Those With Advance Directives More Likely Seek Interventions-Smilecast 59

People Who Fill Out Advance Directives More Likely to Seek Interventions 

A study finds that nearly a third of people who fill out advance directives — a person’s wishes for end-of-life care — request medical interventions. The research from DePaul University was published by Craig M. Klugman, hair of DePaul’s Department of Health Sciences, and co-author Nicole M. Tolwin.

No surprise, younger people requested interventions such as respiratory support or antibiotics more frequently than people over the age of 50. Researchers also discovered that many people may not be discussing their wishes with loved ones after an advance directives is completed.
That is not so good because you really should be discussing your wishes with others, especially the person with medical power of attorney who needs to know in your spoken words exactly what you mean in your written advance directive.

When Advance Directive in Place Dying More Peaceful – Smilecast 58

Advance Directive in Place – Dying More Peaceful

A Belgian study suggests that when a person has an advanced directive in place, dying is more peaceful. Advance care planning is considered a central component of good quality palliative care and especially relevant for people who lose the capacity to make decisions at the end of life.

Investigators set out to investigate to what extent (1) advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2) the existence of written advance general practitioner orders were related to the quality of dying of nursing home residents with dementia.

Researchers concluded that for nursing home residents with dementia there is a strong association between having a written advance directive and quality of dying. Where wishes are written, relatives report lower levels of emotional distress at the end of life.

Poor Sleep and Alzheimer’s Implications

poor sleep

Poor Sleep May Be Early Sign of Alzheimer’s

Poor sleep may be a sign that people who are otherwise healthy may be more at risk of developing Alzheimer’s disease later in life than people who do not have sleep problems, according to a study published in Neurology®, the medical journal of the American Academy of Neurology. Researchers have found a link between sleep disturbances and biological markers for Alzheimer’s disease found in the spinal fluid.

“Previous evidence has shown that sleep may influence the development or progression of Alzheimer’s disease in various ways,” said study author Barbara B. Bendlin, PhD, of the University of Wisconsin–Madison. “For example, disrupted sleep or lack of sleep may lead to amyloid plaque buildup because the brain’s clearance system kicks into action during sleep. Our study looked not only for amyloid but for other biological markers in the spinal fluid as well.”

Amyloid is a protein that can fold and form into plaques. Tau is a protein that forms into tangles. These plaques and tangles are found in the brains of people with Alzheimer’s disease.

For the study, researchers recruited 101 people with an average age of 63 who had normal thinking and memory skills but who were considered at risk of developing Alzheimer’s.

Researchers found that people who reported worse sleep quality, more sleep problems and daytime sleepiness had more biological markers for Alzheimer’s disease in their spinal fluid than people who did not have sleep problems. Those biological markers included signs of amyloid, tau and brain cell damage and inflammation.

“It’s still unclear if sleep may affect the development of the disease or if the disease affects the quality of sleep,” said Bendlin. “More research is needed to further define the relationship between sleep and these biomarkers.”

Bendlin added, “There are already many effective ways to improve sleep. It may be possible that early intervention for people at risk of Alzheimer’s disease may prevent or delay the onset of the disease.”

One limitation of the study was that poor sleep problems were self-reported. Monitoring of poor sleep patterns by health professionals may be beneficial in future studies.

The study was supported by the National Institute on Aging and the National Institutes of Health National Center for Advancing Translational Sciences.

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