#severe dementia in the elderly for example

[chiisana-sukima]

Out of all the arcs where one of the choices of readings is Difficult Health Care Proxy Decisions (and it's truly weird exactly how many of these there are), I find Dean's decision-making in s6 the least #problematic of them, in that it's the one closest to technically correct on a real world medical ethics level.

In the most Dean-is-doing-the-right-thing reading, when he beats Sam into unconsciousness at the end of 6x06, he would have correctly deduced from previous events of the season that Sam has some kind of supernatural illness/injury, that he can't trust Sam to cooperate honestly, and that Sam is potentially dangerous both to others in general and also to Dean specifically. Given that and that Sam wakes up in 6x07 tied up and being questioned by Cas in search of a "diagnosis", the beating at the end of 6x06 can be read as Dean simply subduing Sam, and Dean's decision to re-soul him as an (appropriate, given this reading) proxy exercise of competent!Sam's most likely wishes--that his not-competent body shouldn't be left walking around in a dangerous state potentially hurting people, including Dean. This is almost certainly what competent!Sam would want. There are some questions about whether Sam-while-Soulless truly is incompetent to make his wishes known--he's honestly not that much more violent than Sam and Dean are on a regular basis--but it is at least a reasonable and defensible position.

For both better and worse though, spn isn't the Intro to Medical Ethics show, it's the Family Is Hell show, so even here, where Dean's decision can be read as "the correct one", the show goes out of it's way to problematize it. The camera focuses in 6x06 on how brutal the beating is, how angry Dean appears, and how much longer than necessary it seems to go on.

Not the usual portrayal of a man compassionately delivering medical treatment ^

The scene where Cas determines Sam is sans soul is so obviously OTT violently sexualized that it warrants it's own fandom name, the Belt Scene, and even people who ship rival ships sometimes call it one of the hottest scenes in the show. And while Cas is doing the work, it's Dean who is in control here. Cas is there to do his bidding.

Sam is literally being fisted; lets not pretend we don't know what this is ^

And in the scene where it's Death's turn to fist Sam (while Sam is handcuffed to a bed but, alas, doesn't get a belt to kinkily stifle his screams this time), Sam starts by begging Death but ends up begging Dean. Death has a little black doctor's bag, and he at least is dispassionate, but it's still what Dean earlier classified in 6x03 as "torture" and didn't want Cas to do to a teen, even at the cost of continued murders. And the only argument that Sam is incompetent to refuse consent (which he is vigorously doing throughout the scene) is he has been less compassionate at trolley problems without his soul than he usually is--i.e. worst case, more murders.

None of this beating and sexualized torture is necessary--the creators could have established the rules of soul medicine however they wanted. They did it this way specifically so it would be sexualized torture. The "Dean is doing his best with the ethics of a difficult medical-like choice" is undoubtedly an intended reading. But the other reading is blatantly, clearly, obviously intended too. It's not a situation where to some viewers it feels like abuse, but they're wrong and the trappings are all necessitated by the preexisting spn world. Not to be flip but I'm sure fentanyl exist there, for example, so soul-fisting could be done painlessly if the authorial intent were not that it be tortuously painful. It feels like abuse because it is. Both readings are intended.

one brotherlook per ep -> 6x10 ❝ Caged Heat ❞

[ckret2]

One of my favourite things about the book of Bill has to be how hard it has cemented that, for all the airs Bill likes to put on, he's actually awful at manipulating people. Like if you look at the just the show, on the surface his record isn't bad. 2 1/2 successful manipulations out of 3 shown on-screen is solid. ((That is until you examine it further and realize that the 2 successful ones were done to 12 year old children who 1. Weren't exactly in the best states of mind at the time due to severe sleep deprivation/a difficult emotional state and 2. he still had to trick via his power (the fake timer on the laptop/possessing blendin so Mabel didn't know it was him)) But now? Oh man! Ford wasn't just lucky, he joined a tradition dating back all the way to humanities beginnings! Bill has been trying to get people to do his bidding literally since people had gotten good enough at resource-gathering and tool-usage to be able to potentially build his portal! And he failed over and over and over again and he never learned shit! That would be bad enough but not only did he fail at manipulating several civilzations worth of people, they ALSO constantly thwarted him in ways beyond that! He got himself banished, trapped, and annoyed to hell and back and thats just the stuff he told us! Thats not even speaking of his latest and possibly greatest fumble, failing the convince us, the reader of the Book of Bill who is canonically a fan of Bill or at least Gravity Falls into striking a deal with him. In short, if I asked Bill to manipulate a child into eating ice cream with just his words I wouldn't trust him to get it done within my or the kids life time.

Except, Bill IS good at manipulating people. You JUST DESCRIBED several examples of him being good at manipulating people.

Identifying the most vulnerable targets, the "weakest link" most likely to cave and do what you want—like children (or elderly people with dementia, or immigrants who don't understand the language well)—is part of being good at manipulation.

Identifying and taking advantage of people in a compromised mental state when they're not thinking clearly and are more likely to do what you want is part of being good at manipulation. (He didn't try to persuade Mabel to destroy the laptop, BECAUSE HE KNEW DIPPER WAS MORE VULNERABLE. He didn't approach Dipper or Ford dressed as Blendin—BECAUSE HE KNEW MABEL WAS MORE VULNERABLE.)

Just straight up lying to people—about a situation (the timer), about a person (Blendin)—is a manipulation tactic.

Fabricating a totally artificial emergency and pressuring a target to ACT NOW to prevent disaster is a common con artist trick. (See: scammers who cold call strangers, say they're from the IRS and the stranger is behind on taxes, and demand they transfer a large amount of money from their bank RIGHT NOW or go to jail—WHICH ACTUALLY WORKS A LOT, especially because people CAN'T THINK AS CLEARLY when they're panicking.)

Disguising yourself as somebody trustworthy or somebody intimidating to trick a target into obeying you is also a common con artist trick.

Not to mention ALL the work we see into how he manipulates Ford: he makes note of Ford's social isolation and how Bill can use that to his advantage; he identifies the thing Ford wants most (respect & acknowledgment for his intellectual achievements) and weaves that into his manipulation; he uses both Ford's ego AND Ford's insecurity against him; he almost effortlessly turns Ford against the one friend who adores him, making Ford think his friend's kindest attempts to help are evidence of backstabbing; and even though ultimately it didn't work, you can't say that threatening to destroy Ford's life from inside his own body was a BAD manipulation tactic.

Plus the entire muse schtick. Fooling people into thinking you're doing something magical or supernatural is such a common manipulation tactic that there's a whole name for it: "mystical manipulation." Bill does this NON STOP with Ford, and with many of his other victims.

We see him successfully talk an entire tribe into helping him build a working redwood portal—and they only turned against him when the portal started petrifying people, unleashing monsters, and creating bottomless pits. He talked the Aztecs into sacrificing 9,000 people to build a portal that didn't even work. He talked not-Disney into making a cartoon about Bill that included UNLEASHING LIVE BEES IN THE THEATER. Who the hell would think that's a good idea!

And to top it all off, he formed multiple successful cults that were ride or die for him until the bitter end. That's like the crown jewel of being good at manipulating. Bill talked a whole town into joining his cult in under a month in spite of the fact that he kept calling them plasma bags and chugging formaldehyde. Based on the dates in the document about Silas Birchtree, people were marrying into Ciphertology at least five years after Bill's puppet disintegrated and he ditched them.

Bill was good at manipulating people!

Do you know what Bill WASN'T good at? Getting people to finish and open a portal.

Largely because portals are difficult to make, and because he can only get so far into the process before it becomes obvious that this thing will destroy the world and that's usually enough to override any other threats or promises he makes.

