Tag Archives: Mental Health

Who Are You? Where Am I?

In an effort to increase awareness for the first annual National Memory Screening Week held Nov. 1-7, Vicki Tapia, author of Somebody Stole My Iron, has joined with four other authors of books about dementia/Alzheimer’s. This article describes the campaign and presents a brief synopsis of their books.

Photo Credit: City of Overland Park

It was the weekend of our family reunion and almost everyone was gathered together at my parent’s condo to celebrate a milestone. Our patriarch, my dad, was turning 90. When the front doorbell rang, Mom opened the door, took one look at her oldest granddaughter and asked in a perplexed tone of voice, “Who are you?” After a moment of silence, we all laughed a little uncomfortably, but brushed it off, rationalizing the comment as a manifestation of Mom’s stress in caring for Dad, who had been diagnosed with Parkinson’s disease. It was not mentioned again.

Our family continued to somehow normalize or overlook the ever-increasing signs that something was not quite right with Mom’s behavior. Another two years passed before she finally agreed to be evaluated by her health care provider, around the same time Dad was diagnosed with Parkinson’s-related dementia. Although by this time, our family wasn’t completely surprised by Mom’s Alzheimer’s diagnosis, we were alarmed to hear she was already considered to be in the “moderate” stage of the disease. I later learned this scenario is typical.

Studies tell us that the delay in diagnosis can be attributed to the family’s own denial in not wanting to face the fact that something is wrong. In retrospect, this could be applied to our family, although in many ways, we were simply clueless in the beginning. Sometimes, a fear of diagnosis can result in reluctance on the part of the affected person to agree to an evaluation, particularly if it involves an adult child prodding an intractable parent. Healthcare costs may also be a factor in avoiding an assessment by a qualified health care provider (HCP). The oft-perceived stigma associated with a potential diagnosis of dementia/Alzheimer’s can be a barrier to evaluation for the entire family.

National Memory Screening Week

In an effort to promote the importance of early detection of memory problems, the Alzheimer’s Foundation of America (AFA) has launched the first annual National Memory Screening week scheduled for Nov. 1-7.

The screenings will be free and confidential, and if deemed necessary, refer people onto appropriate follow-up services. One of the goals of the screening is to work toward eliminating the stigma and fears associated with dementia. The AFA also hopes to alleviate fears for people who participate in the memory screening, but do not show a concerning memory problem.

For more information about the screening (date, time) and a list of participating sites, visit National Memory Screening.

Who should consider having a memory screening?

  • Anyone concerned about memory loss or experiencing any of the warning signs of dementia.
  • Anyone who feels they are at risk due to a family history of Alzheimer’s disease or another type of dementia.
  • Anyone who wants a baseline evaluation of their memory for future comparisons, even though they do not have a current concern.

If you or a loved one answer “yes” to any of the following questions provided by the AFA, it may be prudent to participate in the free memory screening.

  • Are you becoming more forgetful?
  • Do you have any trouble concentrating?
  • Do you have difficulty when performing familiar tasks?
  • Do you have trouble recalling names or words during conversation?
  • Do you sometimes forget where you are going or where you are?
  • Have friends or family told you that you are saying the same thing over and over or repeating questions?
  • Do you often misplace things?
  • Have you become lost when driving to a familiar place or walking in your neighborhood?
  • Have your family or friends told you they have noticed changes in your behavior, moods, personality, or desire to engage socially?

For more information, visit Information for Participating Sites on the National Memory Screening website.



The scene described in the opening paragraph of this blog post is based on an excerpt from my memoir, Somebody Stole My Iron, which details the daily challenges, turbulent emotions, and many painful decisions involved in caring for my parents. Laced with humor and pathos, reviewers describe my book as “brave,” “honest,” “raw,” “unvarnished,” as well as a “must-read for every Alzheimer’s/dementia patient’s family.” I wrote this story to offer hope to others whose lives have been intimately affected by this dreadful disease, and to reassure them that they are not alone.

Four other engaging books about dementia/Alzheimer’s disease that I am pleased to recommend include:

 

On Pluto: Inside the Mind of Alzheimer’s by Greg O’Brien

Greg’s story is not about losing someone else to Alzheimer’s, it is about losing himself. Acting on long-term memory and skill, coupled with well-developed journalistic grit, O’Brien decided to tackle the disease and his imminent decline by writing frankly about the journey. On Pluto is a book about living with Alzheimer’s, not dying with it.” 

