ran: “” (June 24) and “” (Sept. 5).

Many of the issues reported as “widespread” are isolated to specific situations or involve sensitive data that cannot be refuted by Deloitte due to client confidentiality obligations. That said, there are many reasons why someone may lose coverage or no longer be eligible for a benefit they once received.

Not every “issue” a constituent faces is the result of a system “error,” and challenges with individual cases in individual systems are not due to some fundamental problem in the way Deloitte supports state Medicaid programs.

On the issue of contract changes, Deloitte rejected the claim in March that our state clients send us a “change request … when a fix is needed.” We said that was inaccurate and explained that when there are policy or rule changes — or a global pandemic — that require modifications to a state’s technology, change orders are not only necessary but appropriate.

They do not represent errors in a system that need to be fixed.

Throughout the unwinding of the covid-19 public health emergency — as technologies evolved and policies changed — Deloitte worked closely with states to minimize challenges for those going through the Medicaid redetermination process. The innovations and human-centered design processes we helped our clients implement enhanced the digital experience for their constituents and made it easier for caseworkers, staff, and community partners to support the 34 million people in their care.

Our clients understand that large system implementations are challenging due to the complexity of the programs they support, and that all IT systems require ongoing maintenance, periodic enhancements and upgrades to software and hardware, and database management.

That is why so many states continue to select Deloitte to help them maintain their mission-critical systems, and why industry analysts like Forrester and Gartner consistently rank Deloitte as a leader in system integration and business transformation.

— Karen L. Walsh, Government & Public Services, Deloitte Consulting LLP, Harrisburg, Pennsylvania

[Editor’s note: 麻豆女优 Health News stands by its reporting on Deloitte and the state eligibility determination systems that Deloitte supports.]

An assistant professor at Harvard voiced her opinion on X:

This is such a grim summary of the state of Medicaid eligibility and enrollment systems

— Adrianna McIntyre (@adrianna.bsky.social) (@onceuponA)

— Adrianna McIntyre, Boston

Far Less Than Meets the Eye

I read your article about the new $2,000 limit for out-of-pocket payments for Medicare Part D (“ Oct. 21). As someone with very high drug costs, I was very excited about this change. However, once I researched the different drug plans available for me and my husband, I realized that the money we spend on drugs that are prescribed by a doctor but not covered by our plan will not count toward the $2,000 limit. Therefore, our cost for necessary drugs will continue to be exorbitant.

I think that there are many seniors who will be very disappointed once they realize this.

— Pia Stampe, Eureka, California

In sharing the article on X, a Florida attorney simply shared their contact information:

“Medicare Drug Plans Are Getting Better Next Year. Some Will Also Cost More:” 
Grady H. Williams, Jr., LL.M., Attorneys at Law P.A.
1543 Kingsley Avenue, Building 5
Orange Park, FL 32073
Tel: 904-264-8800 • Fax: 904-264-0155

— Grady H. Williams (@floridaelder)

— Grady H. Williams, Orange Park, Florida

Shedding Light on Fluorescence in Dental Care

Congratulations on a highly impactful publication (“,” Nov. 1). The facts presented are harrowing for a retired practitioner with multiple specialties who tried a lifetime to preserve teeth and promote human health.

As you might know, oral biofilm is the biggest enemy of oral health and even general health. Dental clinicians have not been able to visualize and identify the presence of pathogenic oral microbiome until recently. Pathogenic oral bacteria are among the significant generators of hard and soft tissue deterioration, such as tooth decay, gum diseases, and even infection of dental implants. The most trusted and used diagnosis procedure is still the X-ray.

X-rays can identify only established diseases. Unfortunately, radiologic diagnosis is still the most trusted diagnostic tool used and taught in dental education.

Microbiology, the microbiome science, utilizes fluorescence as its major identification procedure. Some of the most aggressive oral bacteria, generators of caries, gum diseases, etc., generate so-called porphyrins, which, once excited by a specific wavelength, emit light at a different wavelength. Highly reliable and simple-to-use technologies have been created recently to support direct visualization and point-of-care identification of this pathogenic bacteria through the above-described procedure. These devices support the diagnostic process and help the dental clinician by guiding the treatment execution and identifying when the treatment goal has been achieved. Dental treatment protocols utilizing “Fluorescence-Enhanced Theragnosis” have become reliable and less invasive.

