Dr. Mauk’s Boomer Blog

/Dr. Mauk's Boomer Blog

Each week, Dr. Mauk shares thoughts relevant to Baby Boomers that are aimed to educate and amuse.

Alzheimer’s Disease

Elderly woman with medications

Alzheimer’s disease (AD) is the most common type of dementia seen in older adults. An estimated 5.4 million Americans of all ages had Alzheimer’s disease in 2012. Nearly half (45%) of people over the age of 85 have AD. By 2050, the number of individuals age 65 and over with Alzheimer’s could range from 11 million to 16 million unless science finds a way to prevent or effectively treat the disease. One in eight older adults has AD, and it is the sixth leading cause of death in the United States (Alzheimer’s Association, 2012). Those affected with AD may live from 3–20 years or more after diagnosis, making the life span with this disease highly variable.

Risk factors

Advanced age is the single most significant risk factor for AD (Alzheimer’s Association, 2012). More women than men have AD, but this is because women live longer than men, not because gender is a risk factor. Family history and heredity are also identified risk factors for AD, as are head trauma and poor cardiac health.

Warning Signs

Alzheimer’s disease is characterized by progressive memory loss. The person affected by AD is gradually less able to remember new information and memory lapses begin to affect daily function. It is a terminal disease that over its course will eventually leave a person completely dependent upon others for care.


Initially, the clinical progression of the disease is slow with mild decline; however, deterioration increases the longer the person lives, with an average life span of 8 years after diagnosis (Cotter, 2002; Fletcher, Rapp, & Reichman, 2007). The underlying pathology is not clear, but a growth of plaques and fibrillary tangles, loss of synapses, and neuronal cell loss are key hallmarks of AD that interfere with normal cell growth and the ability of the brain to function. Absolutely definitive diagnosis is still through autopsy, although clinical guidelines make diagnosis easier than decades ago when less was known about the disease. Primary care physicians generally make the diagnosis through a thorough history, physical exam, cognitive testing, and labs. New criteria for diagnosis include staging the disorder and biomarkers (beta amyloid and tau in the cerebrospinal fluid and blood) (Alzheimer’s Association, 2012b). An MRI of the brain may be ordered to rule out other causes of symptoms.

The clinical course of AD is divided into several stages, depending on the source consulted. In the early course of AD, the person may demonstrate a loss of short-term memory. This involves more than common memory loss, such as where the keys were put, and may involve safety concerns such as forgetting where one is going while driving. The inability to perform math calculations and to think abstractly may also be evident. In the middle or moderate phase, many bodily systems begin to decline. The person may become confused as to date, time, and place. Communication skills become impaired and personality changes may occur. As cognitive decline worsens, the person may forget the names of loved ones, even their spouse. Wandering behavior as well as emotional changes, screaming, delusions, hallucinations, suspiciousness, and depression are common. The person with AD is less able to care for her- or himself and personal hygiene suffers. In the most severe and final phase, the person becomes completely dependent upon others, experiences a severe decline in physical and functional health, loses communication skills, and is unable to control voluntary functions. Death eventually results from body systems shutting down and may be accompanied by an infectious process. Although there is no single test, and the diagnosis may be one of exclusion, early diagnosis is important to maximize function and quality of life for as long as possible. Persons experiencing recurring and progressing memory problems or difficulties with daily activities should seek professional assistance from their physician.


Treatment for AD is difficult. There are several medications (such as Aricept, Namenda, Razadyne, and Exelon) that may help symptoms (such as memory), but they do not slow the course of the disease. There is currently no cure; however, research continues to occur in pharmacology, nonpharmacology, and the use of stem cells to manage symptoms and perhaps one day eradicate the disease.

Treatment will focus on symptom management, particularly in the areas of behavior, safety, nutrition, and hygiene. Behavioral issues such as wandering and outbursts pose a constant challenge. Many long-term care facilities have special “memory care” units to care for Alzheimer’s patients from the early to late stages of the disease. These units provide great benefits such as consistent and educated caregivers with whom the patient or resident will be familiar, a safe and controlled environment, modified surroundings to accommodate wandering behaviors, and nursing care 24 hours a day. Additionally, nurses are present to manage medications and document outcomes of therapies. However, many family members wish to care for their loved ones at home for as long as possible.

Thus, another important aspect of care in AD is care for the caregivers. Howcroft (2004) suggested that “support from carers is a key factor in the community care of people with dementia, but the role of the caregiver can be detrimental to the physical, mental, and financial health of a carer” (p. 31). She goes on to say that the caregivers of persons with AD would benefit from training in how to cope with behaviors that arise in these patients and how to cope with practical and legal issues that may occur.

Research has shown that ongoing skills are needed by family caregivers to deal with the progressive decline caused by AD. In fact, “a 63% greater risk of mortality was found among unpaid caregivers who characterized themselves as being emotionally or mentally strained by their role versus noncaregivers” (National Conference of Gerontological Nursing Practitioners & National Gerontological Nursing Association, 2008b, p. 4). Adapting to stress, working on time management, maximizing resources, and managing changing behavior were all skills caregivers needed to develop in order to successfully manage home care of their loved ones. When interventions and resources were not used by caregivers in the early stages of the care recipient’s AD, the risk of a healthy patient being institutionalized due to caregiver burden was higher (Miller, Rosenheck & Schneider, 2012). Caregivers needed not only to acquire knowledge and skills, but also to make emotional adjustments themselves to the ever-changing situation.

