Personal decision-making processes and consideration often evolve as an individual ages. Typically, old age is associated with a decline in cognitive ability and decision-making skills. Recent study results, however, raise the question of whether age-related cognitive decline really does impact our ability to make decisions relevant to management of affairs and estate planning.
A set of studies recently conducted by the University of Basel and the Max Planck Institute for Human Development suggests that older individuals are able to make simple decisions just as well as younger counterparts. Where the results of the study were differentiated was in respect of complex decision-making scenarios. The study credited the enhanced ability of the younger test subjects to make multifaceted decisions more easily than older participants to the association of aging with reduced “fluid” cognitive abilities.
Decline in fluid cognitive abilities has been linked to an inability to understand the consequences of making a particular decision when similar situations have not previously been experienced and determining the most likely results of a certain course of action requires research and learning.
The results of the study do not take into account the prevalence of age-related conditions that do contribute to compromised mental capacity and decision making with age. Approximately 15% of Canadians aged 65 or older live with Alzheimer’s disease and other forms of dementia.
Although there is a presumption of mental capacity, in estate litigation, old age is often considered as a factor in determining whether a person was likely to have possessed mental capacity to execute certain documents or conduct certain transactions at a relevant time. It is important to remember that, just because a person is elderly, this does not in any way mean that he or she lacks the cognitive ability to make valid decisions, and may even be as capable of doing so as a younger person.
Have a great weekend.
Neglected oral health is an overlooked form of elder abuse. According to Dr. Natalie Archer, a dental surgeon specializing in the care of elderly patients, a great number of older adults are currently suffering from terrible abuse and neglect related to oral hygiene. Dr. Archer is certainly well placed to make such an observation. For ten years, Dr. Archer has practiced mobile Geriatric Dentistry throughout Ontario in over 135 Long Term Care facilities, nursing homes, hospitals and independent residences.
Recent statistics suggest that nearly one third of older adults have untreated tooth decay and 50 per cent of those over 75 years of age have root decay. Dental elder abuse or neglect occurs when a person or system (retirement home or hospital) fails to provide necessary dental care for an older adult. Not only does such neglect cause discomfort and pain, but recent studies seem to suggest that it can contribute to illness and even preventable death.
Many elderly individuals are faced with unique challenges when it comes to dental care. Unfortunately as we age, we often become reliant on others to assist with various aspects of our day-to-day lives. One of these aspects is dental care. The elderly often become reliant on others to ensure their mouths are cleaned, either because of arthritis, which makes it difficult or impossible to brush their own teeth, or as a result of dementia which tends to result in those individuals forgetting to brush their teeth. In many cases seniors are also unable to get to the dentist. Many don’t have drivers’ licenses and it seems older adults lose a lot of their freedom when they move into a retirement home and particularly once dementia sets in. Their loved ones and/or caregivers are often busy, and unfortunately, dental care is not always seen as a priority.
In January of 2014, in an effort to bring the issues of dental health and elder abuse awareness to dentists, seniors and the broader community, Dr. Archer launched the Dental Elder Abuse Response Project (D.E.A.R.). Together with co-founder, Laura Tamblyn Watts, a lawyer and senior fellow at the Canadian Centre for Elder Law, and the support of the Federal government, the D.E.A.R. project is creating senior peer-trained workshops, online videos, brochures and checklists to provide practical, hands-on material on how to recognize and prevent dental elder abuse and neglect in the Greater Toronto Area.
The D.E.A.R. project is the first of its kind in Canada. Working with dentists, hygienists, seniors, caregivers and community organizations, the D.E.A.R. Project is “Taking the Bite out of Elder Abuse”.
Thank you for reading,
I recently came across an article published in the Globe and Mail titled, Ultrasound shows new promise as Alzheimer’s treatment.
The article describes how scientist are using ultrasound technology to break apart the neurotoxic amyloid plaques that typically result in memory loss and cognitive decline in those suffering from Alzheimer’s disease.