The high loss of human lives in the ICUs during the pandemic due to ventilator-associated pneumonia could have been dramatically reduced using the above protocol.

Wound-care science has already implemented fluorescence and is undergoing a tremendous protocol change. Tumor surgery celebrates fluorescence-guided surgery as a milestone in its development.

Academic dental education is due for an urgent renewal. We must open the doors and facilitate science translation to benefit humankind!

— Liviu Steier, Needham, Massachusetts

A reader who manages a website predicting the collapse of the American health care system commented on X:

🙄😠👎Technically, American dentistry was once ranked as the best in the world. Unfortunately, It has a history of mismanagement and negligence. It’s a “reputational good” that’s been flooded with scams. Now it’s payback time. It’s demonstrating the…

— Francis Anthony Toto (@francisatoto)

— Francis Anthony Toto, San Diego

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It seemed clear they had some type of cognitive impairment. Yet they were living alone.

Portacolone, an associate professor at the University of California-San Francisco, wondered how common this was. Had anyone examined this group? How were they managing?

When she reviewed the research literature more than a decade ago, there was little there. “I realized this is a largely invisible population,” she said.

Portacolone got to work and now leads the at UCSF. The project that at least 4.3 million people 55 or older who have cognitive impairment or dementia live alone in the United States.

About half have trouble with daily activities such as bathing, eating, cooking, shopping, taking medications, and managing money, according to their research. But only 1 in 3 received help with at least one such activity.

Compared with other older adults who live by themselves, people living alone with cognitive impairment are older, more likely to be women, and disproportionately Black or Latino, with lower levels of education, wealth, and homeownership. Yet for publicly funded programs such as Medicaid that pay for aides to provide services in the home.

In a health care system that assumes older adults have family caregivers to help them, “we realized this population is destined to fall through the cracks,” Portacolone said.

Imagine what this means. As memory and thinking problems accelerate, these seniors can lose track of bills, have their electricity shut off, or be threatened with eviction. They might stop shopping (it’s too overwhelming) or cooking (it’s too hard to follow recipes). Or they might be unable to communicate clearly or navigate automated phone systems.

A variety of other problems can ensue, including social isolation, malnutrition, self-neglect, and susceptibility to scams. Without someone to watch over them, older adults on their own may experience worsening health without anyone noticing or struggle with dementia without ever being diagnosed.

Should vulnerable seniors live this way?

For years, Portacolone and her collaborators nationwide have followed nearly 100 older adults with cognitive impairment who live alone. She listed some concerns people told researchers they worried most about: “Who do I trust? When is the next time I’m going to forget? If I think I need more help, where do I find it? How do I hide my forgetfulness?”

Jane Lowers, an assistant professor at the Emory University School of Medicine, has been studying “kinless” adults in the early stages of dementia 鈥� those without a live-in partner or children nearby. Their top priority, she told me, is “remaining independent for as long as possible.”

Seeking to learn more about these seniors’ experiences, I contacted the National Council of Dementia Minds. The organization last year started a biweekly online group for people living alone with dementia. Its staffers arranged a Zoom conversation with five people, all with early-to-moderate dementia.

One was Kathleen Healy, 60, who has significant memory problems and lives alone in Fresno, California.

“One of the biggest challenges is that people don’t really see what’s going on with you,” she said. “Let’s say my house is a mess or I’m sick or I’m losing track of my bills. If I can get myself together, I can walk out the door and nobody knows what’s going on.”

An administrator with the city of Fresno for 28 years, Healy said she had to retire in 2019 “because my brain stopped working.” With her pension, she’s able to cover her expenses, but she doesn’t have significant savings or assets.

Healy said she can’t rely on family members who have troubles of their own. (Her 83-year-old mother has dementia and lives with Healy’s sister.) The person who checks on her most frequently is an ex-boyfriend.

“I don’t really have anybody,” she said, choking up.

