Prepare for the impact of alzheimers

Even in the early stages of dementia, financial skills can be diminished. These steps can help protect you or a loved one -- and a retirement nest egg.

By Susan B. Garland, Editor, Kiplinger's Retirement Report
February 29, 2012

In drawing up your financial plan for retirement, you may be setting aside money for new hobbies or extensive travel. But perhaps you also should prepare a financial contingency plan for Alzheimer's disease.

That may sound somewhat alarmist, but consider this: A decline in the ability to handle financial matters is one of the early signs of Alzheimer's. Seniors with mild symptoms -- forgetting to pay bills or struggling to balance a checkbook or calculate change -- are easy prey for fraudsters. And the cost of caring for someone with dementia can devastate even a healthy nest egg.

The risk of at least one spouse developing Alzheimer's disease is fairly significant, which makes creating a financial plan so important. According to the Alzheimer's Association, 13% of people 65 and older have Alzheimer's, and 43% of those 85 and older have the disease. Longer life expectancy among baby boomers will increase the prevalence of dementia.

As boomers age and the number of seniors grow, financial advisers and physicians are beginning to come to grips with the financial impact of dementia. AARP and the Financial Planning Association have released a guide for financial professionals on the special issues related to older clients. And in a study in the Journal of the American Medical Association in February 2011, researchers instructed physicians on recognizing signs of impaired financial capacity. The researchers also provided guidance to physicians on the legal help that patients and family members could seek to protect their nest eggs.

Daniel Marson, one of the study's co-authors and the director of the Alzheimer's Disease Center at the University of Alabama at Birmingham, notes that it's sometimes difficult for family members to know when a loved one has mild cognitive impairment (MCI). Those with mild cognitive impairment "don't have significant changes in everyday functioning," he says. But, Marson notes, "Ironically, people who have MCI may be the most vulnerable to making poor financial decisions because a lot of families are not yet willing to admit there are significant declines." About 15% of those with mild symptoms develop Alzheimer's each year, says Marson, a professor of neurology.

So how does a loved one identify the early stages of Alzheimer's? In one study funded by the National Institute on Aging, Marson and another researcher compared healthy seniors to those who had early-stage Alzheimer's. The patients with mild symptoms scored significantly below the healthy seniors on such tasks as obtaining change for vending machine use or making an investment decision. Patients with mild symptoms also were unable to explain the risks of mail and telephone solicitations.

Seniors in the early stages of dementia have difficulty understanding basic financial terms, such as loan and interest, Marson says. They also forget to pay bills or pay them more than once. And they are particularly vulnerable to get-rich-quick schemes, he says. As the baby boomers move into their sixties, securities regulators are accelerating efforts to crack down on scams aimed at seniors with failing mental capacity.

Of course, it's best to make plans while you're still healthy, but someone with early-stage Alzheimer's can sign documents and make decisions. Here are some steps you and your family can take to protect your finances, whether it's before you or a loved one is diagnosed, or just after. Many of these plans work well for anyone who is diagnosed with a chronic illness.

Draw up directives. The first step is to draw up an advance health care directive and a financial power of attorney. Together these documents will allow a spouse, adult child or close friend to make decisions about your finances and medical care if you're unable to make your wishes known.

If your spouse becomes incapacitated and has not appointed an agent to make legal, financial and health care decisions, you'll have to go to court to become a guardian. Typically, spouses will name each other as health care and financial agents. Make sure you each appoint a backup agent, perhaps an adult child or a trusted friend.

Select a team. A financial adviser can develop a long-term strategy to pay for care. The adviser should take an inventory of all of the couple's assets, income and insurance policies. A long-term plan is especially important if one spouse is showing signs of dementia while the other has an acute illness, such as heart disease.

An elder law attorney can set up a "special-needs trust" that would pay for the disabled relative's care and protect a family's assets if he or she seeks government benefits. A lawyer also could help mediate among family members who may have different opinions on how to care for Mom or Dad -- or manage the money.

Moreover, a lawyer and financial adviser could develop plans that will take into account the financial needs of the healthy spouse. Even a short time in a nursing home can drain a couple's savings. At that point, a person with Alzheimer's will likely qualify for care paid by Medicaid. Rules vary by state, but generally the healthy spouse can continue to live at home and is allowed to keep some assets that are not counted in determining Medicaid eligibility. If you take action soon after the diagnosis, there are certain strategies that could protect assets for the healthy spouse and heirs while preserving Medicaid eligibility.

You can hire a geriatric care manager to help the family come up with strategies to assume control of the finances. A care manager also will help with day-to-day tasks, such as hiring home-care aides and finding an adult day-care center. You can find a care manager at the National Association of Professional Geriatric Care Managers (www.caremanager.org).

