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Too Few Older Adults Tell Doctors About Memory Loss:

Too Few Older Adults Tell Doctors About Memory Loss: Study

Experts believe it's often a taboo subject due to fears of dementia

By E. J. Mundell

Thursday, January 28, 2016

THURSDAY, Jan. 28, 2016 (HealthDay News) -- Do you worry that forgetting names, or where you put your keys, might be a sign of impending dementia? If you're like most older Americans, you don't bring this up with your doctor, a new study shows.

Researchers who looked at federal government data on more than 10,000 people found that in 2011, only 1 in 4 adults aged 45 or older discussed memory problems with a health care professional during a routine checkup.

In fact, the likelihood that a person would admit to a memory problem in a doctor's office visit actually declined with advancing age, says a team led by Mary Adams, of On Target Health Data in West Suffield, Conn.

The findings were published Jan. 28 in the journal Preventing Chronic Disease.

"Routine checkups are a missed opportunity for assessing and discussing memory problems for the majority of older adults," Adams said in a journal news release.

Experts agreed that the stigma around memory loss and dementia may hold people back from discussing these issues with their physicians.

"Because dementia is unfortunately an all too common illness, older adults are quite familiar with its heralding signs and symptoms, which they have painfully observed in a long time neighbor or a family member," said Dr. Gisele Wolf-Klein, director of geriatric education at Northwell Health in New Hyde Park, N.Y.

"This reality leads to denial and avoidance, both on the part of the patient and the physician," she said. "'As long as we don't mention it, maybe it's just normal aging.'"

But mentioning memory troubles is important, because it doesn't necessarily have to herald dementia, Wolf-Klein said. "Memory loss may well not be due to dementia, but another highly treatable condition, such as depression," she noted.

And if it is linked to dementia, recognizing that fact early is crucial, she said.

"Patients can promptly meet with family members and elder law advisers, who can best help them in making individualized decisions for their care, rather than rely on last-minute decisions completed by family members at a time when patients now lack capacity," Wolf-Klein said.

Dr. Bruce Polsky is chair of the department of medicine at Winthrop-University Hospital in Mineola, N.Y. He acknowledged that talking about "memory loss and the possibility of the early development of dementia is a difficult discussion for both the physician and patient, mostly because of the long-term implications."

But early diagnosis of dementia can be important, he said.

"Even mild memory loss associated with early Alzheimer's disease may be improved with some of the medicines now available, although these medications do not stop the progression of the disease," he said. "Lifestyle modifications, such as smoking cessation, may also be of value in some cases."

"Although it is difficult for individuals to assess whether their own subtle memory loss is 'normal' or not, open discussion with their physician and, in some cases, testing may result in answers that could potentially lead to treatment and improved functioning," according to Polsky.

SOURCES: Gisele Wolf-Klein, M.D., director, geriatric education, Northwell Health, New Hyde Park, N.Y.; Bruce Polsky, M.D., chairman, department of medicine, Winthrop-University Hospital, Mineola, N.Y.; Jan. 28, 2016, Preventing Chronic Disease

Bladder Health

About Bladder Health

People rarely talk about bladder health, but everyone is affected by it. Everyone uses their bladder many times each day. But they may not know what to do to keep their bladder healthy.

What is the bladder?

Click for more information

The bladder is a hollow organ, much like a balloon, that stores urine. Pelvic floor muscles help hold urine in the bladder. The bladder is located in the lower abdomen. It is part of the urinary system, which also includes the kidneys, ureters, and urethra.

Why do we make urine?

The urinary system makes and stores urine. The body gets nutrients from what we eat and drink. But the body can’t use all parts of foods and drinks. After your body takes what it needs from foods and drinks, it has to get rid of the leftover wastes. The kidneys help remove these wastes and extra water by filtering them out of the blood to make urine. The urine made in the kidneys travels through the ureters to the bladder. The urine is stored in the bladder until you are ready to urinate. When you urinate, the urine exits the body through the urethra.

Daily Urination

Each day, adults pass about a quart and a half of urine through the bladder and out of the body. A quart and a half of urine would fill four 12 ounce cans of soda. But the exact amount of urine made each day is different for every person. The amount of urine you make changes based on the following factors.