David West, 62, is a divorced former social worker with , which can impair thinking and concentration and cause hallucinations. He lives alone in an apartment in downtown Fort Worth, Texas.

“I will not survive this in the end 鈥� I know that 鈥� but I’m going to meet this with resilience,” he said when I spoke with him by phone in June.

Since his diagnosis nearly three years ago, West has filled his life with exercise and joined three dementia support groups. He spends up to 20 hours a week volunteering, at a restaurant, a food bank, a museum, and .

Still, West knows that his illness will progress and that this period of relative independence is limited. What will he do then? Although he has three adult children, he said, he can’t expect them to take him in and become dementia caregivers 鈥� an extraordinarily stressful, time-intensive, financially draining commitment.

“I don’t know how it’s going to work out,” he said.

Denise Baker, 80, a former CIA analyst, lives in a 100-year-old house in Asheville, North Carolina, with her dog, Yolo. She has cognitive problems related to a stroke 28 years ago, Alzheimer’s disease, and serious vision impairment that prevents her from driving. Her adult daughters live in Massachusetts and Colorado.

“I’m a very independent person, and I find that I want to do everything I possibly can for myself,” Baker told me, months before Asheville was ravaged by severe flooding. “It makes me feel better about myself.”

She was lucky in the aftermath of Hurricane Helene: Baker lives on a hill in West Asheville that was untouched by floodwaters. In the week immediately after the storm, she filled water jugs every day at an old well near her house and brought them back in a wheelbarrow.  Though her power was out, she had plenty of food and neighbors looked in on her. 

“I’m absolutely fine,” she told me on the phone in early October after a member of drove to Baker’s house to check in on her, upon my request. Baker is on the steering committee of that organization.

Baker once found it hard to ask for assistance, but these days she relies routinely on friends and hired help. A few examples: Elaine takes her grocery shopping every Monday. Roberta comes once a month to help with her mail and finances. Jack mows her lawn. Helen offers care management advice. Tom, a cab driver she connected with through Buncombe County’s transportation program for seniors, is her go-to guy for errands.

Her daughter Karen in Boston has the authority to make legal and health care decisions when Baker can no longer do so. When that day comes 鈥� and Baker knows it will 鈥� she expects her long-term care insurance policy to pay for home aides or memory care. Until then, “I plan to do as much as I can in the state I’m in,” she said.

Much can be done to better assist older adults with dementia who are on their own, said Elizabeth Gould, co-director of the National Alzheimer’s and Dementia Resource Center at RTI International, a nonprofit research institute. “If health care providers would just ask 鈥榃ho do you live with?’” she said, “that could open the door to identifying who might need more help.”

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care, and advice you need in dealing with the health care system. Visit聽聽to submit your requests or tips.

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By the time their lives intersected at Canyon Creek Memory Care Community in Billings, Montana, both were deep in the grips of dementia and exhibiting some of the disease’s terrible traits.

Shively had been wandering lost in his neighborhood, having outbursts at home, and leaving the gas stove on. Dowd previously had been hospitalized for being confused, suicidal, and agitated, medical records filed in U.S. District Court in Billings show. When Dowd entered Canyon Creek, managers warned employees in a note later filed in court that he could be “physically/verbally abusive when frustrated.”

On Shively’s fourth day at Canyon Creek, carrying a knife and fork, he walked over to a dining room table where Dowd was sitting. Dowd told Shively to keep the knife away from his coffee, according to a witness statement filed in court. Shively, who at 5-foot-2 and 125 pounds was half Dowd’s weight and 10 inches shorter, turned to walk away, but Dowd stood up and shoved Shively so hard that when he hit the floor, his skull fractured and brain hemorrhaged, according to a lawsuit his family filed against Canyon Creek.

“The doctor said there’s not much they could do about it,” his son Casey Shively said in an interview.

Dan Shively died five days later at age 73.

Police did not charge Dowd, then 66. He stayed at Canyon Creek for nearly three more years, during which time he repeatedly clashed with residents, sometimes hitting male residents and groping female ones, according to facility records filed in the court case. His anger would flare quickly. “I’m literally scared to death of Jeff,” one nurse wrote in a filed statement describing Dowd’s dispute with another resident.

