Medications That Can Raise Your Risk of Dementia

A recent study has found there is an entire classification of medications that can raise your risk of dementia. Doctors prescribe these drugs frequently for seniors. The patients do not have to take the medications long-term to be significantly more likely to develop dementia.

The research focused on nearly 300,000 people, age 55 and older, over a 12-year period. The scientists found an association between the drugs and dementia risk. If, indeed, these medicines cause dementia, the statistics indicate these drugs could be responsible for about 10 percent of the cases of dementia. Since so many older adults take the types of medications now associated with a higher risk of dementia, this information could impact the lives of millions of people and their loved ones.

Types of Drugs That Increase Your Risk of Dementia

The category of medications found to have an association with a higher likelihood of dementia is anticholinergic drugs. The medical community has known about a link between these substances and memory issues or confusion for quite some time. The new study took the matter a step further to exploring dementia risk.

The anticholinergic drugs with the strongest association with dementia include:

  • Antidepressants, for example, amitriptyline and paroxetine
  • Treatments for overactive bladder, using bladder antimuscarinics like tolterodine and oxybutynin
  • Anti-seizure medications for epilepsy, like carbamazepine and oxcarbazepine
  • Anti-psychotic drugs, such as olanzapine and chlorpromazine

Doctors prescribe anticholinergic medications to treat a wide range of maladies, including motion sickness, vertigo and the conditions named above.

The Dosage Required to Affect Your Dementia Risk

According to the study, you would only have to take one pill a day for three years to have a higher risk of dementia. The drugs studied can increase the likelihood of dementia by almost 50 percent at that dosage.

Drugs That Do Not Increase Your Risk of Dementia

Some types of anticholinergic medications do not appear to increase the risk of dementia. For example, the researchers found no association between dementia risk and these anticholinergics:

  • Anti-arrhythmic drugs
  • Antimuscarinic bronchodilators
  • Skeletal muscle relaxants
  • Antihistamines
  • Gastrointestinal antispasmodics

The study did not give an explanation for why some classifications of anticholinergic drugs have an association with a higher likelihood of dementia and other types do not. In response to the article that published the study results, some medical experts call for research to determine if a patient can reverse the increased risk factor by stopping the drugs.

What You Should Do If You Take Anticholinergic Drugs

There is a wide variety of increased dementia risk, depending on which type of anticholinergic medication you take. Medical experts warn you should not stop taking your medicine without talking with your doctor first. The type of drug you take might have a low association with dementia.

It can also be harmful to stop taking a medication suddenly. Drugs that prevent seizures, depression, or psychosis should never get discontinued, without medical intervention and monitoring. Work with your doctor to evaluate the risk of the specific medicine you take and consider switching to another drug that could treat your condition without as much chance of developing dementia.

Your state might have different regulations than the general law of this article. You should talk with an elder law attorney in your area.

References:

CNN. “Commonly prescribed drugs tied to nearly 50% higher dementia risk in older adults, study says.” (accessed December 19, 2019) https://www.cnn.com/2019/06/24/health/dementia-risk-drug-study/index.html

Q & A – Medicaid for Nursing Home Care

As we approach our third act, new terminology comes into our daily lives that we may have heard before, but maybe never gave much thought to. Terms like Medicare, Medicaid, Social Security, Long-Term Care, and so on, can become sources of anxiety, if we don’t truly understand them. Therefore, today we’re answering some of the fundamental questions about Medicaid for nursing home care, in the hopes that we can alleviate at least one source of anxiety for you.

Question #1 – What is Medicaid?

Medicaid is a state and federal government-funded program that provides medical services to financially eligible individuals. Unlike Medicare, you do not have to be elderly to qualify for Medicaid, and many elderly individuals receive Medicaid benefits, including nursing home care. Every state administers its own version of Medicaid. For more information on Medicaid programs in your state, visit the Medicaid website, and select your state.

Question #2 – What are Medicaid’s basic financial eligibility requirements for nursing home care?

To determine your eligibility for nursing home benefits under Medicaid, the government will look at your income and resources in a given month to ensure you are within the legal limits for Medicaid benefits. To qualify for Medicaid, your monthly income must be less than the Medicaid rate for nursing home care, plus your typical monthly healthcare expenses. If you are eligible, you are allowed to keep $70 of your income for personal use. The rest is taken to pay for your care.

Question #3 – What is the Medically Needy Program under Medicaid?

For individuals that may exceed the financial limits to receive Medicaid, they may still qualify to receive Medicaid benefits under the medically needy program. This program allows individuals with medical needs to “spend down” their income to acceptable rates, by paying for medical care for which they have no insurance. For individuals over the age of 65, states are required to allow you to spend down your income regardless of medical necessity.

Question #4 – What resources can we have if my spouse is applying for Medicaid?

