KEYTO ALZHEIMER'S PATIENT MANAGEMENT
Los Angeles - Medical researchers suggest that replenishing vital chemicals found depleted in the brains of Alzheimer's disease victims may represent the first step in managing some of the clinical problems associated with the early stages of the disease, now the fourth leading cause of death in adults.
Researchers discussed these conclusions in Los Angeles at the close of a two-day scientific workshop entitled "Neurotransmitter Deficiencies in Alzheimer's Disease," sponsored by the John Douglas French Foundation for Alzheimer's Disease.
"Neurotransmitters are chemical compounds that stimulate or inhibit brain cell activity," said Bruce Miller, MD, French Foundation scientific coordinator and workshop participant. "More than 50 such compounds exist and, according to research, a number are found to be severely depleted in individuals afflicted with Alzheimer's disease. "
Conditions known to accompany Alzheimer's disease, Miller noted, include memory loss, sleep changes, and neuropsychiatrie abnormalities such as delusions, psychosis, and depression. These types of problems "could possibly be regulated" in the future through cell and chemical replacement therapies, he observed.
In addition to Miller, workshop conferees included Robert E. Harbaugh, MD, assistant professor of New Hampshire's Dartmouth-Hitchcock Medical Center, and Stephen Read, MD, of the Brentwood Veterans Administration Medical Center in Los Angeles.
Harbaugh presented preliminary results of a double-blind study involving the artificial delivery of neurotransmitter-like drugs directly to the brains of Alzheimer's sufferers. Harbaugh, who first pioneered the highly experimental procedure of implanting a drug infusing pump, related two significant discoveries that resulted from his research.
"The method of infusion is important," he explained. "This is a way of getting drugs to the brain, getting across the blood-brain barrier - getting around a lot of problems that have plagued efforts to deliver drugs to the brain for a long time.
"If we can circumvent the drug delivery problem, then we can really test whether or not increasing cholinergic activity in the brain has the desired effect of improving day-to-day functioning, initiative, and short-term memory in the Alzheimer's patient."
Harbaugh 's research closely parallels that of Read, who extended his inquiry to focus on the relationship of dose and response when administering bethanechol, the drug analogue that mimics the neurotransmitter acetylcholine.
Read, whose scientific investigation is sponsored by the French Foundation, said that as with any other disease, "people vary in their sensitivity to drugs.
"We know this is a disease that lasts years, and people at various stages of the disease may have different metabolic functions," he pointed out. "Different patients could have varying dosage requirements. We are still early in these trials, and we think it important to give careful scrutiny to the doseresponse question."
Read reported that in addition to testing the efficacy of artificial drug infusion in treatment Alzheimer's, his studies have shed more light on the problem of patient diagnosis and will ultimately contribute to the body of knowledge about the neurochemistry of the disease.
Hungarian neurophysiologist Gyorgy Buzsaki, MD, PhD, conducting research at the University of California, San Diego, reported to workshop participants on his efforts to transplant cells with acetylcholine in laboratory animals deficient in the compound.
Buzsaki, also sponsored by the French Foundation, feels his research may ultimately lead to a better understanding of the potential of neural grafts in treating Alzheimer's. "The key, we think, is to transplant the missing cells and if they survive and regrow their axons, or connections, then neurologic function can be restored."
SUPPORTIVE SERVICES PROGRAM
Boston - The Robert Wood Johnson Foundation has issued a request for grant proposals under its Supportive Services Program for Older Persons. This new national initiative will provide up to $13.5 million in grants to nonprofit home health care agencies in up to 20 communities for projects that offer a range of nontraditional health and health-related services to older persons. These services may include emergency response services, respite care, housekeeping, simple home repair, and transportation. In addition, the US Department of Health and Human Services will provide supplemental funds to assist low-income persons living in public housing to purchase services.
The goal of the program is to develop ways of helping more individuals to continue to function as independently as possible in the community. Grants of up to $750,000 over a four-year period will be made to as many as 20 projects mat cover large areas, for example, a section of a major city or an entire county, with high concentrations of older persons. Preference will be given to projects that include a broad-based population in terms of both income and health status, have formal relationships with one or more local public or private senior housing projects, and include innovative financing arrangements, such as capitation and shared-site services.