In court, Canyon Creek denied liability for Shively’s death. Its privately held corporate owner, Koelsch Communities, declined to answer questions from 麻豆女优 Health News. Chase Salyers, Koelsch’s director of marketing, said in an email to 麻豆女优 Health News that the company prioritizes “the health, well-being, safety, and security of our residents.”

Dowd’s relatives said in a statement via text they would not comment because they had no firsthand knowledge. “We were very pleased with the care Jeffrey received at Canyon Creek,” they added. Dowd was not named in the lawsuit and his current whereabouts could not be determined.

Violent altercations between residents in long-term care facilities are alarmingly common. Across the country, residents in nursing homes or assisted living centers have been killed by other residents who weaponized , shoved into a person’s mouth, or .

A in JAMA Network Open of 14 New York assisted living homes found that, within one month, 15% of residents experienced verbal, physical, or sexual resident-on-resident aggression. Another study found nearly engaged in physical aggression or abuse toward residents or staff members within one month. Dementia residents are to be involved in altercations because the parts of the brain affecting memory, language, reasoning, and social behavior.

More than with Alzheimer’s or other types of dementia reside in nursing homes and assisted living centers. Many of the most seriously impaired live in the roughly 5,000 facilities with locked dementia floors or wings or the 3,300 homes devoted exclusively to memory care. These places are mostly for-profit and often charge thousands of dollars extra a month, promising expertise in the disease and a safe environment.

Clashes can be spontaneous and too unpredictable to prevent. But the chance of an altercation increases when memory care homes admit and retain residents they can’t manage, according to a 麻豆女优 Health News examination of inspection and court records and interviews with researchers. Homes that have too few staffers or nonexistent or perfunctory training for employees have a harder time heading off resident conflicts. Homes also may fail to properly assess incoming residents or may keep them despite demonstrated threats to others.

“As much as long-term care providers in general do their best to provide competent, high-quality care, there is a real problem with endemic violence,” said Karl Pillemer, a gerontologist at Cornell University and lead author of the JAMA study.

“There needs to be much more of an effort to single out verbal and physical aggression that occurs in long-term care,” he said, “and begin to create a model of violence-free zones in the same way we have violence-free zones in the schools.”

A Danger to Others

The first signs of Shively’s emerged in 2011 as confusion, but the disease accelerated in 2016, according to interviews with his wife and children and his medical records. He began referring to mountains he knew well by the wrong name and forgot how to tie flies on his fishing line. “The decline was so slow at first we thought we could manage,” his wife, Tana Shively, said in an interview before this year.

As the disease progressed, his outbursts became hard to handle. He took a swing at one of his sons when upset about the temperature in the house. He refused to swallow his medications and fell repeatedly.

“He would start walking the neighborhood and get lost,” Casey said. “He would turn on the gas stove but not light the stove, and the room would start filling up with gas. He would put clothing in strange places. I found socks in a punch bowl. It got to the point where we couldn’t do this anymore.”

Dowd, meanwhile, had lived in a Santa Fe nursing home and had a long history of dementia with behavioral issues, major depressive disorder with psychotic features, and hypertension, according to medical records filed in court. Dowd entered Canyon Creek in October 2018 to be closer to his brother, who lived nearby in Wyoming, according to an admission notice the facility provided to employees that was included in the court record. The notice said Dowd suffered from .

Two months later, Shively moved in.

Montana licenses Canyon Creek, which has 67 beds, as a Level C assisted living facility, which permits it to house people with cognitive impairments so severe that they cannot express their needs or make basic care decisions. these facilities cannot admit or retain a resident who is “a danger to self or others.”

In the lawsuit, Shively’s family argued that, given that law, Canyon Creek never should have accepted or kept Dowd. The Shively family’s lawyer, Torger Oaas, noted in court papers that Canyon Creek’s intake assessment form for Dowd categorized his behavior as “physically and/or verbally abusive/aggressive 1x per month.” Oaas also wrote in court papers that in Dowd’s first weeks at Canyon Creek, he mocked and threatened to hit other residents and threw someone’s silverware to the ground during dinner.

