An Alzheimer's Disease Research Center
Making the Move to a Residential Care Community
Deciding whether to move your loved one from home to a memory or personal care community is a time full of unknowns, myths, and misunderstandings. Join Lorri Bernstein and Mindy Mozenter from Senior Living Specialists Philly as they dispel these myths and cover decision-making, expected costs, and emotional support.
By Victor Ekuta, MD
Penn Memory Center Clark Scholar
I was in my 3rd year of medical school when I first heard the phrase that “time is brain.” Coined in a 1993 editorial by Dr. Camilo Gomez, this pivotal concept emphasizes the critical importance of early intervention in preserving brain health after a stroke. “Unquestionably,” Dr. Gomez wrote, “the longer therapy is delayed, the lesser the chance that it will be successful, and early intervention will probably be a major determining factor in the limitation of the damage of neurons.”
Recent advancements in stroke neuroimaging have not only affirmed but quantified this urgency. For every untreated minute in an ischemic stroke, the average patient sheds a staggering 1.9 million neurons. For every hour, the loss of neurons is equivalent to almost 3.6 years of normal aging. In essence, this reaffirms the fundamental truth: time is, undeniably, brain!
Penn Memory Center Executive Director Felicia Greenfield
Greetings, and Happy New Year!
During this time of year when we pause and reflect, it’s important to embrace whatever journey we are on, to cherish what’s important, and to be open to what lies ahead. The turn of the new year celebrates renewal, and it is in that spirit that I announce my next chapter.
After 20 years of service at Penn, I am leaving to start my own therapy and consultation service. I’ve devoted decades to supporting families living with Alzheimer’s disease and other dementias at the Penn Memory Center. Now, I will bring my experience to broader audiences through my private practice. I am now accepting new clients. If you or someone you know can benefit from my services, please reach out. My contact information is below.
Felicia Greenfield, Cait Kearney, Leah Fein, and Meg Kalafsky at AAIC
When Cait Kearney joined the Penn Memory Center (PMC), she was a recent college graduate without full-time work experience.
In the three years since, Kearney has had positions at PMC created for her, published hundreds of newsletters, led training programs, represented the center at an international conference, and most recently completed her master’s in professional writing from Northern Arizona University.
Simply put, our communications team would not be the same without her. As she embarks on her newest chapter, we’re looking back at her journey and incredible contributions.
This is Kearney’s PMC story.
Sleep can change in key ways as we age, and while these changes are normal, this transition can be confusing and frustrating for some older adults.
However, there is good news, said UPenn Associate Professor of Medicine Nalaka Gooneratne, MD, MSc: By making a few adjustments to how you approach sleep, you can reduce these frustrations and continue to get good quality sleep.
1. Older adults need less sleep, so adjust your sleep schedule accordingly
The biggest change in sleep you may experience as you get older is that you need less of it.
“Typically, older adults need about half an hour to an hour less sleep than they needed when they were middle-aged adults,” Dr. Gooneratne said. “And many older adults who feel like they’re sleeping worse—sometimes it’s because they’re trying to get as much sleep as they had when they were younger, but their body just doesn’t need it anymore.”
Seven hours of sleep is typical for older adults. The best way to adjust for a shorter sleep schedule, Dr. Gooneratne said, is to first choose a time you want to wake up and then count backwards by seven. So, if you want to wake up at 7 a.m., you will probably have to go to bed around 12 a.m. or you will run the risk of lying in bed awake for a few hours.
But if staying up feels too difficult, you can try waking up earlier. For example, a 10 p.m. bedtime would mean waking up around 5 a.m.
2. Stick to a sleep schedule as much as possible
Once you’ve chosen when you want to get up, try and stick to that schedule as much as possible, Dr. Gooneratne said. Keeping a regular schedule will let your body know when you want to get up and help you fall asleep at night.
“If they want to sleep in, it’s okay to sleep in one night a week, but they really shouldn’t sleep in more than that,” he said. “That’s a particular challenge for many older adults because many of them are retired.”
3. You may wake up in the middle of the night more—do something unstimulating to pass the time
Another normal sleep development as we get older is that we tend to wake up in the middle of the night more often. It’s normal to be awake for up to an hour in the middle of the night as an older adult.
While this can feel frustrating, Dr. Gooneratne said the best thing you can do is try not to fight it and find an activity that is calming and relatively dry.
Usually, things on your smartphone or TV are too engaging to easily fall back asleep, so try reading or writing instead. If you’re a religious person, this could be a good time to say prayers, he said.
4. Look out for sleep conditions, and talk to your doctor
Older adults are also more at risk for sleep conditions, which can disrupt sleep, he said. The most common of these sleep conditions is sleep apnea, which is characterized by snoring and gasping during sleep.
