This section will help you to be more familiar with the language that therapists use. It will not help you to diagnose yourself or others. Consider the following: Click here for a listing of Community Resources. MENTAL HEALTH NEWS
Medicare and Mental HealthMedicare pays for some mental health services. The following describes how and under what circumstances. 1. What and How Much Medicare Pays for Psycho-therapyMedicare will pay 80 % for the initial mental health visit and only pay 50% of its approved amount for future visits. The same payment rate aplies to all approved mental health providers such as psychiatrists, psychologists and social workers. Those individual therapists(such as psychiatrists, psychologists, and social workers) who take Medicare assignment agree to accept the Medicare-approved amount as payment in full for their services. Beneficiaries will have to pay a 50% co-insurance but no additional fees to the provider. If the premiums are affordable a Medicare supplemental insurance policy(Medigap) will help. It will pay for the remaining 50% and most retiree coverage will also pay all or part of the 50% co-insurance. 2. Which Therapists Can Take Payment From Medicare. Medicare will help to pay for outpatient mental health services from:
Medicare will only pay for the services of those therapists if they are Medicare certified and take assignment(they must accept Medicare's approved amount as payment in full). Medicare will pay for the services of medical doctors who do not take Medicare assignment but they can charge up to 15% above Medicare's approved amount, depending on State law. 3. Which Outpatient Mental Health Services Medicare Covers They include:
4. Where Outpatient Mental Health Services Can Take Place Medicare will pay for mental health serivces in an outpatient hospital, a doctor's or therapist's office, or a clinic so long as they are Medicare certified. These services can al;so take place in the home of a beneficiary. 5. How Medicare Pays for In-Patient Mental Health Services Medicare pays for in-patient services in either a psychiatric or a general hospital. Under Medicare Part A for each benefit period(in 2005) the beneficiary pays:
-After the 60 lifetime reserve days have been used Medicare will no longer pay for any coverage until a new benefit period has begun. For more information go to www.medicarerights.org
NEWS ABOUT DEMENTIA
Recent Alzheimer's Disease Research *** Recent research reflects some steps which have been taken towards the development of a vaccine for Alzheimer;s Disease. We are a distance from that goal and this work is based on theories about Alzheimer's Disease. One theory hypothesizes that rising levels of beta-amyloid protein deposited in the brain are at the root of the disease. Therefore, attempts are being made to see if it's possible to rid the brain of this protein and to see if people never get Alzheimer's or get better. However, participants who had a good antibody response and good memory stability experienced brain shrinkage above and beyond that of unresponsive individuals. Forward steps often generate more questions. The research process is very slow and can be frustrating for family members and other caregivers. Ideas and themes have to be tested. All this must be done prior to having a vaccine or a cure .For more information go to: www.medicinenet.com/script/main/art.asp?articlekey=47082
***The following are brief reports of research into Alzheimer Disease Prevention. All were presented at the Alzheimer's Association International Conference on the Prevention of Dementia in June, 2005. 1. One study found that an active social life was associated with a decreased risk of dementia. Another possibility is that social engagement reduces stress, thereby lowering the risk of dementia. Previous reports had shown that late-life social engagement seemed to be protective against dementia. Many of those studies were based on data collected closer to the onset of dementia. These current researchers wanted to look at earlier time frames. A low level of midlife social activity, on its own, was not associated with an increased risk of dementia. 2. Another study found that older Japanese-Americans who drank fruit or vegetable juices at least three times a week lowered their risk of developing Alzheimer's by 75%, compared with people who drank these juices less than once week. 3. A third study found that physical activity and moderate alcohol consumptiuon might also help maintain cognitive ability in later life. 4. Estimated worldwide direct costs for dementia in 2003 totaled $ 156 billion based on global projections that 27.7 million people suffer from that condition. A team led by Bengt Winblad from Sweden prepared the study. The worldwide costs of dementia were estimated from prevalence figures for different global regions and cost-of-illness studies from key countries. The researchers used a model based on the relationship between direct costs of care per demented individual and the gross domestic product(GDP) per capita in each country. As part of the research, several alternative calculation methods were explored and compared. Winblad said that is is of interest for policy makers to have a view of how costs of dementia are distributed world-wide. Winblad said "since detailed national data are lacking from many countries we based our cost estimate on an assumed relationship between the GDP per capita and direct costs of dementia care. Such a relationship is known to be valid for overall costs of healthcare". Winblad continued " Dementia care is a mix of fromal and informal cazregiving and this mix is not uniform throughout the world. Even among the advanced economies there is a great range in how dementi care is provided, due to differences in family patterns, traditions, economic strength, care organization and financing. nevertheless, it is obvious that the worldwide costs are anticipated rapid increase in developing countries, presents a great challenge for social and healthcare systems. ". Currently, 92% of the total worldwide costs of dementia care were found in what the reaearchers termed "the advanced economies," which contain 38% of the prevalence.