In its defense filings in the lawsuit, Canyon Creek said the Montana statute was too broad to be the basis of a negligence claim and argued that all memory care residents are unpredictable. And while Dowd had yelled and cursed at other residents at Canyon Creek, he hadn’t had physical confrontations 鈥� or any conflicts with Shively, Canyon Creek said. “The accident was not reasonably foreseeable,” Canyon Creek argued.

In the days after Shively’s fall, nurses noted that Dowd was “more anxious, angry toward others.” Dowd yelled at a nurse to get off the phone and “do your job,” a nurse wrote in a logbook entry filed in court.

“He got into my face,” the nurse wrote. “It looked like he was going to hit me 鈥� he had his hand/fist raised.”

鈥楢s Bad as I’ve Ever Seen It’

People with dementia will lash out because they no longer have social inhibitions or because it’s the only way they can express pain, discomfort, fear, disagreement, or anxiety. Some 鈥� overstimulation from loud noises, a frenzied atmosphere, unfamiliar faces 鈥� are hallmarks of dementia care institutions.

“We can’t expect someone who is constantly and unfailingly disoriented to adapt to our environment anymore,” said , a licensed clinical social worker and dementia researcher in Florida. “We have to adapt to them.”

Eilon Caspi, a researcher, analyzed 105 fatal incidents involving dementia residents and found 44% were fatal falls in which one resident pushed another. “Some people are aggressive, and some are violent,” Caspi said, “but if you look closely, the vast majority are doing their best while living with a serious brain disease.”

Holly Harmon, a senior vice president at the American Health Care Association/National Center for Assisted Living, an industry trade group, said in a written statement that conflicts cannot always be averted despite facility operators’ best efforts. “If they do occur,” she said, “providers respond promptly with interventions to protect the residents and staff and prevent future occurrences.”

But Richard Mollot, executive director of the Long Term Care Community Coalition, a resident advocacy group, said many operators of assisted living centers, including memory care units, are driven by the bottom line. “The issue that we see quite often is that assisted living retains people they should not,” Mollot said. “They don’t have the staffing or the competency or the structure to provide safe care.” Conversely, he said, when facilities have enough rooms filled with paying customers, they are more likely to evict residents who require too much attention.

“They will kick them out if they’re too cumbersome,” Mollot said.

Teepa Snow, an occupational therapist who founded , a company that trains dementia caregivers, noted that the space inside many facilities, with double rooms, tight common areas, and restricted outdoor access, can fuel conflicts. She said the pandemic degraded conditions in long-term care, as dementia residents with limited social skills atrophied in isolation in their rooms and staffing grew even sparser.

“It’s as bad as I’ve ever seen it,” she said.

鈥榁ery Common Fits of Rage’

The following account of Dowd’s time at Canyon Creek is based on 44 pages of nurse’s notes, witness statements, and internal resident-on-resident altercation reports; all were contained in the facility’s records and filed as exhibits in the court case. After Shively’s death in December 2018, Dowd was given new prescriptions, although the court record is unclear if the change was because of Shively’s death. Still, the records show, Canyon Creek was unable to head off recurring altercations involving Dowd.

Some were verbal threats. Once, Dowd yelled at residents in the living room to shut up, called them “retards” and told them they should all die, a caregiver wrote in a witness statement. He grabbed one resident’s face and threatened to kill him, according to a nurse’s note. Another time, Dowd went up to a resident sitting on a sofa and grabbed his walker. Dowd shook it and told him to shut up. According to a witness statement, as a nurse took the resident to the bathroom, Dowd muttered under his breath: “Stuff his head in the toilet.”

Other conflicts were physical. Dowd shoved a resident “down on his back so hard his head bounced off the floor,” a nurse recorded in a note. In a different incident reported by a nurse, Dowd pushed a resident who had been agitated and cursing into a chair. On separate occasions, Dowd hit two residents on the head, once causing bleeding, according to two resident altercation reports.

The notes detail that Dowd was not always the initiator. Once, Dowd’s roommate scratched and punched him after Dowd told him to use the toilet rather than pee on the floor, resulting in a fight. Caregivers separated the two. Another day, a resident named Bill wandered into Dowd’s room and pulled Dowd’s hair and beard. Dowd told the nurses he “felt unsafe and VERY angry,” a nurse’s note said. The nurse led Bill out of Dowd’s room, but Dowd followed, yelling at Bill that he was “a fat bastard” and saying he was going to make Bill’s wife a widow.