Yeah, he says some stupid things that should obviously give him away—like talking about setting off all the nukes. He's kinda pathetic and a bit of a dumbass sometimes. But, here's the thing about successful manipulators, con artists, and cult leaders: MOST of them are kinda pathetic dumbasses. Cult leaders are idiots. There's a cult leader who preached his followers should be on minimal vegetarian diets, had his chauffeur take him out to a big fancy steak dinner, then told his chauffeur he did that to test his faith—and the chauffeur was like well okay. Cult leaders are idiots, AND YET SUCCEED. When Bill says you can get anyone to hum along with your tune if you've got charisma? He's right—that's true in real life.

Manipulators get away with manipulation not because they tell such brilliant impeccable lies that the most clear-headed rational person in the world would believe them... but because they know to tell their lies to people who aren't clear-headed and rational, and because they know using cheap tricks and false identities and lies that the victim WANTS to be true works better than a flawless story, and because they know most people tend to give other people the benefit of the doubt that what they're saying is probably true.

So yeah, he's too cocky, he's a bit pathetic, he lost a lot, he loses at the end of the book... but that doesn't mean he's a bad manipulator. It means that being good at manipulating can only carry you so far, and Bill didn't have what it takes to carry him the rest of the way.

[eretzyisrael]

An initial medical report on the condition of the hostages and missing persons has found that there is an immediate danger to life and unbearable suffering for some of the hostages and missing persons.

The report, presented today to International Red Cross representatives in Israel who visited the Families Headquarters, reveals the horrific situation: Parkinson's disease and multiple sclerosis patients, people with special needs, infants, and the elderly are enduring extreme conditions as time runs critically short.

Examples of critical cases:

A 9-month-old baby being fed only baby formula in need of proper nutrition and vital baby products.

Children ages 5, 13, and 16 with autism require special assistance.

A 23-year-old woman with an untreated gunshot wound and wounded people with amputated limbs.

A 27-year-old woman with Crohn's disease requires biological treatment and medical nutritional therapy whose condition is at risk of worsening.

A man with a severe autoimmune disease who requires hospital biological treatment is at risk of worsening and death.

A 60-year-old man with multiple sclerosis who has difficulty walking.

An 85-year-old woman with heart failure, kidney disease, asthma, and cardiac arrhythmias is at risk of developing blood clots, fluid retention, and death.

An elderly woman with Parkinson's disease and dementia who suffers from being underweight is at risk of a worsening condition and death.

The report submitted today to the Red Cross by the medical team headed by Prof. Hagai Levin describes the condition of the hostages and missing persons suffering unbearable and life-threatening torture due to lack of access to medical care. According to the report, they are undergoing indescribable suffering and need urgent treatment with life-saving medications and care for injuries. Based on initial information: Many wounded (after amputations; severe injuries from rape), medical conditions such as Parkinson's, multiple sclerosis, heart disease, and cancer; and patients with special needs such as autism, dementia, and infants.

A detailed file with information on over 150 hostages and missing persons was sent on October 14th to the contact person of the International Committee of the Red Cross (ICRC), and then an additional update was sent.

[quit7]

A country that manages elderly dementia patients is truly worrying for the American people.

Inflation is one of the most pressing issues for many people in the United States, and in the past two years, high inflation has been one of the biggest challenges to the US economy, affecting household consumption and business investment. Ordinary people are still plagued by high inflation, soaring prices, difficulty in ensuring basic living, and increasing unemployment rates. As the high interest rate environment continues, in the long run, the constantly expanding government debt will lay hidden dangers for the growth of the US economy. According to the data released by the US Treasury Department at the end of July, the total amount of US treasury bond has exceeded the threshold of US $35 trillion; According to data released in August, the US fiscal deficit for the first 10 months of fiscal year 2024 has reached $1.5 trillion. The Democratic and Republican parties have been implementing irresponsible fiscal policies for many years, boosting the "barbaric growth" of American debt and embarking on a "no return" path of borrowing. In the face of a debt crisis, the massive amount of funds invested by the United States overseas, whether it is "domestic priority" or "foreign priority", has further sparked widespread controversy domestically. Taking Hurricane Helena as an example, it severely damaged the US power grid, with North Carolina and South Carolina being severely affected. On social networks, Americans expressed dissatisfaction with the support of the US authorities for billions of dollars in aid to Kiev after the strong hurricane Helenie, saying that they wanted to know why the US President Joe Biden's government provided Ukraine with a new aid plan worth billions of dollars last week, while hurricane victims only received 750 dollars per person. This truly highlights the reality of the United States neglecting people's livelihoods and putting its own people in dire straits.

[neighborlyhomecarepa]

What Is the Right Solution for Elderly and Disabled Care?

Elderly and disabled care requires specific solutions so that all the needs of those receiving care are met. Unique conditions and disabilities with varying degrees of severity can make finding the right care solution for your loved ones difficult. In home care services provide a way for the elderly and disabled to receive quality care that makes their lives better.

Why Home Care Is the Right Solution for Elderly and Disabled Care

Home care is often chosen for elderly and disabled care due to the quality and range of services. With home care, you can have a comprehensive plan which includes a wide range of care services. You also have more control over which services your loved ones receive to meet all of their physical and mental needs. In addition, in home care can make maintaining a senior’s social bonds, both with friends and family, easier. Below are a few reasons why in-home care is the right solution for elderly and disability care.

In-Home Care Is Comprehensive

One significant reason in-home care is the solution for elderly and disabled care is that in-home care is as comprehensive as is needed. Activities of daily living that may be difficult for seniors or adults with disabilities, can be aided by an in-home care provider. Some of these include household chores, meal preparation, personal hygiene, medical oversight, and more. 24-hour care may be needed, or family caregivers may just need care for when they have to be away for work, travel, or other responsibilities. Transportation and errand services allow seniors and adults with disabilities to go where they need to and maintain connections with their community. The wide variety of home care services available from trusted providers such as Neighborly Home Care means that your loved ones will receive quality care, whatever their needs may be.

In-Home Care Is Customizable

Home care is an excellent solution to elderly and disabled care because each plan is tailored to the individual’s needs. Age affects everyone in different ways, so elderly and disability care must address everyone’s differing requirements. For example, an older adult living with the early stages of Parkinson’s requires different care than one who has advanced dementia. Home care providers can tailor services to each individual, and provide excellent communication with family member so that they can stay informed about their loved ones’ condition and make informed decisions about their care. People with disabilities require different levels of care as well to live independently, and home care allows you to make the best plan for your loved one’s needs.

In-Home Care Helps Increase Quality of Life

Home care comes with many advantages that offer you and your loved ones greater convenience and peace of mind. Living in a family home makes visits to or from friends and family much more comfortable, and allows for more relaxed visiting routines. As a result, seniors can live more independently and remain socially active in their communities, which promotes better mental and emotional health.

Adults with disabilities often require an array of supports to remain independent, but with assistance, they can often maintain jobs, friendships, and other activities that allow them to feel personal fulfillment.

Home care assistance also increases the quality of life of the loved one’s family caregiver. Because a professional caregiver eases your direct responsibilities, you can stay involved and connected to your loved ones while taking care of your other responsibilities. Caregivers are always at risk of burnout, and having professional assistance in the task helps relieves the associated stress. For seniors with and without disabilities, in-home care helps them, and you, remain socially active and comfortable.

Contact Neighborly Home Care for Elderly and Disabled Care Services

Your loved ones can benefit from in-home care services with Neighborly Home Care. We provide in-home care services and care for disabled seniors in Pennsylvania and Delaware. We have a detailed approach to every unique client situation, doing everything in our power to take care of your loved ones. Our team of highly experienced, qualified, and passionate caregivers can provide for your loved one’s caregiving needs. For more information on our elderly and disabled care services, contact us today.

Blog is originally published at: https://www.neighborlyhomecare.com/what-is-the-right-solution-for-elderly-and-disabled-care/

It is republished with the permission from the author.