Alzheimer’s Daughter by Jean Lee

Jean’s memoir details her journey caring for both parents who were diagnosed on the same day. It is written with wincing honesty about the cruel affects of the disease, but a World War II love story held together by faith and family is contained within the pages.

Blue Hydrangeas by Marianne Sciucco

Marianne describes herself as a writer who happens to be a nurse. She writes this work of fiction based upon her care for the elderly. It is a tenderly told love story about Jack and Sara, owners of a New England bed and breakfast. Sara is stricken with Alzheimer’s and Jack becomes her caregiver.

What Flowers Remember by Shannon Wiersbitzky

Shannon writes this work of fiction through the eyes of a young girl, perhaps not surprising, as her author bio notes that her own grandfather had Alzheimer’s. In the story, when thirteen-year-old Delia Burns realizes that her elderly neighbor is beginning to forget, she involves the entire town in saving his memories.

Vicki Tapia, long-time lactation consultant and published author of numerous lactation articles, found her energies redirected to the other end of life when both her parents were diagnosed with dementia in 2004. Her diary documenting their journey resulted in the publication of Somebody Stole My Iron: A Family Memoir of Dementia, a 2015 finalist for the High Plains Book Awards. The mother of three grown children and eight grandchildren, Vicki lives with her husband and Mini Schnauzer in South Central Montana, USA.

 

 

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Australia: Integrating Mental Health Services at the Primary Care Level

Health-hospital-indoors
In many developed countries, the aging populations are on the rise and Australia is no exception. Currently, 13% of Australia’s population is over 65 years and this is projected to grow 19-21% by 2031 and 26% by 2051. The experience of aging can range from a positive, fulfilling one to an anxiety filled, negative experience. In Australia, mental health disorders are highly prevalent among the elderly.

Existing mental health services are provided at the primary care level, with the general practitioner. In 1992, Australia changed its mental health services policy from an institutional to a community-oriented set up. When it comes to health, one’s General Practitioner (GP) is usually the first point of contact for an elderly patient. By integrating mental health services at the primary care level, the Australian government places mental health as a mainstream agenda in the health system.

An example of a model is the case of St. Vincent’s District in the inner city of Sydney. This district had a heterogeneous elderly population, comprising of Holocaust survivors, people who are homeless, or in hostels among others. Less than 1% of the population surveyed went directly to a hospital for mental health services, and a significantly larger proportion went to their GP. Since the elderly have the freedom to choose their GP, they place a high level of trust with these health professionals. The model encouraged collaboration across primary care, community services and specialist services such as geriatric medicine and geriatric psychiatry. An impact evaluation of this program suggested that general practitioners and other primary health care workers became more skilled in assessing and managing elderly mental health, requiring less support. Additionally, there has been better outcomes with regards to maintaining continuity of care.

This model was applauded for not only improving access to mental health services, but also in the collaboration it achieved. However, stigma against mental health issues is a concern. Elderly patients are often victims of the existing stigma around mental health and this is a significant barrier to engaging in dialogue on mental health issues with one’s General Practitioner. Another critique of this program is that care and treatment can be ‘fragmented, piece meal and sometimes non-existent,’ and that there is no nationally consistent protocol.

It is estimated that 10-15% of the elderly population have experienced depression. If one looks specifically at the elderly population in residential care homes, this population has more than twice the rate of the depression, at 35%. Additionally, about 10% have experienced problems with anxiety. Suicide rates among the elderly are also a cause for concern as men over 85 years have the highest likelihood of dying by suicide than any other age group. This age group’s suicide rate  is three times higher than the national rate, at 37.6 deaths per 100,000 people. Some of the key reasons for depression include loss of a partner and deterioration of health.

These figures look grim. Perhaps there is a need for the re-evaluation of this model, looking at health systems factors as well as sociocultural factors affecting access and use of mental health services.

Namratha Rao is currently pursuing her MSPH in International Health in Social and Behavioral Interventions at the Johns Hopkins University Bloomberg School of Public Health.