The services provided through this program are not intended to replace either those health services already provided through existing financial mechanisms or the informal care offered by family and friends. Instead, the program intends to supplement these with services not currently available or inadequately provided in a community.
Applicants must be certified home health agencies that are nonprofit organizations with tax-exempt status under Sec. 501(c)(3) of the Internal Revenue Code and that are not private foundations as defined under Sec. 509(a). Applicants must, at a minimum, serve areas with high concentrations of older persons; have a total current volume of home-based services in excess of 50,000 visits in the previous year; currently provide some essential supportive services to a private clientele; have experience using a variety of funding sources including third-party payers, categorical governmental programs, and direct clientele payments; and have the capacity to market and deliver a complete package of such services to a population large enough for the program to become financially selfsufficient within four years. For more information, call 617-647-2924.
TTPSTOR SELECTING A NURSING HOME
Lubbock, Texas - The pangs of guilt children often feel when placing parents in nursing homes can be allayed if the children can assure themselves they made the best decision possible.
Texas Tech University Health Sciences Center School of Nursing Professor Pat S. Yoder Wise says that, although placement in a nursing home is a last resort for most families, children often feel they are mistreating their elderly or ailing parents when the decision is made.
"A variety of services are available to help maintain a family member in the home," said Dr Yoder Wise. "When these services no longer meet all the needs, the family has to look for other arrangements - typically a nursing home."
But, she said, children should consult a healthcare professional about services such as Meals-on- Wheels, home health nursing, adult day care centers, and financial assistance before opting for nursing home admittance.
"Many people aren't aware of all the community services available to keep the elderly in their own homes," Yoder Wise said. "Children who know they have all the information available and the choice of a nursing home is still the best one can cope better with feelings of, 'I'm stashing my parents away.'"
At that point, the decision-making process has just begun. Regardless of whether parents want to live in a nursing home, they should be included in deciding which home is best for them, she said. A host of factors should be considered in choosing the right nursing home. Items to be considered early in the search are location, level of care needed, and the family physician's recommendation.
"If everything is equal in terms of the quality of care offered, the home best situated for convenience of family visiting is best," she said. "A place in the community that is most like home to the parent will help them to adjust. If your parents grew up in concrete high rises, you would look for something very different in a nursing home than if your parents grew up in the woods."
Nursing homes also offer varying levels of care, which should be considered in light of the parent's physical and mental condition. Skilled care facilities are highly specialized and are usually for short-term residents who need much attention, such as someone who broke a hip or who is recovering from surgery. Custodial care is for long-term residents who have little chance of improving and becoming independent again.
The mistake most often made, she said, is that the parents' needs for care are not matched with institutional climate and offerings. A person who is still very active mentally but who needs considerable physical care would be very frustrated in a nursing home where most of the residents are confused and disoriented.
"The parents' physician can help by advising the family of the level of care needed and which homes in the area provide that [care]. Physicians also may have preferences for nursing homes where they have other patients. If the physician is there on a regular basis, that makes incidental observation of the parent possible."
After preliminary guidelines have been set, the family should start the search with telephone calls to obtain general information. Questions to be asked include whether the facility is licensed, when the last state inspection was conducted, whether Medicare is accepted, bed capacity, typical occupancy rate, staff- to-patient ratio, how many beds there are in a room, and type of dining facilities.
"Licensure is an important consideration," she said. "In itself, it doesn't mean quality care, but it means they have been routinely checked to see if they are maintaining appropriate levels of nursing care, sanitation, and safety.
"The first level of decision making might be whether the person in charge can provide you with all this information over the telephone or direct you to someone who can. If no one can answer your questions, then you might be a little concerned."
One of the most telling aspects is the patients themselv«·. "Some residents, by virtue of their disease, will always look unkempt," Yoder Wise said, "but everyone shouldn't look that way. Noting personal hygiene of current patients will give clues about your parents' potential care.