When a married couple applies for Medicaid, both spouses’ income and resources are included in the qualifying calculations. You may have all of the “exempt” resources, like an automobile and a house, along with one non-exempt item that does not exceed a set value (currently just over $58,000), such as cash or investments. Once your spouse qualifies for Medicaid, after one year, all excess income and resources must be transferred to the non-Medicaid-benefitted individual. That spouse may also accrue income and resources over and above the limits that Medicaid imposes on the benefitted spouse.

More information can be found on the Medicaid website, including requirements and benefits information for the state in which you reside. If you are interested in more information about long term care planning, speak with a qualified elder law attorney.

References:

Medicaid.gov. (Accessed November 28, 2019) https://www.medicaid.gov/medicaid/index.html

Read more about the article How Do I Prepare my Parents for Alzheimer’s?
Concerned aged mother and adult daughter discuss updating their estate planning documents and explore their options with regards to Alzheimer's

How Do I Prepare my Parents for Alzheimer’s?

Can your mom just sell her house, despite her diagnosis of Alzheimer’s?

The (Bryan TX) Eagle reports in the recent article “MENTAL CLARITY: Shining a light on the capacity to sign Texas documents” that the concept of “mental capacity” is complicated. There’s considerable confusion about incapacity. The article explains that different legal documents have a different degree of required capacity. The bar for signing a Power of Attorney, a Warranty Deed, a Contract, a Divorce Decree, or a Settlement Agreement is a little lower than for signing a Will. The individual signing legal documents must be capable of understanding and appreciating what he or she is signing, as well as the effect of the document.

The answer the question of whether the mom can sign the deed to her house over to the buyer.  is likely “yes.” She must understand that she’s selling her house, and that, once the document is signed, the house will belong to someone else. A terminal diagnosis or a neurodegenerative disease doesn’t automatically mean that an individual can’t sign legal documents. A case-by-case assessment is required to see if the document will be valid.

The fact that a person is unable to write his or her name doesn’t mean they lack capacity. If a senior can’t sign her name (possibly due to tremors or neurodegeneration), she can sign with an “X”. She could place her hand on top of someone else’s and allow the other person to sign her name. If this is completed before witnesses and the notary, that would be legal.

A hard part of Alzheimer’s is that a person’s mental clarity can come and go. Capacity can be fluid in the progress of a neurodegenerative or other terminal disease. Because of this, the best time to sign critical documents is sooner rather than later. No one can say the “window of capacity” will remain open for a certain amount of time.

Some signs should prompt you to move more quickly. These include things like the following:

  • Short-term memory loss;
  • Personality changes (e.g., unusual anger);
  • Confusing up or forgetting common-usage words and names; and
  • Disorientation and changes in depth perception.

Any of the signs above could be caused by Alzheimer’s, dementia, or many other problems. Talk to your, or your parent’s, physician and an elder law attorney. He or she can discuss the options, document your parent’s legal capacity, and get the right documents drafted quickly. Your elder law attorney can also give you information about planning for long term care options to consider and can help you understand the costs associated with long term care. 

Are Your Powers of Attorney ‘Hot’ Enough?

Many states, including Texas, allow people to give the agent named in their financial power of attorney what are referred to as “hot” powers, if they wish. This requires careful decision making, says the Glen Rose Reporter in an article that poses a question: “Should you add hot powers to your power of attorney?”

The “hot” powers are well-named, since they give a financial power of attorney considerable power. They allow the agent to create, amend, revoke or terminate a trust during the principal’s lifetime. The agent may also make a gift. In Texas, this is subject to the limitations under Texas Estates Code §751.032 and any special instructions, to create or change rights of survivorship, create or change a beneficiary designation and to authorize another person to exercise the authority granted under the power of attorney.

That is considerable leeway for an agent to be given during one’s lifetime.

In one case, a man decided that he wanted to give some of these “hot” powers to a power of attorney, but not all of them. Unless he made specific directions, he would be giving someone the ability to make gifts outright to individuals, to a trust, an UGMA (Uniform Gift to Minors Act) account or a qualified tuition program that meets the requirements of §529.

The attorney in this case advised the client that the gifts an agent can make, are limited to the dollar limits of the federal gift tax exclusion, or twice that, if the spouse agrees to a gift split as allowed under the Internal Revenue Code.

The gifts the agent can make are further limited to being consistent with the principal’s objectives, if the agent knows what those objectives are. However, if the agent does not know what those objectives are, he or she must still make sure the gift is aligned with the principal’s best interest, based on the value and nature of the principal’s property, foreseeable obligation and the need for maintenance.

The power of attorney in all cases needs to know what their responsibilities are, and if they are given “hot” powers, they need to be informed what those specific powers are. If the agent is someone other than a spouse or descendant, that agent may not make gifts to themselves. A spouse or descendant, however, could make gifts to themselves.

The man in this example wisely decided that while his son was very trustworthy and was going to be named his financial power of attorney, it would not be a good idea to place so much temptation in the young man’s path. Therefore, he instructed his attorney to modify the statutory form of the power of attorney, so his son is not permitted to make any gifts to himself.