• How much fluid you take in. This includes fluids from foods as well as drinks.
• How much fluid you lose by sweating. You may sweat more when the weather is warmer.
• How much fluid you lose by breathing. You may lose more water when you breathe heavily -- such as during physical activity.
• The medicines you take. Some medicines can change the amount of urine you make. Ask your health care professional if your medicines can affect the amount of urine you make.

How Aging Affects the Bladder

As you get older, the bladder changes. The elastic bladder tissue may toughen and become less stretchy. A less stretchy bladder cannot hold as much urine as before and might make you go to the bathroom more often. The bladder wall and pelvic floor muscles may weaken. Weak bladder wall muscles may make it hard to empty the bladder fully. Weak pelvic floor muscles may make it hard to hold urine in the bladder, which may cause urine to leak.

Bladder Problems and Everyday Life

Bladder problems are very common, and they can really lower a person’s quality of life (the person’s level of health, comfort, and happiness). In fact, people with bladder problems may have a lower quality of life than people with diabetes, heart disease, or high blood pressure. Bladder problems can disrupt day-to-day life. When people have bladder problems, they may avoid social settings, such as faith meetings, community gatherings, and family get-togethers. Bladder problems can also make it hard to get tasks done at home or at work.

Common Bladder Problems

Common bladder problems include the following.

• Lower urinary tract symptoms (LUTS) -- a group of symptoms such as trouble urinating, loss of bladder control, leaking of urine, and frequent need to urinate. LUTS are caused by problems with the bladder, urethra, or pelvic floor muscles.
• Bladder infection (cystitis) -- the most common type of urinary tract infection (UTI).  A bladder infection means that bacteria (or germs) have entered the bladder and are causing symptoms, such as having strong and sudden urges to urinate or having to urinate frequently.
• Bladder cancer: cancer in the lining of the bladder.
  Learn more about bladder cancer from the National Cancer Institute.

Bladder Problems and the Prostate in Men

Click for more information

Bladder problems occur more often in women, but they are also quite common in men. The reasons for the problems can be different in men and women. Men have a prostate gland that surrounds the opening of the bladder. While most tissues get smaller with aging, the prostate gets bigger.

When it gets too big, it can restrict the flow of urine through the urethra. This can make it hard to start urinating, cause the urine stream to be slow, and prevent men from completely emptying the bladder.

About Alzheimer's Disease: Other Dementias

• What is dementia?
• Vascular dementia
• Lewy body dementia
• Frontotemporal disorders
• Mixed dementia
• Other conditions that cause dementia

What is dementia?

Dementia is the loss of cognitive functioning—thinking, remembering, and reasoning—and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for basic activities of daily living.

Many conditions and diseases cause dementia. The most common cause of dementia in older people is Alzheimer’s disease. Other causes include different kinds of brain changes that lead to vascular dementia, Lewy body dementia, and frontotemporal disorders.

In addition, some people have mixed dementia—a combination of two or more disorders, at least one of which is dementia. A number of combinations are possible. For example, some people have Alzheimer’s disease and vascular dementia at the same time.

Other causes of dementia include Huntington’s disease, Creutzfeldt-Jakob disease, head injury, and HIV. In addition, some conditions that cause dementia, such as normal pressure hydrocephalus, thyroid problems, and vitamin B deficiency, can be reversed with appropriate treatment. For an overview of all types of dementia, see the booklet The Dementias: Hope Through Research. For more information about these conditions, visit the National Institute of Neurological Disorders and Stroke.

Vascular dementia

Vascular dementia, considered the second most common form of dementia after Alzheimer’s disease, results from injuries to the vessels supplying blood to the brain, often after a stroke or series of strokes. Vascular dementia and vascular cognitive impairment arise as a result of risk factors that similarly increase the risk for cerebrovascular disease (stroke), including atrial fibrillation, hypertension, diabetes, and high cholesterol. The symptoms of vascular dementia can be similar to those of Alzheimer’s, and both conditions can occur at the same time. Symptoms of vascular dementia can begin suddenly and worsen or improve during one’s lifetime.