For information on Family Support Groups go to www.alzmass.org
MILD COGNITIVE IMPAIRMENT IN ELDERLY POPULATION Mild cognitive impairment, a disorder considered a strong early predictor of Alzheimer's Disease, occurs among young elderly and increases with age and fewer years of education, according to a study at the Mayo Clinic(of selected people in Minnesota). The findings suggest that about age:
The findings also suggest about education that:
The researchers suggest that the increase of mild cognitive impairment with age parallels the risk elevation with age seen in previous studies of Alzheimer's Disease. The increased risk for mild cognitive impairment with fewer years of education also parallels other studies' finding of a rise in risk for Alzheimer's Disease. Mild cognitive impairment may encompass dificiencies in any or all of the following categories: LANGUAGE-The use of words. They don't come as quickly as they once did. VISUOSPATIAL ABILITY -Placement of things in time and space become more difficult EXECUTIVE FUNCTION - Decision making becomes more difficult. MEMORY - Recent recall diminishes. People with mild cognitive impairment may function normally in society. Symptoms can be very difficult to detect. click Here for Memory Among Seniors: Improves With Rote learning
NEW COGNITIVE ASSESSMENT TOOLThe Mental Status Questionaire(MSQ) and the Mini Mental Status Examination(MMSE) have been used to assess cognitive impairment in elders for many years. Researchers at St Louis University have developed a new tool(Saint Louis University Mental Status Examination- or SLUMS). They tested more than 700 men over 60 and found that SLUMS was more successful at identifying those with early dementia. Each of these tools can be used but should be complimented by clinical observation and assessment along with appropriate neuropsychological testing. Read an article in the November, 2006 issue of the American Journal of Geriatric Psychiatry. Following is the new assessment tool(SLUMS).
Anxiety Disorders Things You Should Know These disorders can take over an individual's life with anxiety and an exessive irrational fear. They can be chronic and on-going and may become worse. There are a number of types of anxiety disorders and they include: Signs and Symptoms We shall identify symptoms associated with some of the types listed above: Obsessive-Compulsive Disorder These disorders are often accompanied by depression and sometimes by substance abuse. There are two general types of treatments available: Medications and Counseling(talk therapy) or some combination :MEDICATIONS: COUNSELING(TALK THERAPY) Elsewhere on the Site When One Partner of a Couple Has Dementia Dementia and Sexual Relationships Memory Loss Aging and Dementia Introduction Dementia is the loss of intellectual functions such as thinking, remembering, and reasoning which is severe enough to interfere with a person's abillity to function. It is not a disease but symptoms whch are part of various diseases. Some will be listed below. All persons who experience memory loss or confusion should undergo a thorough diagnostic workup. This requires an examination by a physician who is experienced in the diagnosis of dementing disorders, neurological and laboratory testing, a re-evaluation of all medications, a psycho-social history, contact and review with family, and more. This can help the individual obtain treatment for reversible conditions and aid in planning for the future. Dementia may be found in the following: 1. Alzheimer's Disease A progressive degenerative disease which attacks the brain and results in impaired memory, thinking and behavior. 2. Multi-Infarct Dementia(Vascular Dementia) A deterioration of mental capabilities caused by multiple strokes(infarcts) in the brain. 3. Parkinson's Disease A progressive disorder of the central nervous system. These individuals lack the substance dopamine which is critical for the central nervous syatem's control of muscle activity. 4. Creutzfeldt-Jacob Disease A rare, fatal brain disorder caused by a transmissible infectious oranism. 5. Picks Disease A rare brain disorder. 6. Normal Pressure Hydrocephalus An uncommon disorder which involves an obstruction in the normal flow of cerebospinal fluid and which causes a buildup of cerebrospinal fluid on the brain. 7. Huntington's Disease An inherited and degenerative brain disease which affects the mind and the body. Other diseases which may cause or mimic dementia include: 1. Alzheimer's Disease 2. Multi-Infarct Dementia 3. Parkinson's Disease 4. Creutzfeldt-Jakob Disease 5. Pick's Disease 6. Normal Pressure Hydrocephalus 7. Huntington's Disease 1. Alzheimer's Disease A definitive diagnosis is only possible with the examination of brain tissue which is usually done at autopsy. 