Reference: Glen Rose Reporter (Jan. 3, 2019) “Should you add hot powers to your power of attorney?”

Is There an ADU in Your Future?

The idea of aging in place is something we’d all like to do. However, homes with many stairs or that are located in cold climates don’t always make this possible. One way that some families are addressing this wish to age in place: the Accessory Dwelling Unit, or ADU, according to Next Avenue in the article“Could an Accessory Dwelling Unit Help Your Aging Parent?” The flexibility—a home for mom for a few years, then used as an income-producing apartment—makes this an attractive option.

Sometimes referred to as a “granny pod,” the ADU is usually a small structure in a backyard, with little more than a bathroom, sleeping quarters and a kitchen. They are basically “tiny homes,” the very small living quarters that some people are opting for, in place of sprawling homes.

A survey by AARP found a third of adults 50 and older would be open to living in an ADU. Why not? It’s a great way to have some degree of privacy, while living near, but not with, children and grandchildren.

Communities are starting to update their zoning laws to permit the construction of ADUs, especially where housing costs are high. In Los Angeles, ADUs have been legal since 2017, when new laws about their use went into effect and the increase of ADU construction permits increased by 1,000%. Housing codes changes are being examined in many other cities, including Boston, Denver, Chicago, Denver, Seattle and Washington DC, say industry experts.

Some barriers still exist, and they may not go away quickly. One is that ADUs are not cheap, even thought they are small. Many cost $150,000 or more. Much of the cost is to hook the little house up to local utilities, as well as the cost of construction. Most lenders don’t offer ADU mortgages, so payment tends to be with cash or with a home equity line of credit. This restricts the number of people who can afford an ADU.

Local communities not behind the concept of an ADU, may be concerned about the little houses being less like a tiny home and more like a shack, having a negative impact on neighborhood looks and values. Zoning codes, even those that are changing, are strict about maintaining the structures.

If your family would benefit from an ADU, start by checking with your town’s planning or building department. If the community permits the use of ADUs, you’ll want to find local builders who have constructed ADUs before. Some builders may not be interested in what they perceive as a very small project.

As boomers grow and strive to maintain their independence, expect to see more communities embrace the use of ADUs.

Reference: Next Avenue (Jan. 2, 2019) “Could an Accessory Dwelling Unit Help Your Aging Parent?”

Who Will Pay for Your Nursing Home Care?

It’s hard for everyone in the family, when a beloved parent or grandparent must enter a nursing home, because they can no longer live on their own. Often the result of a physical or mental decline, the difficultly is compounded by worries about how to pay for the care, reports The Ledger in the article “The Law: Are you eligible for Medicaid nursing home coverage?”

Once health insurance coverage ends, the cost of care becomes enormous, with the monthly cost for a private-pay resident at nursing homes often exceeding $10,000 a month. What usually happens? Residents can’t afford the care and only have two options: qualify for Medicaid Nursing Home coverage, or sell every asset they can, impoverish the spouse, and ask adult children or other family members for help. Most people contact an elder law attorney and explore becoming eligible for Medicaid Nursing Home coverage.

Let’s use the state of Florida for an example of how to qualify for this coverage. A person must pass a three-part test that examines their assets, income and health, at the time the application is filed.

Income. As of Jan. 1, 2019, you could have a maximum of $2,313 per month in income (before deductions) to be eligible for Medicaid Nursing Home coverage. If your income was above that number, then legal planning is necessary to create a qualified income trust. Timing is extremely important, because if the trust is not set up correctly or in a timely fashion, you will not qualify for Medicaid.

There is a common mistake made about a spouse’s income being too high. It’s happily not true: a spouse’s income can be unlimited, and it does not impact a Medicaid applicant’s eligibility for benefits.

Assets. As of Jan. 1, 2019, you may have a maximum of $2,000 of countable assets and be eligible for Medicaid Nursing Home coverage. If the assets are above that threshold, there are a number of acceptable legal options to help the individual become eligible. There are two types of asset classes to consider when applying for Medicaid Nursing Home coverage: countable and non-countable.

Some non-countable assets are as follows: In Florida, homestead property up to $585,000 in value, one automobile, a prepaid burial contract and term life insurance without a cash value. Countable assets include bank accounts, investment accounts, life insurance with cash value, CDs and annuities.

As of Jan. 1, 2019, a spouse may have a maximum of $126,420 of countable assets, without having an impact on their spouses’ Medicaid eligibility.

An elder law attorney should be consulted to help the family understand the income and asset tests and create a strategy to help the individual qualify, if they anticipate needing Medicaid Nursing Home coverage. It’s best to do this well in advance, if possible.

ReferenceThe Ledger (Jan. 9, 2019) “The Law: Are you eligible for Medicaid nursing home coverage?”