Some types of vascular dementia include:

• Multi-infarct dementia
• Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL)
• Subcortical vascular dementia (Binswanger’s disease)

Research has shown that Alzheimer's and vascular disease-associated cognitive impairment are closely intertwined. For example, a large proportion of people diagnosed with Alzheimer's also have brain damage caused by vascular disease. In addition, several studies have found that many of the major risk factors for vascular disease may also be risk factors for Alzheimer's.

The overlap between these two types of dementia may be important because medications and lifestyle changes known to help prevent vascular disease, such as controlling high blood pressure, lowering cholesterol, and engaging in physical activity, may also help prevent Alzheimer's disease.

See also:

• The Dementias: Hope Through Research
• Vascular Dementia: A Resource List (National Institute on Aging)
• Vascular Dementia fact sheet (University of California, San Francisco, Memory and Aging Center)

Lewy body dementia

Lewy body dementia (LBD) is another common brain disorder in older people. LBD is caused by abnormal deposits of a protein called alpha-synuclein in the brain. These deposits, called Lewy bodies, can lead to problems with thinking, movement, behavior, and mood. For example, symptoms may include changes in alertness and attention, hallucinations, tremor, muscle stiffness, sleep problems, and memory loss.

The two types of LBD are:

• Dementia with Lewy bodies, in which cognitive symptoms appear within a year of movement problems
• Parkinson’s disease dementia, in which cognitive problems develop more than a year after the onset of movement problems

Lewy body dementia can be hard to diagnose because Parkinson's disease and Alzheimer's disease cause similar symptoms. Scientists think that LBD might be related to these diseases, or that they sometimes happen together.

See also:

• Lewy Body Dementia: Information for Patients, Families, and Professionals
• Dementia with Lewy Bodies Information Page (National Institute of Neurological Disorders and Stroke)
• Lewy Body Disease (MedlinePlus/National Library of Medicine)
• Lewy Body Dementias fact sheet (University of California, San Francisco, Memory and Aging Center)
• Lewy Body Dementia fact sheet (Emory University Alzheimer’s Disease Research Center)
• A comprehensive LBD symptom checklist (Lewy Body Dementia Association)

For health care professionals:

• Lewy Body Dementia Association—For Professionals
• Diagnosis and treatment (Lewy Body Dementia Association)
• LBD diagnostic checklist (Lewy Body Dementia Association)

Frontotemporal disorders

Frontotemporal disorders are a form of dementia caused by a family of brain diseases known as frontotemporal lobar degeneration (FTLD). These disorders are the result of damage to neurons (nerve cells) in parts of the brain called the frontal and temporal lobes. As neurons die in the frontal and temporal regions, these lobes atrophy, or shrink. Gradually, this damage causes difficulties in thinking and behaviors controlled by these parts of the brain. Many possible symptoms can result. They include strange behaviors, emotional problems, trouble communicating, or difficulty with walking and other basic movements.

Frontotemporal disorders can be grouped into three types, defined by the earliest symptoms physicians identify when they examine patients. The following conditions are frontotemporal disorders:

• Behavioral variant frontotemporal dementia (bvFTD)
• Pick’s disease
• Primary progressive aphasia (PPA)
• Corticobasal syndrome
• Progressive supranuclear palsy (PSP)
• Frontotemporal dementia with parkinsonism
• Frontotemporal dementia with amyotrophic lateral sclerosis (FTD-ALS)

See also:

• Frontotemporal Disorders: Information for Patients, Families, and Caregivers
• Frontotemporal Disorders: A Resource List (National Institute on Aging)
• Frontotemporal Dementia information (University of California, San Francisco, Memory and Aging Center)
• What Is Frontotemporal Degeneration (bvFTD)? (PDF, 78K) (Northwestern University)
• What Is PPA? (PDF, 394K) (Northwestern University)
• Primary Progressive Aphasia (University of California, San Francisco, Memory and Aging Center)

Mixed dementia

Autopsy studies looking at the brains of people who had dementia suggest that a majority of those age 80 and older probably had “mixed dementia,” caused by processes related to both Alzheimer’s disease and vascular disease. In fact, some studies indicate that mixed vascular-degenerative dementia is the most common cause of dementia in the elderly. In a person with mixed dementia, it may not be clear exactly how many of a person’s symptoms are due to Alzheimer’s or another type of dementia. In one study, about 40 percent of people who were thought to have Alzheimer’s were found after autopsy to also have some form of cerebrovascular disease. Several studies have found that many of the major risk factors for vascular disease also may be risk factors for Alzheimer’s disease.