While still in the early clinical trial stages, scientists have found that the use of the non-invasive focused beams of an ultrasound almost completely cleared the plaques in 75 per cent of the animals, without any apparent damage to brain tissue. As such, this promising new discovery could be used to treat Alzheimer’s disease and restore memory. More detailed information about the research can be found here.
Research initiatives such the one outlined above are particularly important given the increasing prevalence of dementia in today’s society. A recent fact sheet published by the World Health Organization (the “WHO”) indicates that as of 2015, 47.5 million people are living with dementia worldwide.
Unfortunately, as a result of increased life expectancies and an aging boomer population, the number of dementia cases is expected to increase exponentially in the years to come. The WHO estimates there will be approximately 75.6 million people suffering from dementia by 2030, and 135.5 million by 2050.
Accordingly, dementia is quickly becoming a global health concern. Last week, the WHO hosted its first Ministerial Conference on Global Action Against Dementia in Geneva. The conference drew researchers, health officials and ministers from more than 80 countries around the world.
As such, it is likely that we will see an increase in government spending and a rise in research initiatives in this area, such as the one outlined above, in the months and years to come.
Thank you for reading,
I recently came across a website created by Alzheimer’s Research UK that provides simulated insight into the real effects of Alzheimer’s disease.
In its application, Alzheimer’s Research UK harnesses “the power of Facebook to illustrate some of the symptoms experienced by the 820,000 people in the UK affected by dementia”.
According to the Alzheimer Society of Canada, in 2011, 747,000 Canadians, or 14.9 % of Canadians over 65, were living with cognitive impairment, including dementia. By 2031, if nothing changes, this figure will increase to 1.4 million Canadians. The combined direct (medical) and indirect (lost earnings) costs of dementia total $33 billion per year, and, if nothing changes, will climb to $293 billion per year by 2040.
The Alzheimer’s Research UK website uses your Facebook account to replicate and illustrate the effects of dementia. The dementia awareness tool presents an overlay using your Facebook photos and posts to show how dementia could affect you and your memories.
The experience is frightening, and eye-opening.
Their message is that Alzheimer’s is not a normal part of ageing, but is caused by disease. Diseases have been beaten in the past, and with support, can be beaten again.
The Alzheimer’s Research UK team encourages browsers to experience the simulation, and then spread the word by sharing with one’s Facebook family and friends.
Thank you for reading.
On Thursday February 17, 2011, in the idyllic-sounding community of Sunny Isles Beach, Florida, former Chicago Bears safety Dave Duerson shot himself in the chest. He left behind a suicide note that read: “Please, see that my brain is given to the NFL’s brain bank.”
Duerson was 50 years old at the time of his death.
According to Ann McKee, the co-director of the Boston University School of Medicine Center for the Study of Traumatic Encephalopathy, the results of tests on Duerson’s brain revealed “classic pathology of CTE and no evidence of any other disease. He had severe involvement of areas that control judgment, inhibition, impulse control, mood and memory.” In spite of these cognitive deficiencies, it is not a grand leap to infer that Duerson had a great depth of insight into his condition or the arc his disease would follow in the future.
CTE (chronic traumatic encephalopathy) is a form of progressive, degenerative damage to the brain caused by repetitive closed head injuries (i.e. ‘blows to the head’). It is characterized by the buildup in the brain of an abnormal protein called tau which tends to form in clumps and disrupt brain function. CTE first came to public light after it was identified in the brain tissue of former Philadelphia Eagles player Andre Waters after his suicide in 2006. The CSTE Brain Bank was established in 2008 for the sole purpose of collecting and studying post-mortem brains, because there is no medical test that can detect CTE in a living person. The Brain Bank ultimately hopes to answer some of the critical questions about CTE. How many concussions does it take to cause CTE? Is CTE time-dependent? – is it the number of years of repeated blows that will determine who gets CTE and who doesn’t? In 2009, McKee published a study indicating that of the 51 confirmed cases of CTE at the time, 90% of the cases occurred in athletes. If you have 10 minutes to spare today, watch this TIME video called "This is Your Brain on Football" in which McKee is featured.