Designate a money manager. Because money-management skills are among the first to slide, a family member or the designated financial agent should start keeping tabs on the household finances. James Sullivan, a certified public accountant for Core Capital Solutions in Naperville, Ill., suggests that a family select two people to watch over the finances. "The family needs to establish checks and balances," he says.

It's not just financial abuse you're watching for, but also negligence. Sullivan recalls one incident where a mother was in a nursing home for five months before the son got around to filing for benefits under her long-term-care insurance policy.

Taking over the finances can be a delicate task if the senior has been in charge of the money. If your husband, for example, does not want to give up control of the finances, Sullivan suggests setting up a small checking account and depositing perhaps $200 or $300 a month. This way, he can still write checks, but the damage would be limited if he were tempted by a questionable financial scheme. "You're not taking away everything at once," says Sullivan, who specializes in planning for clients with chronic illness.

Family members can hire a daily money manager to pay bills, sort through the mail, balance checkbooks and decipher medical bills. You can find a money manager at the American Association of Daily Money Managers (www.aadmm.com).

There may come a time when a physician will be able to conduct a simple brain scan that will show whether you're in danger of losing your financial decision-making capacity. Research funded by the National Institute on Aging suggests a relationship between changes in the brain and diminished financial abilities in patients with mild cognitive impairments. "Wouldn't it be nice if we can tell patients that we're seeing certain changes in the brain that puts them at risk for declining financial capacity?" says Marson, a co-author of the study, published in the Journal of the American Geriatrics Society, in February 2010. "Then they can take protective steps."

Marson says such a scan could be 20 years away. In the meantime, you can watch out for the warning signs and make moves to guard yourself or your loved one -- and the retirement nest egg -- from harm.


Read more: http://www.kiplinger.com/columns/retirement/archives/prepare-for-the-financial-impact-of-alzheimers.html#ixzz1pbL0lCJn

Exercise for the Elderly -- There are Tremendous Benefits

By Marlo Sollitto

Reprinted from agingcare.com

The benefits of exercise throughout life are often touted. But is it safe for seniors older than 65 years to exercise? Absolutely. According to the American Academy of Family Physicians almost all older people can benefit from additional physical activity. Regular exercise protects from chronic disease, improves mood and lowers chances of injury.

With age, the body does take a little longer to repair itself, but moderate physical activity is good for people of all ages and of all ability levels. In fact, the benefits of your elderly parents exercising regularly far outweigh the risks. Even elderly people with chronic illnesses can exercise safely. Many medical conditions are improved with exercise, including Alzheimer's and dementia, heart disease, diabetes, colon cancer, high blood pressure and obesity.

Regular exercise provides a myriad of health benefits in your mom and dad, including improvements in blood pressure, diabetes, lipid profile, osteoarthritis, osteoporosis, and neuro-cognitive function.

Regular exercise improves:

Immune Function – A healthy, strong body fights off infection and sickness more easily and more quickly. Rather than sapping energy reserves entirely, recovery from illness should be less strenuous.

Cardio-Respiratory and Cardiovascular Function – Regular physical activity lowers risk of heart disease and high blood pressure. If the elderly person has hypertension, exercise will lower blood pressure.

Bone Density/Osteoporosis – Exercise protects against loss in bone mass. Better bone density will reduce the risk of osteoporosis and lowers risk of falling and broken bones. Post-menopausal women can lose as much as 2 percent bone mass each year and men also lose bone mass as they age. Research done at Tufts University shows that strength training can dramatically reduce the loss of bone mass, help restore bones, and contribute to better balance and less fractures.

Gastrointestinal Function – Regular exercise promotes the efficient elimination of waste and encourages digestive health.

Chronic Conditions and Cancer – Regular physical activity lowers risk of Alzheimer's disease and dementia, diabetes, obesity, heart disease, osteoporosis and colon cancer, to name just a few. It also helps in the management of high cholesterol and arthritis pain.

Regular physical activity is also associated with decreased mortality and age-related morbidity in older adults. In addition, a study by the Journal of the American Geriatrics Society examined exercise in the elderly and found that exercise training led to improvement in functional reach, balance and fear of falling.

Often, frail elderly people are unable to tolerate aerobic exercise routines on a regular basis due to lack of endurance. But while age-related changes in the cardiovascular system have significant effects on cardiac performance, it has been estimated that 50% of endurance loss can be related to decreased muscle mass.

The ideal exercise prescription for the elderly consists of three components: aerobic exercise, strength training, and balance and flexibility.