Researchers are still working to understand how underlying disease processes in mixed dementia influence each other. It is not clear, for example, if symptoms are likely to be worse when a person has brain changes reflecting multiple types of dementia. Nor do we know if a person with multiple dementias can benefit from treating one type, for example, when a person with Alzheimer’s disease controls high blood pressure and other vascular disease risk factors.

Other conditions that cause dementia

• Creutzfeldt-Jakob disease (CJD)
• Huntington’s disease
• Secondary dementias
• Head injury and chronic traumatic encephalopathy
• HIV-associated dementia (HAD)
• Reversible dementias

NIA Information on Other Dementias

• 2014-2015 Alzheimer's Disease Progress Report: Advancing Research Toward a Cure
• Understanding Memory Loss: What To Do When You Have Trouble Remembering
• Forgetfulness: Knowing When to Ask for Help
• Frontotemporal Disorders: Information for Patients, Families, and Caregivers
• The Dementias: Hope Through Research
• Lewy Body Dementia: Information for Patients, Families, and Professionals

Other Dementias News

• NIH offers new resources on Lewy body dementia and dementia research
  December 11, 2013
• Alzheimer’s disease-related dementias take spotlight at NIH workshop
  July 26, 2013
• 2013 webinar series on Alzheimer’s disease and resources
  May 9, 2013

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Winter Weather Slips, Trips and Falls

Dementia Drug May Lower Risk of Falls Among Parkinson's Patients

Those who took rivastigmine in study were 45 percent less likely to have an accident

     

By Robert Preidt

Wednesday, January 13, 2016

TUESDAY, Jan. 12, 2016 (HealthDay News) -- A widely used dementia drug shows potential in reducing the risk of falls among Parkinson's patients, new research suggests.

"With the degeneration of dopamine-producing nerve cells, people with Parkinson's often have issues with unsteadiness when walking. As part of the condition, they also have lower levels of acetylcholine, a chemical which helps us to concentrate -- making it extremely difficult to pay attention to walking," said study lead author Emily Henderson, from the University of Bristol in England.

The study included 130 people with Parkinson's disease who had fallen in the past year. Half took the drug rivastigmine (Exelon), while the other half took a placebo.

After eight months, those who took the rivastigmine capsules were much steadier when walking and 45 percent less likely to fall than those who took the placebo, according to the researchers.

The study, published Jan. 12 in The Lancet Neurology, was funded by Parkinson's UK.

Parkinson's disease is a chronic and progressive movement disorder marked by tremors, stiffness and loss of coordination. About 70 percent of Parkinson's patients fall at least once a year and one-third have repeated falls, increasing their risk of broken bones and hospitalization, the researchers said.

"We already know that rivastigmine works to treat dementia by preventing the breakdown of acetylcholine [in Parkinson's patients], however our study shows for the first time that it can also improve regularity of walking, speed and balance. This is a real breakthrough in reducing the risk of falls for people with Parkinson's," Henderson said in a Parkinson's UK news release.

One U.S. doctor added a caveat, however.

Dr. Andrew Feigin, director of the Experimental Therapeutics Unit at the Feinstein Institute for Medical Research in Manhasset, N.Y., said the finding suggests "that rivastigmine may reduce falls in these patients, though the difference between the rivastigmine and placebo groups may have been driven by increases in falls in the placebo group as opposed to decreases in the rivastigmine group.

"Nonetheless, if validated in a larger trial, these findings could have significant implications for the treatment of gait abnormalities and falls in advanced [Parkinson's disease] patients," Feigin added.

Arthur Roach, director of research at Parkinson's UK, stressed the importance of preventing falls among Parkinson's patients.

"People affected by Parkinson's, their [caregivers], and health and social care professionals have said that preventing falls and improving balance is the biggest unmet need for people living with the condition, other than finding a cure," Roach said in the news release.

