Harvard Medical School - Day Two - Sat, 11/6/10

Today began with a presentation by Ellen Ogintz Fishman, LICSW, on Respecting the Presence of History in the Lives of Older Clients. She emphasized cultural competence for clients who are survivors of historical traumas including Armenian genocide, Hiroshima and Nagasaki, WWII combat vets, holocaust survivors, Japanese-American internees, Vietnam vets, Cambodian refugees, and Hmong refugees. Cultural and historical sensitivity is the awareness of memory triggers. For example, some triggers for Holocaust survivors include sirens, trains, dogs [especially German shepherds], uniforms, hospitals, antiseptic smells, loud noises, and bright lights at night.

Stephen L. Pinals, MD: Alternative and Traditional Treatments for Cognitive Enhancement. There have been vast improvements in the last eighteen years for reducing the symptoms of Alzheimer's Disease [AD] and cognitive decline. The three consistent hallmarks of AD are the presence of Amyloid P, neurofibrillary tangles, and neuronal degeneration. What guides treatment regimens are the side effects. Some of the drugs that reduce symptoms and may improve caregiver burden are Exelon, Razadyne, Namenda, and combination treatments of donepezil and mematine. Earlier treatment is best. The research shows that although there is no "cure" for AD, the benefits of early treatment benefits caregivers the most by reducing the amount of time spent supervising patients declines. Because there is no known cause of AD, there is no "cure." However, prevention of cognitive decline begins with a healthy lifestyle that includes healthy diet by lowering cholesterol and eating a Mediterranean diet high in fish. Starting healthy habits early in life is best as a protective factor; starting late after midlife is not as beneficial over the lifespan. A conference attendee asked about older adults with memory impairment being "diagnosed" by the family doctor with Alzheimer's and placed on drugs, what to do? Dr. Pinals recommended that anyone with cognitive decline should be evaluated at a Memory Disorders clinic- "go to the experts before any treatment." I concur!

David B. Doolittle, PsyD, Psychodynamics and Psychotherapy at the End of Life. Dying and bereaved patients have developmental tasks at the end of life. They can be helped with psychotherapy and supportive counseling. Panic in the face of death interferes with planning and preparation of death. There are logistical and practical approaches to dying. Death anxiety is not a reaction to dying but rather a sense of unfolding of life over time. A "good death" is different for all people. Be flexible and do not insist that your clients follow a script. In fact, many people and families do hot hold onto the narrative of a "good death." The Kubler-Ross linear "stages" of death are no longer the model for grief work. Now, we recognize that it is circular and malleable and we can revisit stages. Midlife is a critical time for establishing death awareness as we mourn the lost body of youth and reflect on mistakes made earlier in life. When facing death, we encounter collective reparation- the things we have done that has harmed others. We believe that by dying we abandon people and therefore harm them. Psychotherapy and counseling can help.

The remainder of the day included a presentation by Barbara E. Moscowitz on Alzheimer's caregiving, clinical vignettes of adventures in longterm care by Grace Gannon Rudolph, LSW, and a panel discussion with Meckle Elston, Stephen Pinals, and Sally Thompson.

It was a wonderful two days and I am looking forward to sharing the new information with my television viewers and students. Absolutely terrific! AgeDoc