Last Friday, 28 year old New York Rangers enforcer Derek Boogaard was found dead in his Minneapolis apartment. While details regarding the specific circumstances surrounding his death have been few, it spoke volumes that within 24 hours, Boogaard’s family had stepped forward to donate his brain to the Boston University School of Medicine.
Jennifer Hartman, guest blogger
* image courtesy of Microsoft
As an avid sports fan, I enjoy watching the physical nature of most sports. Recently, our media has reported on the severity of head injuries, which are caused by “head shots”, and the need to implement rules in professional sports to prevent catastrophic head injuries from happening.
Alan Schwarz, an author for the New York Times, recently wrote an article about a loophole in the California workers compensation system that allows retired professional athletes to file a claim for injuries sustained decades before, particularly retired N.F.L. players.
Schwarz states, “Most states require workers’ compensation claims to be filed within one to five years of the injury; California’s statute of limitations does not begin until the employer formally advises the injured worker of his or her right to workers’ compensation.” Also, California’s workers compensation statutes “require a professional athlete to have played only one game of his or her career within state borders to file a full claim for cumulative injuries.” The logical policy reason behind this legislation is to protect outside workers who temporarily pass through the state, like truckers or flight attendants.
As you can imagine, this loophole has opened the flood gates for retired athletes to file their workers compensation claim. In fact Schwarz states that “about 700 former N.F.L. players are pursuing cases in California, according to state records, with most of them in line to receive routine lump-sum settlements of about $100,000 to $200,000.”
What makes Schwarz’s article interesting is the claim filed by Ralph Wenzel. Wenzel has filed a claim arguing that his dementia at 67 years of age is related to his career as an N.F.L. lineman between the years of 1966 to 1973. The theory of Wenzel’s case is that “hitting your head over and over on the football field causes certain conditions.” In fact, researchers at “at the University of North Carolina have recently linked pro football careers and concussions with heightened rates of depression, mental decline and Alzheimer’s disease.”
As we continue to see a rise in those who are diagnosed with dementia and Alzheimer’s, I think it will be interesting to see how the sporting industry reacts to this disease, particularly, the rules each professional league implements to eliminate “head shots.”
Thank you for reading.
Rick Bickhram-Click here for more information on Rick Bickhram
The Toronto Star recently reported on Alzheimer’s disease, stating that “cases of the mind-robbing disease will more than double to 1.25 million within 30 years as baby boomers age”.
With the numbers pointing upward as the population grays, a recent report by the Alzheimer Society, entitled Rising Tide: The Impact of Dementia on Canadian Society suggests the following steps to help reduce the impact of dementia:
1. Prevention programs based on healthy diet and physical activity that can delay the onset of dementia by two years, with a potential cost saving of $219 billion over the 30-year period.
2. Enhanced skill-building and support programs for family caregivers, many of whom suffer financial hardship because they must leave jobs to look after a relative with dementia.
3. Assigning a case manager to each newly diagnosed dementia patient and their caregivers, which could help the person remain at home longer and lessen the strain on the long-term-care system.
Today, annual funding for Alzheimer’s is approximately $24 million. The Toronto Star reports that if “nothing changes, this sharp increase in the number of people living with dementia will mean that by 2038, the total costs associated with dementia will reach $153 billion a year”.
We have already seen a substantial influx with respect to Will challenges, particularly because there has been a big question mark about the testator’s capacity. The grim realty is that this will be a continuing problem that Estate Solicitors are going to have to tackle.
Thank you for reading.
Rick Bickhram – Click here for more information on Rick Bickhram.
After Alzheimer’s Disease, Lewy body Dementia (LBD) is one of the leading causes of dementia in the elderly, accounting for up to 20% of cases of dementia.
In Lewy body Dementia, abnormal protein structures called Lewy bodies develop in regions of the brain responsible for thinking and movement. These Lewy bodies were first described in 1912 by Friederich Lewy, a colleague of Alois Alzheimer.