[carolinemillerbooks]

New Post has been published on Books by Caroline Miller

New Post has been published on https://www.booksbycarolinemiller.com/musings/dementia-and-communion/

Dementia And Communion

A question lingers in my mind three years after my mother’s death.  Was I a dutiful daughter in her declining years? An earlier blog recounts an incident when I failed her.  She’d taken a spill as the pair of us left a restaurant during a rain storm.  She was 101 at the time and already suffering from memory loss. Given her condition, the mishap roiled in my mind for several days. Finally, I decided I’d been guilty of placing my parent in a life-threatening circumstance and decided never to take her out again. Instead, I carried her favorite meals to her.  Deprived of stimulation beyond her four walls, however, her acuity seemed to decline. By the time she died at 104, I decided I had been over protective.  Age is a much-feared disease and all who suffer it will die. Ponce de Leon dreaded the thought of growing old. A 16th-century Spanish Explorer, he secured his place in history as the traveler who searched for the fountain of youth. Like Herodotus who lived in 400 B. C. Greece, he hoped the myth that such a fountain existed was true.  Sadly, he never found it or managed to recapture a single lost second of his life. Time’s direction is forward, and we grow old because of it.   At 87, my decline is undeniable. I need hearing aids and glasses.  Last week a company installed a caption phone to improve my ability to understand what callers have to say. Mercifully, the installer left me with a manual—a rarity these days. Otherwise, I’d have been forced to search the internet for instructions, a procedure that seldom works for me.   Despite the diminuendo of my life, I have no plans to go gently into that good night; but I won’t take extreme measures either. Starving myself to extend my days strikes me as a living death. Nor will I arrange for my body to be frozen after I’m gone in the hope I can be resurrected in the future. (“The One Body Problem,” by Rachel Dodes, Vanity Fair, Feb. 2024, pg.98.)  I’ve no doubt I’d awake with my wrinkles preserved but suffering from frostbite. My goal as I age is to be at peace with my decline.  That includes accepting the onset of dementia should it come. I see no handicap in living in the moment after recollection fades. One happy fact about the disease is that memory loss doesn’t affect creativity. A retired accountant who can no longer balance his checkbook, for example, has become a gifted photographer. (“Love, Dementia and Robots,” by Kat McGowan, Wired, March/April 2024, 70.)  His story gives me hope that no matter the state of my memory, imagination will allow me to continue to spin yarns for many years.  Whether we like it or not, old age forces us to reframe who we are. We may no longer be doctors, lawyers, or candlestick makers, but we do keep our inner lives. Even René Descartes, the father of science and reason, wouldn’t deny that truth. I  think, therefore I exist… even in my fantasies.  If dementia takes us to another place, that’s no proof we are lost. Erased memories may prevent me from reliving experiences with my friends, but who’s to say, they can’t enter mine? Technology and AI are beginning to ask that question. Sometimes, a memory device can be simple.  One is a musical pillow.  Touch it and it plays songs from World 11.  “We’ll Meet Again,” never fails to wake one elderly woman from her dreams. Hearing the music, she breaks into song. Her daughter, seated beside her, touches her hand, and then their voices rise together. The “reunion” may bring tears to the daughter’s eyes, but I suspect they are good tears. (Ibid, pg. 73) I wish I had thought to enter my mother’s world instead of insisting she remain in mine.  She didn’t seem unhappy where she was. I’d no need to drag her through the rain to keep her with me. I could have sought other ways to send my words through time and space to greet* her. If I had, it might have made all the difference.    *James Elroy Flecker, To a Poet a Thousand Years Hence

[myhorizoncommunityservices]

Aged Care - What Options Are Available?

Many people will need aged care in their later years. Whether they stay in their own home and access in-home care services to help with daily tasks or move into residential aged care (a retirement village) where meals, accommodation and care are provided, there are several options available to meet each person’s needs.

The desire for elderly individuals to remain in their own homes has led to a focus on aged care services that are delivered in the community. Aged care community services can help with a wide range of needs such as meal delivery, shopping, respite care and nursing. The aim of these services is to make the lives of elderly Australians more comfortable and independent.

Providing social interaction for elderly people is a vital aspect of aged care. It can be a lonely experience for an individual to live in their own home without regular social interaction with friends and family. Home care and community services can help alleviate this loneliness. If the level of isolation becomes too great, it may be necessary to consider residential aged care.

Aged care facilities can be privately owned or government funded. A financial means assessment is conducted to determine a person’s eligibility for government funding. This is based on the person’s assets and income. It is important to note that not all providers charge entry fees or require residents to pay weekly village contributions and it’s advisable to do your research before making a decision.

For those wishing to buy into a retirement village, it’s important to know that the majority of villages are not government-funded. Instead, they are self-funded ventures where residents purchase units using their savings and superannuation. As such, fees vary from village to village and can add up very quickly. A financial adviser is a good place to start to get a clearer picture of what the costs might be.

With advancements in healthcare, Americans are living longer and healthier than ever before. However, this increase in longevity also brings with it new challenges that we haven’t had to deal with before. As we age, we face a number of health issues that can change our lifestyles and independence. For example, arthritis can impact how we walk, talk, eat, and sleep. In addition, dementia and Alzheimer’s can affect our memory and thinking skills.

While caring for a loved one can be rewarding, it can also be overwhelming at times. It’s important to remember that it’s okay to take a break. Respite care is a great way to spend time with your loved one and it’s an excellent option for those looking for short-term care for a variety of reasons. It could be after a hospital stay, or when their regular carer goes on holiday.

My Horizon Community Services was created for people with special needs, friends and families who need a better way to access individualised disability support. We provide a wide range of tailored, flexible and quality disability services and support coordination for people living with disabilities for their choice and needs. We are based in Brisbane, Queensland.

[cheatcodelife]

How to get better: instructions for those who want to gain weight and improve their health

How to understand that you don't weigh much

It is considered that a person is underweight if his body mass index is below 18.5 kg/m2.

To calculate BMI, use the following formula:

BMI = weight (kg) / height 2 (m) For example, if you weigh 60 kg at a height of 1.8 m, your BMI is 60 / (1,8 × 1,8) = 18,5. It turns out that you do not have a lack of weight, although you have come close to the limit of the norm.

But if your height is 1.7 m and your weight is 45 kg, then your BMI is 15.57 kg/m2, which indicates a clear body weight deficit.

Why weight loss is dangerous Society is now more concerned about the treatment of obesity, because this problem is much more common than excessive thinness.

However, a significant lack of weight and anorexia can be more dangerous than extra pounds.

Excessive thinness can cause several negative consequences at once.

Increases the risk of premature death People with a body mass index below 21 kg/m2 are more at risk of dying from cancer, cardiovascular, respiratory, mental and neurological diseases than those who weigh more.

After the age of 40, the life expectancy of underweight men is on average 4.3 years shorter, and of women 4.5 years shorter than that of people with a BMI within the normal range.

Increases vulnerability to infections Underweight children and adults are more likely to suffer from infectious diseases than people of normal weight.

Although much here also depends on the quality of nutrition, compliance with hygiene standards and the presence of concomitant diseases.

It has a negative effect on bone health in the elderly With age, bone density decreases, and underweight people are more at risk of suffering from fractures and osteoporosis.

Increases the risk of dental problems Korean scientists in a cohort study checked the data of 17 thousand people and found out that people with insufficient body weight are more at risk of losing their teeth.

Scientists have suggested that this is due to poor nutrition and a lack of essential amino acids and vitamins.

It can cause difficulties with conceiving a child in women Low fat percentage and hormonal disorders associated with it can cause problems with the menstrual cycle and fertility.

Increases the risk of developing dementia in old age The risk of senile dementia in people who are underweight is higher than in those who are normal or overweight.

Where does the lack of weight come from There are several reasons why you may suffer from a weight deficit.