Cardio/Endurance Exercises

Physicians recommend 30 minutes of cardio respiratory endurance exercise each day for your elderly mom or dad. This means getting the heart rate up and breathing faster. Walking, cycling and swimming are all examples of cardio/endurance exercises. If the elderly person tires easily and for those just starting to exercise, it is OK to do three 10-minute periods of exercise.
Cardio respiratory endurance exercise increases the body's ability to deliver oxygen and nutrients to tissues and to remove waste over sustained periods of time. After exercising consistently for a few weeks, there will likely be an improvement in the person's ability to exercise and ability to perform everyday tasks without getting winded and out of breath.

Strength/Resistance Training

Strength training uses and strengthens muscles with repetitive motion exercises. Your elderly parent can do strength training with weights, resistance bands, nautilus machines or by using walls, the floor and furniture for resistance. Two to three strength/resistance training workouts a week will provide the greatest benefits. Exercise all muscle groups by doing 1 to 2 sets of 10 to 15 repetitions at moderate intensity. Progressively increase size of weights used during workouts.

Strength training helps prevent loss of bone mass and improves balance. Both of these things will help avoid falls and broken bones among seniors.

Stretching/Flexibility Exercises

Stretching is vital to exercise. Stretching helps muscles warm up and cool down gradually. Stretching improves and maintains flexibility, prevents injury, and reduces muscle soreness and stiffness.

Stretching can also be a time of meditation and a time to appreciate how the body feels. Activities like yoga or Pilates can provide a good form of stretching as well as strength training because they focus on isolating and developing different muscle groups. A number of exercise programs, like yoga and Pilates, focus on developing a strong ‘core,' a term which refers to the set of muscles connecting the inner stomach to the lower back and spine. Because the core muscles provide the foundation for all movement and strength, having a strong core can help with all movement, encourage better posture and reduce allover muscle pain.

Of course, there are some people whose physical abilities are limited by medical conditions or frailty in the elderly. These seniors have to go about exercise more carefully than others, but don't have to dismiss it entirely. With proper instruction and guidance, the elderly can learn activities and exercises that improve mobility and reduce frailty. Especially for those who are frail, it is particularly important to be careful, but to find a way to move the body, because regular exercise greatly reduces the risk of falling and broken bones. Try exercise in a class setting with proper supervision and definitely consider swimming or another form or water exercise as it can be less jarring to the body – the local YMCA or YWCA are good places to start when looking for exercise programs that address special needs.

Reprinted from Senior Health

Alzheimer’s Disease is a form of dementia that most often strikes people over the age of 65, although it is possible to occur at an earlier stage in life. It is incurable, and while treatments do exist, they generally have little effect on the disease’s progression. The best hope may be to recognize Alzheimer’s at its earliest stages in order to make the daily challenges of the sufferer less burdensome. Here are six common signs of Alzheimer’s.


1.Memory loss: Trouble remembering simple things is perhaps the most commonly-known symptom of Alzheimer’s. While some difficulty with memory is normal as a person ages, the problem is much worse in a sufferer of Alzheimer’s. The trouble extends to simple tasks that are part of everyday life, including things like not remembering where one recently put the car keys, or repeatedly asking someone the same question.

2.Problems following a plan or completing a familiar task: A person with Alzheimer’s will likely lose cognitive skills, which can make it hard to “use their brain.” It may suddenly become more difficult to solve crossword puzzles or cook a familiar dish. They may have trouble finding the way home from a place they visit often, or following the rules of a favorite game. This cognitive deterioration will also lead to problems doing multiple things at once.

3.Losing track of location or time: Someone suffering from Alzheimer’s will often have trouble with the details of the time and place in which they exist. This can be as simple as forgetting where the kitchen garbage can is. Or they may lose track entirely of what day it is or where they are, and forget significant events in their own lives and the world around them. Often they will only understand what is occurring in their immediate presence, and sometimes not even that. These symptoms will vary, and memory can temporarily return as quickly as it disappears.

4.Difficulty speaking or writing: As the brain degrades, those with Alzheimer’s will often experience trouble with their words, both when writing and when speaking. They may have trouble remembering the name of a familiar person or thing, may use the wrong word for something or find previously familiar words difficult to pronounce. They may jumble many words up so that though they think they are communicating, they are actually speaking nonsense.

5.Moodiness or personality changes: While changes in mood are expected as one ages, those suffering from Alzheimer’s may have more drastic changes than normal that can disrupt their daily life. They may find themselves apathetic, no longer enjoying things they previously did, such as hobbies or favorite foods. However this can extend to relationships as well, as the sufferer becomes withdrawn from their social life, and even fearful or anxious towards the people around them.

6.Making poor decisions: A common symptom of Alzheimer’s is a decrease in one’s judgment. The sufferer may have difficulty recognizing danger in common situations, such as crossing a busy street or using tools. They may also exercise poor judgment with their money and become susceptible to scams, because they are unable to understand when someone is taking advantage of them.
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