LBD symptoms closely resemble those of both Alzheimer’s disease and Parkinson’s disease. The Alzheimer’s-like symptoms of LBD include fluctuating levels of attention and alertness, and a progressive loss of memory, language, reasoning and higher mental functions such as calculation. The Parkinson’s-like symptoms of LBD include rigidity, stiffness, stooped posture and a shuffling gait. Complex, well-formed, but oddly unthreatening visual hallucinations are one of the earliest and most common (>80% incidence) symptoms of LBD and usually consist of people, children or animals.
Here are some more quick facts about LBD:
· LBD is slightly more common in men than women. The average age of onset is 75 to 80 years of age.
· There is no single test to diagnose LBD. Like Alzheimer’s disease, a diagnosis of LBD is considered ‘possible’ or ‘probable’ after other possible diagnoses are considered and eliminated.
· Lewy body Dementia usually has a rapid onset and rapid progression. The average span of time between diagnosis and death is about 5 to 7 years.
· There are no know therapies to slow the progression of LBD, nor is there a known cure. The goal of treatment is to control the cognitive, psychiatric and motor symptoms of the patient.
Jennifer Hartman, Guest Blogger
Pseudodementia is a dementia syndrome which resembles dementia, but is actually the result of an underlying psychiatric disorder, most often depression. While the presentation of pseudodementia in the elderly varies widely, it closely mimics dementia in that common symptoms include:
· poor attention and concentration;
· a reduction in speed of cognitive response;
· compromised problem-solving and decision-making; and
· impaired immediate recall.
The two identifying hallmarks of pseudodementia are: i) there is no known neurological condition to otherwise explain the symptoms and ii) the cognitive deficits show considerable improvement, or even reverse, when the psychiatric illness is treated.
The concept of pseudodementia is a controversial one, in that it is considered a ‘soft diagnosis’, as there are no explicit diagnostic criteria; a physician’s checklist, if you will. There is no validated test, or group of tests to differentiate depression-related cognitive dysfunction from degenerative conditions such as Alzheimer’s Disease. Compounding the confusion surrounding pseudodementia is the fact that depression is frequent in patients with irreversible dementia. As a result, pseudodementia is often misdiagnosed as simply ‘true’ dementia.
In the context of estates litigation, a diagnosis of pseudodementia has the potential to significantly change the landscape of a capacity challenge. As an example, an article in the Bulletin of the American Academy of Psychiatry and the Law describes a nearly successful attempt to defraud a patient of their estate during her ‘presumed’ dementia, when in fact, she suffered from pseudodementia from which she later made a dramatic recovery.
Jennifer Hartman, Guest Blogger
Sunnybrook Health Sciences Centre houses Canada’s largest Veteran’s care facility, offering care to a current population of 500 vets, a few from the Korean War, but the majority of whom are from World War II. Residents are housed in two wings: the Kilgour Wing which promotes independent living, and the George Hees Wing with supportive care. Innovative dementia care is provided for Veterans in the Dorothy Macham Home, which is a therapeutic environment based on a residential model.
An article in last Saturday’s Toronto Star highlighted the unique challenges presented when a history of wartime service is coupled with a present day diagnosis of dementia. The hallmark of dementia is a (usually) progressive loss of memories, starting with the most recent memories formed. In a nutshell, this is why patients with dementia ‘forget’ that their spouse has died, or ‘forget’ that their children are now adults. For some of Sunnybrook’s Veterans, this means the war is not over. It is here. And it is now. According to Dr. Jocelyn Charles, medical director of the Veteran’s centre, behavioural problems in Sunnybrook’s dementia patients are twice as prevalent as the provincial average. In fact, in a study of Sunnybrook’s Veterans, 16 percent still showed active symptoms of PTSD, such as ‘distressing dreams, flashbacks and anxiety.’
Canada’s WWII veteran’s are dying at the rate of 400 a week.
Will you remember?
David M. Smith
David M. Smith – Click here for more information about David Smith.