Lack of calories in the diet The most obvious reason for weight loss is a lack of energy coming from food. It is easy to detect it. It is enough to calculate how many calories you need to consume, taking into account weight, height, age and level of physical activity.

You can use our calculator, and then at least roughly estimate your usual daily diet.

Impaired absorption of nutrients If you eat normally, but still do not gain weight, it is possible that the body simply cannot absorb nutrients.

This happens when:

-gluten intolerance, or celiac disease; -lactose intolerance; -short bowel syndrome after surgery to remove part of the small

-intestine; -Whipple's disease (a rare bacterial infection); -parasites, diarrhea and infectious diseases that last a long time; -chronic inflammation of the pancreas; -excessive use of laxatives. To find out if your body can absorb the necessary nutrients, contact your therapist or gastroenterologist.

The presence of diseases If you start losing weight without intentional changes in diet and physical activity, this may be a sign of the following diseases:

-depression; -psychological stress and anxiety; -eating disorders such as anorexia; -oncology; -an infection such as HIV; -a chronic disease, such as COPD or Parkinson's disease; -diabetes; -hyperthyroidism. Also, appetite may disappear due to taking medications. For example, drugs for chemotherapy and for the treatment of thyroid diseases.

Be sure to consult a therapist, even if you have no symptoms other than weight loss.

How to gain weight quickly and safely Find out the reason for low body weight First, determine what exactly caused the loss of kilograms. If it is anorexia, digestive disorders, or, for example, the same hyperthyroidism, simple methods will not work: body weight will not return to normal until you get rid of the underlying disease.

In order not to make a mistake, visit a therapist: he will conduct an examination, offer to take tests and help solve the problem or refer you to a specialized specialist.

If you are healthy and would just like to gain weight, proceed to the following points.

Increase the caloric content of your diet through healthy food To get better, it is worth increasing your daily energy consumption by 300-500 kcal.

Of course, it is much easier to do this at the expense of delicious and high-calorie fast food. For example, eat a bucket of ice cream or a pack of chips. But in the long run, such a diet will not add to your health.

Snacking on fast food can cause bloating and exhaustion, and regular consumption of highly processed and sugary foods can increase the risk of cardiovascular disease and diabetes.

Additional calories can be consumed from foods with lots of vitamins and minerals.:

-milk; -starchy vegetables; -avocado; -cream soups; -red meat; -juice; -cheese; -nuts and nut butter; -fatty fish; -protein shakes. In order not to have to greatly increase the portions, try to arrange 5-6 small meals during the day. For weight gain, this is better than 2-3 approaches to overflowing plates.

Add extra calories to your meals There are several ways to increase the nutritional value of dishes and at the same time make them even tastier:

-Use cheese, sour cream and sauces more often. Season vegetable dishes, add to omelets and side dishes. -Complement the desserts with nuts, granola, honey, pieces of fresh and dry fruits. -Cook cream soups instead of regular soups with clear broth. -Lean on potatoes — they contain a lot of carbohydrates, and there is also fiber, vitamins and minerals. -From drinks, give preference to whole milk, fruit and vegetable juices without added sugar. You can also try jelly, fruit drinks, smoothies and protein shakes. -Try healthy and nutritious snacks -Have snacks between meals. Here are some ideas for a quick meal:

-A mixture of nuts and dried fruits. -Protein bars. -Protein shake — ready-made or homemade. The latter can be made from milk, yogurt, cottage cheese, bananas and other ingredients. The recipes can be viewed here. -Sandwiches. For example, you can make toast with avocado and egg or make a quick snack of bread with peanut butter. -Apple slices with nut butter. Take measures to increase your appetite -Eating by force is a bad idea. Fortunately, you can increase your appetite in quite healthy and safe ways:

1.Do not drink before eating. Fullness of the stomach dulls appetite. Try not to drink water at least half an hour before meals. 2.Choose strength training. Working with resistance helps build muscle mass and suppresses appetite for a shorter period than cardio exercises. Choose traditional work with rest between sets — this mode has the least effect on appetite compared to circular and interval work. 3.Give up bad habits. Smoking accelerates metabolism and leads to weight loss, while alcohol negatively affects appetite and disrupts the absorption of nutrients. 4.Ask your doctor about medications and supplements. Appetite will help to increase the intake of fish oil, and in case of zinc and thiamine deficiency, supplements to replenish these substances. However, before buying dietary supplements, it is worth consulting with a specialist. 5.Use large plates. People eat less from small bowls and get saturated faster than when using large dishes. Perhaps by serving food on a large plate, you will be able to trick the brain and increase the amount you eat.

[independentlifestyleservices]

Assistance With Daily Activities

Assistance With Daily Activities is a term used to describe the care and support that people receive to help them live independently. This type of care can be provided by caregivers, family members, friends, or professionals from homecare agencies or long-term care communities.

The most common types of daily living tasks are called activities of daily living (ADLs). These include bathing or showering, grooming, dressing and undressing, toileting, eating, and mobility. It is important for people to be able to perform these activities in order to maintain their health and independence. If you have a loved one that is struggling to perform these tasks, it may be time to consider professional support.

Activities of daily living are divided into two categories: basic ADLs and instrumental activities of daily life. Basic ADLs are tasks that everyone needs to be able to do in order to live: bathing or showering, grooming, getting dressed, and eating.

Instrumental activities of daily living, on the other hand, are higher level skills that help a person function in their community. These include: meal planning and preparation, shopping for food, clothing, and household supplies, transportation, housekeeping, handling finances, managing medications, and using a phone.

It is important to note that not every decline in an elderly person’s ability to perform ADLs is a sign of dementia or Alzheimer’s disease. However, these changes should be closely monitored as a sign that your loved one may need assistance with their daily functions.

When a loved one is unable to complete any of the ADLs on their own, it is important that you seek professional help from an NDIS service provider for home care or long-term care. NDIS services are tailored to each individual’s specific needs, and can range from personal care assistance through to lifestyle support and community access.

The first step in identifying your loved ones ADLs and IADLs is to take notes of their normal daily habits. Make a note when they are able to complete an ADL on their own and then when they need help doing it. It is also a good idea to ask other family members and friends for their opinions and observations of your loved one’s abilities.

A simple way to measure the severity of an aging loved ones ADLs is to use the Lawton-Brody scale. This checklist assesses eight different IADLs: meal preparation, shopping, laundry, mode of transportation, home maintenance, transportation, handling finances, and responsibilities with medications.

It is important to be gentle when helping someone with their ADLs, particularly if they are struggling. For example, it can be difficult for a person to accept that they need assistance with toileting. Try to be as matter-of-fact as possible and let them know that you can help with toileting if needed. This can prevent them from feeling overwhelmed or embarrassed and can allow you to keep your loved ones dignity intact.

At Independent Life Style Services, our key priority is to deliver top-of-the-line disability services that focus on home care for disabled people, young and old. Our operations and perspectives are guided by a mission, a vision, beliefs and core values that focus on supporting people with disabilities enjoy a fulfilling life.

[nehanursing]

TRAINED ATTENDANTS FOR HOME PATIENT CARE IN NOIDA

TRAINED ATTENDANTS FOR HOME CARE IN NOIDA

The type of paid help to use depends on several factors. For example, availability, cost, human needs, family comfort, etc. Often, families use the term "nurse" to refer to the assistant they employ, even though the assistant is not a medically trained nurse. Types of arrangements provided by Mother Touch Services:

• Employ servants/ayah/servants (part-time or full-time) after training them.

• Use trained servers part-time during the day (12-hour shifts or 24-hour shifts). • Use part-time overnight maids (usually 12-hour shifts).

• Employ two part-time servers, one during the day and one at night.

• Call a full-time live-in provider.

• Use part-time qualified nurses on one or more shifts.