He said to look out for any signs of snoring, gasping, or choking in you or your partner and tell your doctor, as sleep apnea can greatly interfere with your sleep quality.
Talk to you doctor as well about how medications you’re taking interact with sleep, as these could also disrupt your sleep.
More sleep tips
Exercise can help
If you’re struggling with insomnia, exercise is a great way to make sure you feel tired at the end of the day, Dr. Gooneratne said.
For people over 65, the CDC recommends 150 minutes of exercise a week that is moderate-intensity, like brisk walking, or 75 minutes of vigorous-intensity such as hiking or jogging.
Use technology to manage and track sleep
Dr. Gooneratne also recommended a few devices to help you keep track of your sleep.
If you’re going on a trip, Jet Lag Rooster by Sleepopolis can help you come up with a plan to help reduce the effects of jetlag. Type in where you’re flying from and flying to, when you’re departing and arriving, and when you normally go to bed and wake up, and the website calculates a plan to transition you to a new time zone.
Fitbits are another device that will track your sleep; however, Dr. Gooneratne said to ignore REM sleep tracker and sleep score because they are often inaccurate. Pay attention to the amount of time it says you slept because this is fairly accurate and can give you a sense of how much you’re waking up in the night.
Overall, while it might be hard, the best thing you can do is not overly fixate on how much sleep you’re getting. If devices bring you more anxiety around sleep, then it’s best to ditch them completely.
Originally published on BBC.com.
According to Dr. Mark Lachs, of Weill Cornell Medicine and his colleague, Dr. Jason Karlawish, from the Penn Memory Center, financial capacity can be one of the first things to decline when the brain is damaged through disease or age.
They want this process to be identified as a condition they call Age Associated Financial Vulnerability – a pattern of risky behavior that is inconsistent with choices that would previously have been made.
Dr. Karlawish says: “Financial decision-making is very challenging cognitively. Even with mild cognitive impairment, you can make mistakes with finances, even though you’re otherwise doing generally OK in your daily life.”
The Penn Memory Center’s Empowering Caregivers series focuses on helping caregivers with the emotional, physical, and logistical challenges they face tending to their loved ones. The series gives caregivers access to area experts who present on a variety of intensive topics from symptom management to end-of-life care.
Below are recordings of our last four workshops. If you would like to sign up for future Empowering Caregivers Workshops, please click here.
Dawn Mechanic-Hamilton discusses challenges with thinking that impact daily functioning and how to support areas of cognitive change. Dawn also explains how keeping our minds engaged can help support cognition and combat boredom, apathy, and agitation.
I-MEASURED is a study that seeks to better understand the experiences and priorities of persons living with dementia and their loved ones in order to improve the way we test new treatments for Alzheimer’s Disease and Related Dementias (ADRD). I-MEASURED is led by Dr. Catherine Auriemma of The PAIR Center in partnership with Dr. Jason Karlawish of the Penn Memory Center.
By Meghan McCarthy
In July of 2023, Quest Diagnostics released the Quest AD-Detect, a blood test marketed for individuals who have cognitive and memory problems and/or a family history of dementia. The test is not FDA approved.
Yet, instead of inciting excitement in the field of Alzheimer’s disease and related dementias (ADRDs), the test release left experts across the country concerned over test reliability and practice.
Here’s what you should know.
Rose looks down at a stack of bills on her kitchen counter and bottles of prescriptions besides them. The bills need to be paid. The pills, organized.
A month ago, the sight would cause immediate overwhelm for Rose. After her diagnosis of mild cognitive impairment (MCI) earlier in the year, managing such tasks has become increasingly difficult.
Yet Rose doesn’t feel overwhelmed. After her diagnosis, Rose recognized that she needed more familial support. It was then that her clinician first taught her about supported decision making.
Just a month earlier, she and her niece developed a supported decision-making agreement. In it, they specified that Rose’s daughter would spend the first Saturday of the month helping pay bills and organize medications.
Supported decision making is a process by which somebody who has cognitive impairment finds a trusted other or network of others who can help them make their own decisions.
A supported decision-making agreement, like the one between Rose and her niece, is a customizable agreement between a deciding individual and their supporter. The document can specify support in areas ranging from personal care and money to health choices and work arrangements. It can be provided to third parties, such as the patient’s doctors, lawyer, or financial managers.
For individuals like Rose, or those with Alzheimer’s disease or related dementias (ADRDs), there will come a time when an individual’s capacity to make decisions declines or becomes limited.
At the Penn Memory Center (PMC), decision making capacity and the ability to support loved ones as this capacity changes is at the heart of the work done by Emily Largent, PhD, JD, RN, Jason Karlawish, MD, and Andrew Peterson, PhD. Their collaboration is a blend of skills in law, public policy, ethics, dementia care and the philosophy of mind.