2. Multi-Infarct Dementia Neurological examination and brain scanning(ex.- computerized tomography or CT scan and magnetic resonance imaging or MRI). 3. Creutzfeldt-Jakob Disease An examination of brain tissue at autopsy. 4. Picks Disease An examination of brain tissue at autopsy. 5. Normal Pressure Hydrocephalus MRI 6. Huntington's Disease Treatments and Cures With few exceptions these diseases are not yet subject to treatments or cures. Parkinsons Disease Levodopa may improve some of the motor symptoms but not the mental changes. Normal Pressure Hydrocephalus Insertion of a shunt may divert fluid away from the brain. Our brains change as we age just like the rest of our bodies We may experience some slowed thinking and problems remembering. However, serious memory loss, confusion and other major changes in the ways our minds work are not a normal part of aging. There are conditions which can disrupt memory and mental (or cognitive) functioning. Symptoms can improve if the underlying cause is treated. Some causes of memory loss include: Some memory changes may be age related and others are not. Following are some differences: Forgets whole experiences Gradually unable to care for self Memory loss which disrupts everyday functioing is not a normal part of aging. The Alzheimer's Association has develped a checklist which helps to recognize the differences between normal, age-related memory changes and Alzheimer's disease. Do elders without a diagnosis of dementia experience memory loss or impairment? If so, is the loss a precusor to dementia or does it lead to that diagnosis? Brenda Plassman, Ph.D. associate research professor of psychiatry at Duke University is the lead author of a study on memory loss among elders. There is a team of researchers involved in the study from Duke University Medical Center, University of Michigan, University of Iowa, University of Southern California, and the Rand Corporation. It is published in the Annals of Internal Medicine. According to the study: Some conclusions and possible outcomes: In a study by the National Alzheimer's Foundation of America(AFA) it was found that people do not report memory concerns or loss to their physicians or other healthcare providers. Several thousand adults across the USA were surveyed in 2007. They found the following: .Of those who spoke with someone: Among those who were screened some had other healhcare concerns which are risks for a brain disorder including: Thanks to Michelle Mazzone, RN for the following. INTRODUCTION It is a challenge to determine which medication(s) will the most effective. Medications and their side effects impact each individual differently. Talk to a physician and be prepared to consider some issues. The following are some questons which you may ask: Medications to treat Alzheimer's disease can slow it down and may delay the need for institutional care. The following are descriptive statements about four medications used to treat Alzheimer's Disease. ARICEPT This is approved to treat all stages(mild, moderate, severe) of Alzheime 's Disease. It may help cognition and functional ability in performing everyday tasks. Side Effects include: Fainting, nausea, vomiting, diarrhea, bruising, sleeplessness, muscle cramps, loss of appetite, tiredness It should not be taken if at risk for somach ulcers or other serious stomach problems. EXELON This is approved to treat at the mild to moderate stages. Side Effects include: Vomiting and weight loss. RAZADYNE This is approved to treat at mild to moderate stages It can slow down memory loss. Side Effects include: Stomach upsets and slowed heart rate(which can lead to fainting). NAMENDA NAMENDA This approved to treat moderate to severe stages. Side Effects include: Dizziness, constipation, headaches, temporary period of confusion when beginning the medication. How does the diagnosis of Dementia or more specifically of Alzheimer's Disease impact the intimate relationship between patients and their partners? Many couples are too embarrassed to ask the questions they really need answered. For some sex is a non-negotiable need.Many couples find it beneficial to have a discssion, soon after the diagnosis, about their individual expectations. nvigating this territory can be murky. Decisions should be based on what works for both people individually and as a couple. A dementia diagnosis not only introduces other sexual issues it can also excaberate existing problems. As a person's cognition changes, so do the ways in which they relate to their partner. The ebb and flow of dementia symptoms can create tension in and out of the bedroom: For the partner without dementia: In the late stages of Dementia: In skilled nursing facilities: Communication is complicated when the person without dementia acts as both caregiver and a partner. The duality of roles can be difficult, troubling, and for some, seemingly impossible. The Alzheimer's Association is a good place to start searching for support and resources in your community. Read article in the Worcester Telegram and Gazette about a family member and Elderly Depression. For Resources on Depression Click Here For More Information about Depression Click Here This is a fairly common disorder but is not a normal part of the aging process. It should and can be addressed. Things You Should Know: Depression Some Signs or Symptoms May Include: Symptoms should persist for two weeks or more and may occur continuously or in cycles for years. Some individual symptoms may not reflect depression at all (could be a medical illness, medication problem, etc.). The presence of four or more symptoms can be a key indicator. In any case don't wait until you are sure. Contact a professional to get an assessment and to identify appropriate steps. Treatment Choices may Include: While depression is not ususual among elders suicide is also far too prevalent and also can and should be addressed. On this section about Depression there will be over time some information about elder suicide, including demographics, warning signs, risk factors, evaluation tips, etc. You should Know Demographics(Elder Suicide) Elder Risk Factors The following are factors or characteristics to look for. They do not cause suicide and their presence does not mean that a particular individual will attempt suicide. However, if any are present then be more aware. Warning Signs What You Can Do SUICIDE ASSESSMENT EVALUATION AND TRIAGE This tool was developed by Dr. Douglas Jacobs and provided by Screening for Mental Health. I.IDENTIFY RISK FACTORS Note those which can be modified to reduce risk. II. Identify Protective Factors Note those which can be enhanced. III. CONDUCT SUICIDE INQUIRY Specific questions about thoughts, plans, behaviors, intent. IV. DETERMINE RISK LEVEL/INTERVENTION RISK LEVEL - LOW RISK/PROTECTIVE FACTORS - Modifiable risk factors; Strong protective factors SUICIDALITY - Thoughts of death, no plan, intent, or behavior. POSSIBLE INTERVENTIONS - Outpatient referral, symptom reduction;Give emergency informtion. RISK LEVEL - MODERATE RISK/PROTECTIVE FACTORS - Multiple risk factors/ Few protective factors SUICIDALITY - Suicidal ideation with plan, but no intent or behavior POSSIBLE INTERVENTIONS - Admission may be necesssary depending on risk factors. Develop crisis plan. Give emergency information. RISK LEVEL -HIGH RISK/PROTECTIVE FACTORS - Comorbidity, high risk diagnosis, minimal protecive factors. SUICIDALITY - Perisistent suicidal ideation with strong intent, suicide rehearsal,, aborted attempt or failed attempt. POSSIBLE INTERVENTIONS - Admission Generally Indicated Unless a Significant Change Reducs risk. Suicide precautions. V. DOCUMENTATION SUICIDE ASSESSMENT Should be conducted at first contct, and for any subsquent suicidal behavior/ideation, or pertinent clinical change; For in-patients prior to increasing privileges and at discharge note follow-up instructions. Documentation Includes: Risk level, the basis for its determination and the treatment plan to address/reduce the current risk( i.e., medication, seting, ECT., contact with significant others, consultation). For additional information about depression, click here. Substance Abuse including alcohol and drugs (particularly prescription medications) is the hidden and secret malady among elders. The following two sections will include brief descriptions about alcohol and then drug abuse. What You Should Know: Behaviors and Symptoms to Look For: For More Information About Alcoholism and Elders Click Here Some resources: Among elders, this is often prescription medications. Some resources: Treatment/Intervention Choices for Substance Abuse May Include: Detoxification: This may be necessary at times to withdraw from alcohol or drugs in a hospital setting in order to: 1. Increase safety; 2. Remove access to alcohol or drugs. This may be useful when: MEDICATIONS When people age and also take different kinds of medications their bodies may respond differently than when they were younger. Some medications will not mix well with other medications - including over the counter and harbal remedies.Many will not mix well with alcohol. Some may take too many or too few medications or forget to take them. Look For The Following As Signs Of A Problem: You Can Do The Following: Talk to someone or refer to someone you trust If you speak with someone have appropriate information |
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Mental Health Problems |