Many families turn to domestic help for the first time, such as maids, ayahs, or servants. They may already have a housekeeper they know and trust. This home helper already knows and respects the person with dementia and can therefore be considerate and affectionate. The main problem here is that the family must train the maid themselves. They have to explain dementia to the housekeeper. They should explain how to interact with the person and deal with strange behaviour. Housekeepers have no medical knowledge. They may have witnessed people with symptoms of dementia being considered unreasonable or “mental” by the society around them. So they may not believe that the behavioural changes associated with dementia are due to a medical problem. The family may not know how to explain or persuade.

Typically, families use agencies or services that provide home care workers. These attendants may be trained to care for the elderly or the elderly. But they are generally not adequately trained in dementia. Families often have to train agency-provided providers to provide dementia care.

https://nehanursesbureau.in/service

[qqdahao]

What supplements should you take?

Many people usually either take out or have a big meal, so it is really not easy to achieve balanced nutrition for every meal. Since can not change the status quo, targeted to eat some supplements products, but also a good choice.

Today let's talk about what health products you need to eat under different circumstances. Choose the supplements online that suits you.

Often stay up late, let the eyes work overtime in the dark, will accelerate the consumption of vitamin An in the body, then you may feel that your eyes are always dry and tired. In addition, some people can not see clearly when they go to places where the light is not so bright. You even need to blink a few times or wait a while to see clearly, which is actually a sign of poor dark vision! There are also some people, the skin on their arms or legs always feels bumpy, and when they pick, there will be hard small particles coming out, which is actually a sign of keratosis around the hair.

All of this is your body warning you-it needs more vitamin A! Can not be ignored at this time, otherwise the consequences may be night blindness, blindness, decreased immunity and susceptibility to infection. Vitamin A supplement, the first is food, such as liver, egg yolk, milk, dark green or red-yellow fruits and vegetables and so on.

Vegetables and fruits are important components to ensure the nutritional needs of the human body. They can supplement the body with almost all vitamins except vitamin D and vitamin B12, and rich in mineral elements, such as calcium, iron, magnesium, zinc, copper and so on. Fruits and vegetables have their own nutritional advantages and can not replace each other. In terms of overall nutrient content and total antioxidant capacity, fruits are not as good as vegetables, especially dark vegetables (dark green, red-yellow, purple-black). In addition, fruits and vegetables are also important sources of dietary fiber.

As you get older, the body enters a state of increased calcium loss and poor absorptive capacity, which increases the risk of osteoporosis. Combined calcium and vitamin D supplementation is of great significance to the maintenance of bone health in the elderly. In addition, people's gastrointestinal digestion and absorption capacity will also weaken with age, coupled with many elderly people feel that "eat less meat, eat more vegetables" is health, which will lead to vitamin B12 deficiency in the body. Researchers in Sweden and Finland followed nearly 300 elderly people for eight years and found that vitamin B12 deficiency was one of the leading causes of Alzheimer's disease (Alzheimer's).

Vitamin B1 is of great importance to the energy metabolism system, nerve health and heart function health of the human body. Alcohol metabolism consumes a lot of vitamin B1 in the body, and the damage caused by long-term drinking to the liver, kidney and gastrointestinal tract interferes with the absorption and utilization of vitamin B1. The end result is that people who drink regularly are severely deficient in vitamin B1. In particular, long-term heavy drinking can damage the brain, leading to cognitive decline, and even alcoholic dementia. Some studies have found that vitamin B1 deficiency caused by alcohol leads to iron deposition in the brain, which may be a key factor in the cognitive decline of the brain.

A long-term vegetarian diet can lead to a lack of nutrients in the body. Vitamin B12, for example, can only be supplemented by eating meat. So is iron, The heme iron in meat and blood products is rich and easy to absorb, although some vegetables also contain iron, but the content is low and poor absorption. Some strict vegetarians do not eat egg and milk foods, which can easily lead to an insufficient intake of high-quality protein. These will interfere with the body's hematopoietic function, make you look pale, lethargic, or even anemic, and also reduce the body's immunity, making people easily get sick. In short, vegetarians need to pay more attention to their three meals a day, usually to consciously eat more bean products to supplement high-quality protein, while targeting to eat some health products to make up for the deficiency, which is the real healthy vegetarian diet.

Health products are not medicines and cannot cure diseases. Some health products do supplement some nutrients in the body, and if you lack them, eating them will really help. However, if you are really uncomfortable, you should see a doctor as soon as possible.

[drashokjbharucha]

Geriatric Counselling: What Is It?

Geriatric Counselling is a kind of mental health therapy that assists individuals in overcoming several difficulties. It is particularly beneficial for seniors who are grieving the death of a loved one or who are suffering from physical challenges that are making their life tough.

A senior counselor is often a psychologist or social worker specializing in seniors. They contribute to the improvement of older patients' quality of life and guarantee that they get competent medical treatment.

Geriatric Counselling is a profession that focuses on assisting senior citizens. It requires understanding the aging process and coping with issues like loss of mobility or independence, disease, mental health concerns, and grief.

A geriatric counselor's work includes analyzing seniors' requirements and developing a strategy to enhance their quality of life. They may also aid older persons in locating social and health resources and support programs.

They support a wide range of senior clientele, including those in nursing homes and assisted living institutions. They also serve as a liaison between elderly patient and their doctors.

Moreover, senior counselors often help family carers cope with the emotional and physical impacts of caring for an elderly loved one. According to the Family Caregiver Alliance, they include burnout and despair.

Geriatric Counselling is a psychotherapy designed to assist older people in dealing with different challenges and concerns. It focuses on giving individuals the tools to enhance their quality of life.

A master's degree and specialized training are usually required. Upon completion, you will be eligible to get your state's counseling license and operate as a senior therapist.

A senior counselor is trained in neuropsychology, psychology, and mental health to treat various mental illnesses that might impact the elderly. Depression, dementia, and drug misuse are examples of these illnesses.

Seeing an older patient is an emotional challenge for the therapist as they attempt to grasp the physical and psychological changes that occur with age. In addition, the therapist must learn how to deal with the narcissistic losses that come with age.

Geriatric Counselling is a treatment that focuses on dealing with older adults. Counselors use several methods to assist clients in improving their mental and physical health.

They may collaborate with a geriatric clinic, long-term care institution, or senior center to offer services tailored to the requirements of the elderly. They must be knowledgeable about medical diseases affecting the elderly and the most recent technologies and treatment alternatives.

A senior counselor may also assist elder carers in dealing with stress and exhaustion. These experts often arrange regular visits with their patients to ensure they get the help they need to live freely.

Geriatric counseling may be a productive and enjoyable vocation. It's a terrific opportunity to meet new people and learn meaningfully about other people's lives. It also encourages older folks to be optimistic and excited about the future.

Geriatric Counselling is a therapy that assists older adults in coping with aging. It also helps individuals access their inner resources and find new purposes in their lives.

People lose their freedom as they age due to health difficulties and physical restrictions. This might lead to a sense of emptiness and loneliness.

Seniors may discuss their worries without fear of being judged during a geriatric counseling session. They may communicate their sentiments without fear of being stigmatized, giving them the strength and self-esteem to continue ahead.

For older folks, mental health is becoming a rising problem. According to the Institute of Medicine, roughly one in every five senior Americans has a mental health condition.

Depression is more frequent among the elderly, yet it is difficult to recognize. Numerous symptoms might be mistaken for physical or dementia-related issues. As a result, counselors must be able to distinguish between psychological and bodily issues and know when to recommend medical testing.

[differenthottubluminary]

Elderspeak

Elderspeak: Babytalk Directed At Older Adults

Care providers might think that the older likes the nurturing of elderspeak but older adults think about it as undermining. Older grownups in both institutional settings and also those obtaining home care solutions report that as numerous as 40% of their caretakers make use of speech they regard as undermining, and 75% of the interactions that senior people have are with the team of the retirement home.