"Things that may be simple to us, such as walking upstairs or getting up in the middle of the night to get a glass of water or go to the toilet, are much harder and more dangerous when you could easily fall. You risk breaking bones and then needing an emergency hospital admission," he explained.

"This trial shows that there may be drugs already available, being used for other purposes, that can be tested to help treat Parkinson's. This takes us a step closer to improving the quality of life and finding better treatments for people with Parkinson's," Roach said.

SOURCES: Andrew Feigin, M.D., director, Experimental Therapeutics Unit, Feinstein Institute for Medical Research, Manhasset, N.Y.; Parkinson's UK, news release, Jan. 12, 2016

HealthDay

Learn about the legal, financial, and health care planning documents a person with Alzheimer’s may need.

• Legal, Financial, and Health Care Planning Documents
• Advance Directives for Health Care
• Advance Directives for Financial and Estate Management
• Who Can Help?
• Other Advance Planning Advice
• Resources for Low-Income Families
• Summary
• For More Information

A complication of diseases such as Alzheimer’s is that the person may lack or gradually lose the ability to think clearly. This change affects his or her ability to participate meaningfully in decision making and makes early legal and financial planning even more important. Although difficult questions often arise, advance planning can help people with Alzheimer’s and their families clarify their wishes and make well-informed decisions about health care and financial arrangements.Many people are unprepared to deal with the legal and financial consequences of a serious illness such as Alzheimer's disease. Legal and medical experts encourage people recently diagnosed with a serious illness—particularly one that is expected to cause declining mental and physical health—to examine and update their financial and health care arrangements as soon as possible. Basic legal and financial instruments, such as a will, a living trust, and advance directives, are available to ensure that the person's late-stage or end-of-life health care and financial decisions are carried out.

When possible, advance planning should take place soon after a diagnosis of early-stage Alzheimer’s disease while the person can participate in discussions. People with early-stage disease are often capable of understanding many aspects and consequences of legal decision making. However, legal and medical experts say that many forms of planning can help the person and his or her family even if the person is diagnosed with later-stage Alzheimer’s.

There are good reasons to retain the services of a lawyer when preparing advance planning documents. For example, a lawyer can help interpret different State laws and suggest ways to ensure that the person's and family's wishes are carried out. It's important to understand that laws vary by State, and changes in situation—for instance, a divorce, relocation, or death in the family—can influence how documents are prepared and maintained.

Legal, Financial, and Health Care Planning Documents

When families begin the legal planning process, there are a number of strategies and legal documents they need to discuss. Depending on the family situation and the applicable State laws, some or all of the following terms and documents may be introduced by the lawyer hired to assist in this process. Broadly speaking, these documents can be divided into two groups:

• documents that communicate the health care wishes of someone who may no longer be able to make health care decisions
• documents that communicate the financial management and estate plan wishes of someone who may no longer be able to make financial decisions

Advance Directives for Health Care

Advance directives for health care are documents that communicate the health care wishes of a person with Alzheimer’s disease. These decisions are then carried out after the person no longer can make decisions. In most cases, these documents must be prepared while the person is legally able to execute them.

A Living Will records a person's wishes for medical treatment near the end of life. It may do the following:

• specify the extent of life-sustaining treatment and major health care the person wants
• help a terminal patient die with dignity
• protect the physician or hospital from liability for carrying out the patient's instructions
• specify how much discretion the person gives to his or her proxy (discussed below) about end-of-life decisions

A Durable Power of Attorney for Health Care designates a person, sometimes called an agent or proxy, to make health care decisions when the person with Alzheimer’s disease no longer can do so. Depending on State laws and the person's preferences, the proxy might be authorized to:

• refuse or agree to treatments
• change health care providers
• remove the person from an institution
• decide about making organ donations
• decide about starting or continuing life support (if not specified in a living will)
• decide whether the person with Alzheimer’s will end life at home or in a facility
• have access to medical records

A Do Not Resuscitate (DNR) Order instructs health care professionals not to perform cardiopulmonary resuscitation if a person’s heart stops or if he or she stops breathing. A DNR order is signed by a doctor and put in a person’s medical chart.