Such findings suggest that nurses should focus a good deal of time on educating caregivers of persons with AD to cope with, as Nancy Reagan put it, “the long good-bye.” Scientists continue to explore the causes of AD and hope in the near future to be able to isolate the gene that causes it. In the meantime, results from a fascinating longitudinal study (called the Nun study) on aging and AD, which used a group of nuns who donated their brains to be examined and autopsied after death, has suggested that there is a connection between early “idea density” and the emergence of AD in later life. That is, essays the nuns wrote upon entry to the convent were analyzed and correlated with those who developed AD. It was found that those with lower idea density (verbal and linguistic skills) in early life had a significantly greater chance of developing AD (Grossi, Buscema, Snowdon, & Antuono, 2007; Snowdon, 2004). The nun study has allowed researchers to examine hundreds of brains so far in nuns who died between 75 and 107 years of age and discover other important facts such as a relationship between stroke and the development of AD in certain individuals, and the role of folic acid in protecting against development of AD (Snowdon, 2004). Scientists from a number of fields continue to research the causes and possible treatments for AD and the Nun study project is continuing at the University of Minnesota. Snowdon’s research suggests that early education, particularly in verbal and cognitive skills, may protect persons from AD in later life.

For more information on Alzheimer’s disease, visit the Alzheimer’s Association website at: http://www.alz.org/


Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L.
Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.



By | 2018-03-12T09:41:42+00:00 March 17th, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Alzheimer’s Disease

Guest Blog: Should We Be Saving for Our Care in Old Age?


‘Carpe diem’ is a phrase that you’ve no doubt heard before. Your grandchildren might be announcing instead that ‘YOLO – you only live once’. The message is simple – live each day as though it’s your last, you never know what’s around the corner. According to those phrases, saving for old age might be a waste of money. We never know if we’ll make it to retirement, or how far into our retirement years we’ll get. Aren’t there more important things to be spending our money on than our old age care? Should we be saving at all?

What are your future prospects?

As much as you might convince yourself that you never know what lies ahead, the reality is that you can assume that you’ll live to see old age. Thanks to medical advances, more and more people are living full and healthy lives past an age that would previously have been considered to be ‘old’. After those healthy years, in many cases, come the not-so-healthy years when medical costs and care costs increase.

If you’re trying to convince yourself that saving isn’t worthwhile because you might not ever be ‘old’, bear in mind that by 2030 it is expected that 1 person out of 5 in the U.S. will be 65 or over.

Should you save for old age?

Your future is unknown. A majority of people pay a small fortune in costs for their care when they reach old age. The amount of support available could increase by the time you’re there, or it could dramatically decrease. It is far better to assume the latter and be prepared for every eventuality than to assume that you’ll have financial support and then discover later on that you don’t.

As you age, you may become less able to earn money and may be less capable of making your own decisions. If you don’t prepare in advance, then the eventual burden of your old age care will fall to your loved ones. By saving for old age, you are able to ensure that you get the best place to live, the best support and the best medical treatment, without impacting on the finances and livelihoods of younger family members.

Ecuva is an online health and wellness store where customers can purchase daily living aids, disability aids and items that can make old age easier, more comfortable and more independent.

By | 2018-03-12T09:41:18+00:00 March 16th, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: Should We Be Saving for Our Care in Old Age?

Guest Blog: 4 Legal Documents Every Senior Needs

A Living Will document closeup with pen

Before your loved one has a health scare, it’s important to have these legal documents ready to protect them and your family. Start the conversation early about your loved one’s healthcare wishes and end-of-life care. Learn what legal documents every senior needs by reading on!

1. Last Will and Testament

Having a will ensures your loved one’s wishes for their estate are properly carried out after their death. If a person doesn’t have a will, state law determines what happens to their assets. It’s recommended that your loved one update their will every five years to keep up with changing circumstances in day-to-day life.

2. Advanced Directive

If your loved one is ever unable to make decisions for themselves due to memory loss or a serious health condition, the family is left to make decisions for them which could lead to disagreements about your loved one’s wishes. An advanced directive, also know as a living will, is a document used to specify your loved one’s health care decisions ahead of time. They can accept or refuse certain types of care (e.g. feeding tube, oxygen administration, life support, etc.) depending on what their wishes are.

3. Power of Attorney

By granting power of attorney to a trusted and responsible family member (proxy), this allows them to make decisions on your loved one’s behalf in case they are unable to. A standard power of attorney allows the family member to pay bills and write checks—while a durable power of attorney for medical care can make healthcare decisions for your loved one.

4. Do-Not-Resuscitate Order

A do-not-resuscitate (DNR) is a legal document that instructs health care providers not to provide life sustaining treatment if a patient’s heart stops or they stop breathing. If your loved one is nearing end-of-life care or terminally ill, they may not want to be resuscitated in a medical emergency. Only the patient or their health care proxy can sign a DNR order.

You can download a free starter kit from The Conversation Project to help guide the conversation with your loved one about their end-of-life care. Don’t wait until it’s too late.


About the Author: Peter Kang is a writer for eCaregivers. He is inspired by his caregiver experience with his late grandfather and role model, a Korean War veteran, to help families find affordable care for their loved ones. Follow Peter on Facebook and Twitter.

By | 2018-03-12T09:40:53+00:00 March 15th, 2018|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: 4 Legal Documents Every Senior Needs
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