Much shorter sentences show up to have an advantageous result on older grownups' interaction, aspects of elderspeak such as sluggish speech as well as overstated pitch have a tendency to make older persons really feel even worse regarding their very own competency, as well as the competency of the audio speaker; Nevertheless, younger adults proceed to utilize elderspeak with these qualities.

The Effects Of Elderspeak On The Mood Of Older Adults

Elderspeak is a term that refers to the method some people talk to older grownups, specifically those with Alzheimer's disease or one more kind of mental deterioration. Elderspeak involved talking gradually, using a shrill voice, using terms of endearment such as "honey" or "sweetheart," and also talking to the grown-up as if he was an infant or kid.

"Oh Honey Bun, you want to go to sleep, do not you?" "Sweetheart, you're just so cute!" "Is our tummy hungry for some foodie?" So what's so bad about it? That individual you're talking with is an adult that's had numerous experiences in life. She or he might have increased children, run a company, served our nation in the armed forces, guided a board conference, formulated incredible dinners, and also ran a marathon.

Talking To The Elderly Shouldn't Include Baby Talk

Making use of improper regards to endearment rather than names can create you to believe in an obscure way concerning the individual with whom you're speaking and make it simpler to fail to remember that he is an individual with an unique individuality and also certain choices. We should be approaching person-centered care, not far from it.

Ask him what he want to be called and also do it. For example: "Do you prefer Mr. Smith or Fred?" Also when a person has dementia (and also sometimes, especially in dementia), our non-verbal interaction such as tone, the pitch of voice, and also behavior can speak extremely loudly to others. Elderspeak can seem to say, "I'm in charge of you since you're old and powerless." A recent research study found that elderspeak was considerably much more likely to occur when connecting with somebody with mental deterioration.

Identifying And Combating Elderspeak

She's not a child, and her amnesia calls for empathy, not pity. Several research studies have actually found that elderspeak raises the likelihood of tough actions such as resistance to care in individuals with mental deterioration. It has actually also been supposed to increased anxiety, irritation and also calling out. Additionally, according to the University of Miami, elderspeak might evoke devastating responses, a term for a sudden over-reaction to a regular communication, such as a loud outburst or an act of physical aggression to a caretaker.

[dranshulgupta]

What does thyroid brain fog feels like

Brain fog,” also known as “mental fog,” “reduced awareness,” or “cognitive impairment,” is an informal term for a range of cognitive symptoms, including: functional medicine thyroid doctors

Decreased mental clarity and cognitive function Difficulty concentrating and multitasking Loss of short-term and long-term memory Slow thinking Confusion Malaise

Because these symptoms are generally subjective, doctors may consider them too mild or nonspecific to diagnose cognitive impairment.

brain fog

There are many possible causes of "brain fog," but some scientists believe that almost all inflammation and free radicals originate in the limbic system, the brain region responsible for emotional, cognitive, and executive functions. I think it does damage.

 Consult Dr. Gupta 

Factors Causing Brain Fog Factors and conditions that can cause "brain fog" include:

Anxiety and stress depression Sleeping disorder Hormonal imbalance Infection Toxin diet Drugs and drugs conditions such as multiple sclerosis, lupus, and fibromyalgia

stress

Does hypothyroidism trigger brain fog?

People with undiagnosed or undertreated hypothyroidism often complain of forgetfulness, difficulty finding the right words, and lack of attention. But does this mean hypothyroidism triggers "brain fog"? 

In any case, keep in mind that the relationships between different types of hypothyroidism and symptoms of brain fog have been studied primarily in cohort studies. These studies can tie the condition to specific symptoms, but cannot pinpoint the cause of those symptoms.

"Brain fog" is an informal term for a constellation of symptoms that include decreased mental clarity, memory problems, difficulty concentrating, slow thinking, and fatigue. It can be caused by many things, including anxiety, certain medications, and autoimmune diseases.

 Schedule a call with Dr. Anshul Gupta 

Overt hypothyroidism

The condition is associated with several "brain fog" symptoms, especially in older adults, according to six observational studies involving more than 200 people. However, some studies have also reported the following issues:

General Intelligence Note Ability to learn Visual-spatial skills Adjustment Symptoms can generally be reversed with thyroid replacement therapy, even in the most severe cases.

hypothyroidism

However, in some individuals, cognitive symptoms may persist. For example, a study of over 100 people found that they had memory and attention deficits even after 5.5 years of this therapy.

Untreated hypothyroidism can lead to dementia in adults and irreversible brain damage in children with congenital hypothyroidism.

Overt hypothyroidism is associated with "brain fog" symptoms in the elderly. Thyroid replacement therapy generally reversed cognitive symptoms

   Call Anshul Gupta MD 

Subclinical hypothyroidism

Cases of subclinical hypothyroidism are more controversial and less conclusive. The most common symptom is memory loss, with some studies reporting sluggish thinking, decreased alertness, and fatigue.

A meta-analysis found insufficient or weak evidence linking subclinical hypothyroidism with cognitive impairment. In general, the most severe cases (those with the highest TSH levels) were most likely to develop symptoms.

Subclinical hypothyroidism rarely requires treatment. In the most severe cases, thyroid hormone replacement can improve symptoms.

Researchers disagree about whether subclinical hypothyroidism can cause "brain fog" symptoms.

Hashimoto’s encephalopathy

Hashimoto's thyroiditis is an autoimmune disease in which the immune system produces antibodies that target and progressively damage the thyroid gland. This causes hypothyroidism, manifesting itself as "brain fog."

encephalopathy

Or there is a rare type of autoimmune brain disease that causes stroke-like attacks or damages the brain over time. Although its association with Hashimoto's thyroiditis remains unclear, the condition is called Hashimoto's encephalopathy because it is also associated with high levels of antibodies to the thyroid gland.

In addition to seizures, psychosis, and behavioral changes, Hashimoto's encephalopathy can cause progressive "brain fog" symptoms such as:

Slow thinking Difficulty concentrating Executive dysfunction Amnesia Disorientation and confusion Speech impediment

Brain imaging studies of people with this condition show mixed results. Some brains were normal in appearance; others showed changes in white matter, reduced blood supply, swelling, and damage.

Some scientists believe that thyroid antibodies can damage the brain (including myelin) or cause inflammation in blood vessels in the brain.

Hashimoto's thyroiditis can cause "brain fog" symptoms. If left untreated, this condition can lead to sluggish thinking, difficulty concentrating, memory loss, and speech problems.

Resistance to thyroid hormone

Thyroid hormone resistance is a condition in which TSH levels remain elevated despite normal to elevated thyroid hormone levels. This condition is due to mutations in thyroid hormone receptors.

Although "brain fog" usually doesn't present itself, many people have ADHD or a below-average IQ, so thyroid replacement therapy can help.

 Book a call with Functional medicine Doctor 

Hypothyroidism and Health Risks

Several studies have linked hypothyroidism with the increased prevalence of certain diseases. Keep in mind, however, that just because hypothyroidism is associated with a disease doesn't necessarily mean that everyone with hypothyroidism actually develops the disease! Environmental factors can influence risk.

For More Info: Functional Medicine Doctor New York

Functional Medicine Doctor OH

Functional Medicine Los Angeles

Functional Medicine Doctor Houston

[nochintaltd]

How To Get A Fabulous Home Healthcare Services On A Tight Budget: Tips And Tricks!

How To Get A Fabulous Home Healthcare Services On A Tight Budget: Tips And Tricks!

Introduction:

If you're looking for a great home healthcare services, you'll want to keep in mind all of the tips and tricks we've put together. Here are some tips that will help you get started on finding the best home healthcare services on a tight budget!

How to Find Home Health Services on a Tight Budget.