Access to private medical information is closely regulated. The person with Alzheimer's disease must state in writing who can see or use personal medical records.

Advance Directives for Financial and Estate Management

Advance directives for financial and estate management must be created while the person with Alzheimer’s still can make these decisions (sometimes referred to as "having legal capacity" to make decisions). These directives may include some or all of the following:

A Will indicates how a person's assets and estate will be distributed upon death. It also can specify:

• arrangements for care of minors
• gifts
• trusts to manage the estate
• funeral and/or burial arrangements

Medical and legal experts say that the newly diagnosed person with Alzheimer’s and his or her family should move quickly to make or update a will and secure the estate.

A Durable Power of Attorney for Finances names someone to make financial decisions when the person with Alzheimer’s disease no longer can. It can help people with the disease and their families avoid court actions that may take away control of financial affairs.

A Living Trust provides instructions about the person's estate and appoints someone, called the trustee, to hold title to property and funds for the beneficiaries. The trustee follows these instructions after the person no longer can manage his or her affairs.

The person with Alzheimer’s disease also can name the trustee as the health care proxy through the durable power of attorney for health care.

A living trust can:

• include a wide range of property
• provide a detailed plan for property disposition
• avoid the expense and delay of probate (in which the courts establish the validity of a will)
• state how property should be distributed when the last beneficiary dies and whether the trust should continue to benefit others

Who Can Help?

Health Care Providers—Health care providers cannot act as legal or financial advisors, but they can encourage planning discussions between patients and their families. Qualified clinicians can also guide patients, families, the care team, attorneys, and judges regarding the patient's ability to make decisions.

Elder Law Attorneys (ELAs)—An ELA helps older people and families:

• interpret State laws
• plan how their wishes will be carried out
• understand their financial options
• learn how to preserve financial assets while caring for a loved one

The National Academy of Elder Law Attorneys and the American Bar Association can help families find qualified ELAs. See the list of resources at the end of this fact sheet for more information.

Geriatric Care Managers—Geriatric care managers (GCMs) are trained social workers or nurses who can help people with Alzheimer’s disease and their families:

• discuss difficult topics and complex issues
• address emotional concerns
• make short- and long-term plans
• evaluate in-home care needs
• select care personnel
• coordinate medical services
• evaluate other living arrangements
• provide caregiver stress relief

Steps for Getting Your Affairs in Order Gather everything you can about your income, property, investments, insurance, and savings. Put copies of legal documents and other important papers in one place. You could set up a file, put everything in a desk or dresser drawer, or just list the information and location of papers in a notebook. If your papers are in a bank safe deposit box, keep copies in a file at home. Check regularly to see if there's anything new to add. Tell a trusted family member or friend where you put your important papers. You don't need to tell this friend or family member your personal business, but someone should know where you keep your papers in case of emergency. If you don't have a relative or friend you trust, ask a lawyer to help. Get more tips for getting paperwork and legal and financial affairs in order.

Other Advance Planning Advice

Start discussions early. The rate of decline differs for each person with Alzheimer’s disease, and his or her ability to be involved in planning will decline over time. People in the early stages of the disease may be able to understand the issues, but they may also be defensive or emotionally unable to deal with difficult questions. Remember that not all people are diagnosed at an early stage. Decision making already may be difficult when Alzheimer’s disease is diagnosed.

Review plans over time. Changes in personal situations—such as a divorce, relocation, or death in the family—and in State laws can affect how legal documents are prepared and maintained. Review plans regularly, and update documents as needed.

Reduce anxiety about funeral and burial arrangements. Advance planning for the funeral and burial can provide a sense of peace and reduce anxiety for both the person with Alzheimer’s and the family.

Resources for Low-Income Families

Families who cannot afford a lawyer still can do advance planning. Samples of basic health planning documents can be downloaded from State government websites. Area Agency on Aging officials may provide legal advice or help. Other possible sources of legal assistance and referral include State legal aid offices, the State bar association, local nonprofit agencies, foundations, and social service agencies.

Summary

Facing Alzheimer’s disease can be emotionally wrenching for all concerned. A legal expert and members of the health care team can help the person and family address end-of-life issues. Advance health care and financial planning can help people diagnosed with Alzheimer’s and their families confront tough questions about future treatment, caregiving, and legal arrangements.