“Jeff kept making a closed fist as tho he was going to hit Bill,” the nurse wrote in a witness statement. “I was legit scared because there was nothing I could do to defuse the situation. I’m literally scared to death of Jeff. I’m scared to approach him and talk to him when he gets into these very common fits of rage.”

Dowd ultimately went back to his room and a worker locked his door so no other resident would go in.

The records describe how Canyon Creek caregivers intervened after altercations began, often separating the fighting residents and updating Dowd’s brother on the clashes. Nurses would remove Dowd or the other resident from a room and discourage such acts. “Tried to explain it was inappropriate to hurt others,” one nurse wrote after one incident.

Salyers, the company marketing director, said in his email that the workers at Canyon Creek and other Koelsch facilities are “highly qualified” and “extensively trained.” He said the company’s memory care communities are “distinctively designed and staffed” for people with Alzheimer’s and other forms of dementia.

鈥業t’s Nice To Have a Girlfriend’

The nursing notes and statements in the court file suggest that incidents were frequent enough that nurses commented on Dowd’s occasional serenity. “No agitated or aggressive behaviors this shift,” one note said. Another nurse note said Dowd “continues to isolate at meals, sitting at a table by himself.” While Dowd enjoyed reading books and doing puzzles, he was overheard saying he was depressed and was “wondering if he wouldn’t be better off if he wasn’t around anymore.”

Nurses noted Dowd repeatedly exhibited sexual behavior that was either inappropriate 鈥� making “crude oral gestures while looking at younger females” 鈥� or ambiguous, such as placing his hand on a resident’s shoulder and commenting, “It’s nice to have a girlfriend.” Someone saw Dowd “grabbing on multiple residents[’] private areas,” a witness statement said. When nurses caught the behavior, they separated those involved and rebuked Dowd. A staff member wrote in a statement that Dowd was inappropriate throughout her shift, making sexual jokes and “trying to grab me.”

According to nursing notes, in summer 2021, Dowd told one female resident he wanted to see her genitals and later touched her breast. In August, a caregiver walked into Dowd’s room and found him touching the same resident under her shirt and pants. The caregiver told Dowd to “stop it and not ever do that again” and brought the woman out to meet her family, who had come to visit her.

After that incident, Canyon Creek sent Dowd to the emergency room at Montana State Hospital, a public psychiatric facility, according to a nurse administrator’s testimony in a deposition filed in court. The nurse testified Dowd was no longer at Canyon Creek. That is the last mention of Dowd’s whereabouts in the public record. A spokesperson for the Montana Department of Public Health and Human Services, which oversees the hospital, would not confirm whether he was a patient.

At a pretrial hearing, the judge excluded discussion about Dowd’s altercations after Shively’s death. In a court filing, Shively’s lawyer asked permission to share evidence with the jury that Canyon Creek gave its executive director a bonus any month when 90% or more of the beds were filled so he could argue Canyon Creek had a financial motivation to admit Dowd. But the judge also barred that information from the trial, which Canyon Creek said in a court filing was irrelevant.

The Shively case went to trial in 2022 before a federal civil jury in Billings. Despite the exclusions, the jury decided Canyon Creek’s negligence caused Shively’s death. It awarded the family $310,000.

“For us, the money wasn’t a huge factor,” said Spencer Shively, another of Dan Shively’s sons, who called the as to be a victory for Canyon Creek or its insurer. “At least they were negligent per se. But I don’t know it really changed anything. For me, I got some closure. I feel like these facilities are just continuing to do the same things they’re going to do because there hasn’t been systemic change.”

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Céline Gounder, 麻豆女优 Health News’ senior fellow and editor-at-large for public health, on “CBS Mornings” discussed new research that found the shingles vaccine may delay the onset of dementia. Gounder also discussed a covid-19 study that shows state mask and vaccine mandates save lives on CBS’ “CBS News 24/7.”

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