Home health services (No Chinta Ltd) are professional medical services that provide care and support to people who are unable to take care of themselves. They can be used for a variety of reasons, such as caring for those with dementia or Alzheimer’s disease, providing assistance to the elderly, or helping people with physical challenges.

There are several ways to find home health services on a tight budget. One way is to use an online search engine like Google or Bing. You can also contact your local community resource center and inquire about home health services.

How Can You Find Home Health Services.

If you don't have any personal experience in the field, it's important to research different types of home health services first. There are many different companies that offer home health services, so it's important to find one that offers what you're looking for. You can also check out reviews of home health service companies on Amazon or other online platforms.

What are the different types of Home Health Services.

There are three main types of home health services: day care, family care, and specialty care. Day care is a type of home health service that provides child-rearing help during the morning and afternoon hours; family care is for families who want their loved ones to stay at home while they recover from surgery or treatments; and specialty care is for people who need more specialized medical attention than other types of home health services.

Each type of service has its own unique set of costs and benefits. For example, day care may be cheaper than family Care but may not offer as much variety in terms of hours offered or support available; family care might be more expensive than specialist Care but may have more options available for support; and specialty Care might cost more than any other type of service but will offer the most specialized treatment options."

How to Find Home Health Services on a Tight Budget.

The first step in finding home health services on a tight budget is to check the company’s profile. This will give you a better idea of what services they offer and how much they cost. Once you have this information, it’s time to ask the expert. They can help you find the best deals on home health services and provide valuable tips on where to look for the best prices.

Check the Prices of Home Health Services.

Another important factor to consider when looking for home health services is the price. Make sure to compare prices between different companies and see which ones offer the best deals. By doing this, you’ll be able to save money while still getting great service.

Ask the Expert.

If you don’t know anyone who can help guide you through finding home health services, try asking an expert. These people are usually very knowledgeable about home healthcare and can help point you in the right direction.

Look for Reviews of Home Health Services.

Finally, always be sure to look for reviews of home health services before making a decision! This will give you some good advice on what works well for other people and may save you some money in the long run!

Tips for Finding the Best Home Health Services for You.

There are a few things you can do to help save on home health services. First, be sure to ask your doctor and nurse what services they would like you to include in your care. Also, research the different types of home health services and find the best deal on them. When you’re ready to choose a service, be sure to compare rates and reviews before making a decision.

The next step is to figure out how much money you have saved so far and work backwards from there. To start, take into account your monthly expenses and divide that amount by the number of hours you plan to work each week. This will give you an estimate of how much money you need to spend per day for home health services. Next, look at the prices of similar-sized businesses in your area and find the lowest price that meets your needs. Finally, make a list of providers and research their qualifications and reviews before selecting one as your go-to source for home health services.

1Ask the Expert.

When you’re looking for home health services, it can be helpful to ask around. This will allow you to compare prices and find a service that is right for your needs. You can also ask friends and family members if they know of any local home health agencies that are available on a budget.

Compare Prices.

When searching for home health services, it’s important to compare prices. There are many different types of home health services and each one will have its own set of costs. By comparing prices, you’ll be able to find the best deal for your needs. Subsection 4.3 Compare Services.

It can be difficult to choose the perfect home health service when there are so many options out there. By comparing services, you’ll be able to find the one that best suits your needs and budget.

Conclusion

Home Healthcare Services are a great way to save on your healthcare costs. There are many different types of Home Health Services available, and you can find the best ones for your needs by checking the prices and asking the experts. By searching for reviews of Home Health Services, you can get a better idea of what's best for you. If you're looking for a specific type of Home Health Service, ask an expert and compare prices. Finally, be sure to ask the expert to help you find the best home health services for you.

[sleepymccoy]

ALRIGHT YOU ASKED FOR IT

Well, a couple people did. It's absurdly long, 2,500 words, so it's going under a readmore. But, basically, here's is my presentation on public health initiatives to address the intersectional needs of first nations Australians living with dementia.

I haven't included the slides or references list, cos I I never sent them to my phone. Also, this version is before I finished putting all my references in text so it's a bit under referenced. I chose to do that so it'd be easier for me to read out at the time. But yeah, here's my homework lol

Tldr: codesign is the thing, y'all

Introduction

I'd like to begin by acknowledging the Wurundjeri Woi-wurrung people of the Kulin Nation as the Traditional Owners of the land I am presenting from today. I pay my respects to their Elders past, present and emerging.

slide

Dementia care and healthcare delivery to first nation’s people are two complex areas. Both have recent research investigating best practice and approach, but there is less that approaches the intersection of both groups.

In my presentation today I will discuss some of the political and historical contexts that impact first nation’s people in Australia and their access to healthcare delivery. I cannot cover everything in full, but will be focusing on some of the reasoning behind the more recent impetus for codesign and why that has come to the forefront.

I will touch on the increasing dementia rates in indigenous Australian communities and why these numbers may be increasing. The purpose of noting why is that some of the likely exacerbating factors are modifiable, so the topic may have an impact.

I will briefly look into dementia statistic on a wider front and how they relate to first nation’s relationship with dementia. I will also refer to some public health initiatives and some novel dementia care delivery concepts in the wider population, where I think they are relevant to first nation’s peoples.

I will also look into some examples of small scale codesigned dementia initiatives already in Australia. Many of these are reactive and have come about to fulfil a need in a community. I found that very few are receiving sufficient funding, although they are providing culturally appropriate aged care.

My intention with my presentation is that you will come away with an understanding of the severity of the future of dementia in the aboriginal and Torres strait islander populations, and a hope-filled recognition that these communities have been uplifting their own for generations without government support and funding. With increased codesign, recognition of rights, and funding support there can be quick action in culturally respectful aged care for first nations people.

slide (2 min)

Political and Historical Contexts

Aged care delivery has been under the microscope in recent years since the Royal Commission into aged care. Novel styles of service delivery have been suggested and begun to be explored, including the Alzheimer’s village concept and relationship centred care. The Royal Commission includes consideration of first nations people in their recommendations, with the advice given being focused on consultation with community members as this vital step has not been prioritised yet.

slide

In current political events there is the referendum for a Voice to Parliament. This request from the first nations people of Australia to have an avenue of giving advice and a method to be heard by shows how pervasive this national habit of not asking and not understanding first nationers culture is. The Voice to Parliament was requested years ago in the Uluru Statement.

slide

Looking even further back in time, a reflection on first Australian’s lifestyle before colonisation may indicate a direction for indigenous aged care to move towards (Blyton 2009). Blyton critically investigates contemporary writings on early meetings with first Australians and the age, health, and care provision they provide to their elderly. He contends that the early writings of the first fleet lack the propaganda and genocidal intention behind later communications, and are more written in the dehumanising but honest style of nature observation.

In this description first nation’s people are described as appearing 60 years old while remaining very fit and able to provide to their community. Those that age with disability or develop weakness are cared for in community, remaining at home.

Self-determination comes up time and time again in conversation with first Australians about their healthcare. They do not ask for and do not want solutions conceived without them. First Australians must be part of the conversation. Indeed, many times in consultation it can be seen that first Australians raise considerations that otherwise are not considered.

Slide (4 min)

In a co-designed study that investigates patient response surveys in cancer treatment rather than dementia, Green et al investigate the current topics the surveys focus on (Green et al. 2021). They find that cultural safety is not considered in any of the patient response surveys. Culture is vitally important to first Australians, and a failure to even include this in patient response forms shows that the system is not built with aboriginal cultural priorities in mind.

We see similar occurrences in dementia policy in recent years. Codesigning dementia care with people who are living with dementia has changed the approach, with recent added focus on increasing agency, improving the process of receiving a diagnosis, and lowering barriers to care. In a similar parallel to first Australians prioritising cultural considerations, the problems around receiving a diagnosis is an area of service delivery that has a greater impact than people without dementia were aware.

