Chapter 1 What Is Alzheimer's Disease?
Library | Alzheimer's and the Practice of Law: Counseling Clients with Dementia and Their Families (ABA) (2013 Ed.) |
CHAPTER 1 WHAT IS ALZHEIMER'S DISEASE?
Alzheimer's disease is a form of dementia characterized by the loss of memory and other intellectual abilities to the point that the disease interferes with daily life. It is the most common form of dementia, accounting for 50 to 80 percent of all dementia cases.1
"Dementia" is a term used to describe a multitude of diseases or conditions that develop as a result of damage to the brain's nerve cells (neurons). The damage to or destruction of the neurons creates changes in an individual's memory and behavior and affects the person's ability to think clearly.
As Alzheimer's runs its course, it ultimately impairs basic bodily functions, like walking and swallowing, and finally results in death.2
A person can have dementia but not have Alzheimer's disease. However, a person cannot have Alzheimer's and not have dementia. The term "Alzheimer's disease" comes from German physician Dr. Alois Alzheimer. Dr. Alzheimer presented a case history of a 51-year-old woman suffering from a rare brain disorder at a medical meeting in 1906. An autopsy of the woman's brain revealed the plaques and tangles that characterize Alzheimer's disease.3
The Alzheimer's Journey
Lawyers need to be aware of the many questions that must be addressed when a client or a client's loved one has Alzheimer's disease. These questions should include the following:
• How do we get health care for the patient?
• What options are available for health care?
• How are these options going to affect the patient and the family/spouse?
• What is the long-term outlook for everyone?
• How can we protect the family assets?
(Foremost on lawyers' minds may also be the ethics of working with clients with Alzheimer's and how to protect themselves; this is discussed in detail in chapter 2.)
Most lawyers are not accustomed to dealing with a client with Alzheimer's and probably are not prepared to answer these types of questions. This book is designed to educate lawyers so that they will have the knowledge needed to answer these questions and guide their client through the arduous journey of dealing with Alzheimer's disease.
Before the questions can be answered, lawyers have to be able to identify the signs signifying the onset of Alzheimer's or dementia. Unfortunately, the initial signs of Alzheimer's or dementia are usually the most difficult to spot. It may be months or longer before family members realize that a loved one is forgetting a few too many things or is confused too frequently. Often, these first signs are dismissed as "natural aging." However, neither Alzheimer's nor dementia is a natural part of growing old.
One of the first signs of dementia is also one of the most dangerous—a growing inability to understand and control financial matters. In the oldest American generation, those who saw World War II and the Korean War, most couples' finances have been controlled by the husband; it is not unusual for the wife to have no idea of the family's financial situation. That can be particularly problematic since men, on average, decline and die earlier than their wives.
It is very important that the healthy spouse and their children be alert for signs of memory loss, which can lead to both financial vulnerability and folly. The sooner these signs are identified and reported to the family doctor and lawyer to be dealt with, the better off everyone will be. Once a lawyer suspects that a client has some form of dementia, he or she should take extra care to protect the financial assets.
There is no legal standard for "vulnerability," but vulnerable individuals are more likely to make poor financial decisions and are prime targets for scam artists and criminals. Many so-called charities send direct mailings to senior citizens that are actually solicitations for donations but, to the untrained eye, appear to be bills. Some of the less scrupulous charities are hoping that these solicitations will result in donations from recipients who are confused and think that they must owe this amount since they are receiving a "bill" from a charity. Other organizations prey on the fears of senior citizens and send out mailings promising a dire future or political upheaval that is unavoidable without contributions from good people like the recipient.
The lawyer needs to make the client's family aware of these dangers and to warn the client's relatives of the possibilities that their loved one could become the victim of financial foul play.
Criminal enterprises and scam artists are not the only financial threat to clients with dementia. Online shopping, infomercials, and the lottery can be just as dangerous to a person with Alzheimer's.