Overview of Medical, Legal, and Financial Planning Documents

Medical Document	How It Is Used
Living Will	Describes and instructs how the person wants end-of-life health care managed
Durable Power of Attorney for Health Care	Gives a designated person the authority to make health care decisions on behalf of the person with Alzheimer’s
Do Not Resuscitate Form	Instructs health care professionals not to perform CPR in case of stopped heart or stopped breathing

Legal/Financial Document	How It Is Used
Will	Indicates how a person's assets and estate will be distributed among beneficiaries after his/her death
Durable Power of Attorney for Finances	Gives a designated person the authority to make legal/financial decisions on behalf of the person with Alzheimer’s
Living Trust	Gives a designated person (trustee) the authority to hold and distribute property and funds for the person with Alzheimer’s

For More Information

Alzheimer's Disease Education and Referral (ADEAR) Center
P.O. Box 8250
Silver Spring, MD 20907-8250
1-800-438-4380 (toll-free)
www.nia.nih.gov/alzheimers

The National Institute on Aging's ADEAR Center offers information and publications for families, caregivers, and professionals on diagnosis, treatment, patient care, caregiver needs, long-term care, education and training, and research related to Alzheimer’s disease. Staff members answer telephone, email, and written requests and make referrals to local and national resources. Visit the ADEAR website to learn more about Alzheimer's and other dementias, find clinical trials, and sign up for email updates.

Eldercare Locator
1-800-677-1116 (toll-free)
www.eldercare.gov

Families often need information about community resources, such as home care, adult day care, and nursing homes. Contact the Eldercare Locator to find these resources in your area. The Eldercare Locator is a service of the Administration on Aging.

National Institute on Aging Information Center
P.O. Box 8057
Gaithersburg, MD 20898-8057
1-800-222-2225 (toll-free)
1-800-222-4225 (TTY/toll-free)
www.nia.nih.gov/health
www.nia.nih.gov/espanol

National Library of Medicine
MedlinePlus
www.medlineplus.gov

Search for:
"Advance Directives"
"End-of-Life Issues"

NIHSeniorHealth
www.nihseniorhealth.gov

This senior-friendly website from the National Institute on Aging and the National Library of Medicine has health and wellness information for older adults. Special features make it simple to use. For example, you can click on a button to make the type larger.

Other Organizations

AARP
601 E Street, NW
Washington, DC 20049
1-888-OUR-AARP (1-888-687-2277; toll-free)
www.aarp.org

Aging with Dignity
P.O. Box 1661
Tallahassee, FL 32302-1661
1-888-5WISHES (1-888-594-7437; toll-free)
www.agingwithdignity.org

Alzheimer's Association
225 North Michigan Avenue, Floor 17
Chicago, IL 60601-7633
1-800-272-3900 (toll-free)
1-866-403-3073 (TDD/toll-free)
www.alz.org

Alzheimer's Foundation of America
322 Eighth Avenue, 7th floor
New York, NY 10001
1-866-232-8484 (toll-free)
www.alzfdn.org

American Bar Association
Commission on Law and Aging
1050 Connecticut Avenue, NW, Suite 400
Washington, DC 20036
1-202-662-8690
www.americanbar.org/aging

Family Caregiver Alliance
785 Market Street, Suite 750
San Francisco, CA 94103
1-800-445-8106 (toll-free)
www.caregiver.org

National Academy of Elder Law Attorneys
1577 Spring Hill Road, Suite 220
Vienna, VA 22182
1-703-942-5711
www.naela.org

National Association of Professional Geriatric Care Managers
3275 West Ina Road, Suite 130
Tucson, AZ 85741
1-520-881-8008
www.caremanager.org

National Hospice and Palliative Care Organization
1731 King Street
Alexandria, VA 22314
1-800-658-8898 (toll-free)
1-877-658-8896 (Spanish/toll-free)
www.caringinfo.org

Organdonor.gov
Health Resources and Services Administration
1-877-275-4772 (toll-free)
1-877-489-4772 (TTY/toll-free)
www.organdonor.gov