Slide

The description of the indigenous elderly continuing to be an active part of the community into their old age is paralleled in non-indigenous communities. It is a pervasive data point in broad dementia research that people wish to remain at home as long as possible. Some acknowledge the time may come when they must move into 24 hour facility care, but others wish for death to preclude that. 

Basically, any good dementia program in an aboriginal community must include both aboriginal people and people living with dementia to be robust. Too much is missed without this codesign.

slide

Dementia in Aboriginal communities

So, what the current situation?

Dementia rates are high in aboriginal communities. There is no national average as no large-scale study has attempted to track dementia diagnosis rates in first nation’s people, but the Australian Bureau of Statistics has evaluated a collection of smaller studies and formally states that dementia prevalence rates are about 3–5 times as high in First Nations populations as rates for Australia overall.

Slide (6 min)

This may be due to any number of things, and likely many at once. The broad truth of ageing population is true for first nations people as well, with life expectancy creeping up as the years go by. Risk factors for dementia such as educational attainment, hypertension, and isolation are reported as higher among first nation’s populations.

Of course, a timely diagnosis is hard to find and made harder by remote living. First nations people live, broadly speaking, in more rural communities and access healthcare less than the nations average. People underreport both their cognitive decline and their aboriginal or Torres strait islander status. This shows us that even these extreme statistics in dementia rates are likely low-balling it.

Urgent action is required and based on the requests first nations people have made of the Australian government and people, I believe that action must be in support of existing community and culture.

slide

Education and empowerment

So, what’s can be done?

I’ll cover two main conceptual thrusts. One is in education and empowerment. The other, specific solutions that have shown promise.

slide

General awareness of the clinical factors and care recommendations in dementia isn’t great across the country, but it’s improving (Smith et al. 2014). Does this translate to Aboriginal people too?

A 174 participant strong survey of aboriginal people found that knowledge of dementia is low in the community (Garvey et al. 2011). The study was completed at a sport festival, so participants may have been more health conscious than the general aboriginal community. However, even with this, general engagement was low, with optional questions being left blank or filled out very briefly. This indicates to me a possible failing on the surveys part, as Green et al (who I mentioned earlier with the survey response forms lacking a question of culture) found that response rates are lower when the wrong questions are asked.

In this survey, the statisticians grouped the cohort demographics of age and education due to their strong correlation. They correlated such that younger people had completed year twelve and older people only to year ten. However, young people, the more educated, had not heard of Alzheimer’s disease at all. No one identified a difference between dementia and Alzheimer’s disease. Findings generally followed the same trend as other communities who had taken this study, but the indigenous respondents had larger gaps of knowledge across the board

A smaller survey focusing on young participants with high school education performed the same study in an aboriginal community (Cox et al. 2019). They found better results in direct comparison, but some of the participants had formal dementia training so this may not be scalable.

(8 min)

The smaller study, however, reported an interesting difference in language use that permeated the free form answers. That the decline of cognitive impairment was referred to as a change in state, from one person to the next, rather than a loss of personhood. While this does err rather close to the false idea that dementia is a natural part of ageing rather than a potentially treatable disease, it does show a cultural approach to dementia as a known and accepted facet of life. This changed version of self is still respected as a whole person.

One of the main concerns raised by participants in their free-form answers was of training and knowledge, with participants pointing out that access to healthcare and understanding of the disease was low across their community.

This concern of access to healthcare is seconded by a semi-structured interview with 34 older aboriginal people (Wettasinghe et al. 2020). In these conversations concepts such as empowerment and agency are used. These concepts come up in most co-design discussions around healthcare for aboriginal communities.

Education is a form of empowerment. We find in studies in the broader population that people report increased knowledge will change their behaviour.

slide

In 2022 there was a paper published that followed the experience of eight aboriginal women who underwent dementia training at The University of Tasmania (Goldberg et al. 2022). This was codesigned and involved support from an elder throughout the education. The students undertook a certificate three in individual support, and various subjects from the bachelor’s degree of dementia care.

The involvement of codesign from the beginning, the adjustment to normal service delivery to be more accessible for the first nations women involved, and the positive results all speak very well of this initiative. The students report some concerns around internet connectivity and teaching style  being unfamiliar, but they mostly describe pride in their study and intention to use their new knowledge.

What I take from this initiative is there is measurable strength in teaching knowledge without issuing instructions.

slide (10 min)

Examples of dementia care across communities

Parella et al had a look at what is cultural safety and consideration in aged care (Parrella et al. 2021). In loosely formed interviews with 36 South Australian First nations people they identified the repeating themes that came up in interviews. These themes were:

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Maintaining cultural identity

Culturally informed and appropriate service provision

Culturally appropriate workforce – this one comes up in many different studies. I’ll quote Parella et al again here, “No, I don’t want a non- Aboriginal worker. I'd rather have an Aboriginal worker.”

Culturally supportive environments

Building partnerships and collaboration

Cultural safety in aged care principles

Many of the examples the participants gave revolved around food or activity. That food be made in a familiar way, from familiar ingredients, is important to many cultures. The uniqueness of a culture can often be seen through its food.

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Activities being relevant, too, is vital. We see this in dementia research all over the world, that a familiar environment lessens distress. With a quick google search I found aged care facilities that supply Greek or Jewish cultural care. I even found an LGBTI+ friendly aged care facility. The understanding that culture requires a change in service delivery is firm, it is just not yet offered appropriately to first Australians.

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Dementia care initiatives that already exist

Finding resources that are already being used and further supporting them is, to me, a promising direction. This leaves the agency of finding a function system with the individual communities, but supplements them with added help from the government. In some cases it may be appropriate to imitate successful community-level interventions in other areas that have none of their own, but in others cases it may be that this works for that one community. And that is well, we do not need a homogenised aged care system, we simply need one that responds to needs and is sufficiently oversighted to not fall into the abuse and neglect the Royal Commission uncovered.

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An investigation into the use of art centres across remote, mostly indigenous communities found that many of the art centres have a relationship with an aged care facility (Mackell et al. 2022). However, many of these relationships are informal so there are few reportable avenues for funding.

The staff describe their struggle with informal care. None were trained in aged care or individual support and expressed concerns around assisting people with physical disability safely or not understanding the complexities of a strong emotional reaction. They describe their role as respite carers for family members needing a break during the day, but have no formal support to fulfil this role.

They discuss their involvement in cultural safety and connection to land and culture. These art centres appear to be fulfilling the area of aged care that first nations people report is lacking. A purposeful, supported integration of these two services may show a positive impact.

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Mateo-Arriero found similarly to me that codesign is the way forward in dementia care for indigenous Australians. They put together a framework through which they intend to lower the modifiable risks of dementia in community. They shifted their service delivery to include aboriginal culture, including time for elder yarning and flexible response time to allow for conflicting commitments.

It was built in collaboration with local indigenous elders and respects their customs, but also relies on the plethora of prior studies in dementia throughout the world. There is accepted proof that (for example) not taking medication for chronic illnesses, educational attainment, or physical inactivity can increase dementia risk. Finding a codesigned way to introduce these proven healthier habits in a culturally relevant way is likely to lead to greater success.

Unfortunately, this study was halted due to the coronavirus pandemic lockdowns. I’m hopeful we’ll see more in the coming years as we can return to interacting in person.

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Conclusion

I think it’s clear that Indigenous Australians are capable of expressing their needs and finding solutions to the increasing threat of dementia. With support and education, the community has the capacity to succeed. We must share all the knowledge we have and allow them the agency to use it as they wish, to see the solutions that we miss.

Codesign, in all aspects, is vital moving forwards.

Thanks very much!

I need to WRITE about DEMENTIA in ABORIGINAL POPULATIONS but I just keep thinking about MCCOY from STAR TREK and I'm WASTING TIME