Senior citizens afflicted with Alzheimer's on a fixed income may choose to spend thousands of dollars buying gifts for their relatives on their computer, or they may buy what they see on an infomercial because the commercial convinces them that they need something that they do not really need and quite possibly cannot afford.
Who does not enjoy playing the lottery occasionally? Legitimate lotteries are incredibly popular and, when the jackpots grow, the television and radio news coverage can be very exciting. Most people are able to play the lottery without going overboard and spending more on tickets than they can afford. However, one of the effects of dementia is the lessening of healthy cynicism. Most people "know" they are not really going to win the lottery and may buy a ticket here and there and daydream about winning, but deep down they do not expect to really win. Individuals with dementia may not understand that they are not going to win or that they are spending more money on tickets than they can afford. Individuals with dementia lose their capacity to understand financial meaning and to appreciate the consequences of their own actions.
People on the Alzheimer's journey often progress through this trajectory:
• memory loss ignored
• memory loss masked/denied
• unsafe alone
• aid needed
• assisted living required
• nursing home required
• hospice care required/death
The family of a loved one with Alzheimer's often progresses through a complementary trajectory that may have some of these components:
• memory loss ignored
• memory loss masked/denied/facilitated
• memory loss assistance needed by loved one, but hidden from "outsiders"
Family members need to be extremely proactive in carefully investigating a loved one's change in behavior. It is equally important for lawyers to be aware of these stages so that they may identify the stages themselves or assist the family in identifying or coming to terms with the symptoms of Alzheimer's disease.
Memory Loss Ignored
It is difficult to determine when memory loss is the first step of Alzheimer's or just normal aging. As people age, they forget things. However, forgetting what they had for lunch last Saturday is different from forgetting that they do not have unlimited financial assets.
Lawyers often need to rely on the client's family members when dealing with a client with Alzheimer's disease. Lawyers must be able to determine which relatives the client believes are honest and reliable, and who may be able to safeguard family finances and provide ongoing care and attention to the situation. Familiarity with multiple family members gives more options if signs of dementia do start to appear, and an atmosphere of open communication can go a long way toward preventing suspicion, family fights, and claims against the lawyer by disgruntled family members later on.
Once a lawyer has discussed options for the future with the client's family members and determined who might be the best person to take control of the client's finances in the event that the client is unable, the lawyer can assist the family with the development of appropriate legal documents and power of attorney for financial decision making. These documents give a nominated agent the power to make financial decisions for the affected loved one. The time to work on these plans is while the client with Alzheimer's still has sufficient capacity to make a will, trust, power of attorney for health care, power of attorney for property, and any other estate protection plans. Lawyers trained in this area of planning work to make sure that the healthy spouse is not excessively impoverished by long-term care expenses. (More on estate planning in chapter 4.)
There is no single factor that can provide a clear sign that an adult is functioning with diminished capacity, but there are clues that, when taken together, may indicate that professional medical tests should be conducted. For a lawyer, the potential signs of incapacity focus on decisional abilities rather than a person's cooperativeness or friendliness. Therefore, the lawyer will have to rely on the client's family to provide much of the information. Knowing the factors to look for allows the lawyer to ask the client's family the correct questions.
Some of the factors include
• change in the client's typical manner of behavior (these changes may take place over a long period of time and may not be instantly recognizable);
• unusually poor grooming or hygiene;
• short-term memory loss;
• comprehension problems;
• lack of mental flexibility;
• calculation problems;
• emotional signs of incapacity, such as emotional distress or emotional inappropriateness; and
• behavior incapacity, such as delusions or disorientation.
Do not assume that the normal aging process is the same as diminished capacity.
Memory Loss Masked/Denied
One good way to help determine if a client has diminished mental capacity is to observe the "15-minute reset." Look at a watch to note the beginning of a conversation with a person suspected of being affected by Alzheimer's or a related disorder. Often, people with excellent social skills (still common in women in their 80s and 90s) are able to hold a conversation that includes all the correct words and head nods. They are so adept at...
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