When an older adult begins having problems with memory or thinking, a doctor may recommend a cognitive assessment. These are short tests that look at how well a person remembers information, pays attention, solves problems, uses language, and understands the world around them. Cognitive tests do not hurt, and they usually do not require special equipment. Most involve answering questions, remembering words, drawing something, or completing simple tasks. It is important to remember that these tests are not school exams that someone either passes or fails. Their purpose is to provide health care professionals with useful information about how a person's brain functions and whether further evaluation could be helpful. Most importantly, a cognitive screening test does not diagnose Dementia on its own. Results may indicate a problem that warrants closer examination. Doctors then consider the results along with the person's medical history, medications, daily abilities, physical health, and other information. Two tests that people may encounter are the Mini-Cog and the Montreal Cognitive Assessment, or MoCA. The Mini-Cog The Mini-Cog is a very short screening test. It usually takes about three minutes. It combines a memory task with a clock-drawing task. First, the doctor gives the person three words to remember. The person repeats the words so the doctor knows they heard them correctly. Next comes the clock-drawing test. The person is asked to draw a clock, place the numbers in the correct positions, and set the hands to a specific time. Drawing a clock may sound easy, but it requires the brain to perform several jobs at once. A person must understand the directions, remember what a clock looks like, organize the numbers, and correctly position the clock hands. After drawing the clock, the person is asked to recall the three words from earlier. The doctor scores the word recall and clock drawing. A lower score may suggest that additional evaluation is needed. However, a Mini-Cog result is not a diagnosis of Alzheimer's disease or another Dementia. It is a screening tool that helps doctors decide whether they should investigate further. The MoCA Another commonly used assessment is the Montreal Cognitive Assessment (MoCA). It is more detailed than the Mini-Cog and examines several types of thinking skills. The MoCA generally takes about 10 minutes to administer and is scored out of 30 points. During the test, a person may be asked to complete several activities to evaluate attention, language, executive function, and orientation to time, location, and date. For example, the person may be shown pictures of animals and asked to name them. They may hear a list of words and be asked to remember them later, or be asked to work with numbers. Other Cognitive Tests Doctors have several other tools available that you may hear about: General Practitioner Assessment of Cognition (GPCOG) Saint Louis University Mental Status Examination (SLUMS) Mini-Mental State Examination (MMSE) AD8 What Happens After a Cognitive Test? A concerning test result does not automatically mean that a person has a form of Dementia. Many conditions can affect thinking and memory. These may include medication side effects, depression, sleep problems, thyroid problems, vitamin deficiencies, infections, and other medical conditions. The doctor may therefore review medications, perform a physical or neurological examination, order blood tests, or ask additional questions about the person's ability to handle everyday activities. In some cases, the doctor may recommend more detailed testing with a neurologist, geriatrician, or neuropsychologist. Brain imaging, such as an MRI or CT scan, may also be considered. Cognitive screening is best viewed as one piece of a larger puzzle. It helps doctors identify changes that deserve attention and determine what should happen next, and for families, knowing what to expect can also make the process less intimidating. Sources Alzheimer's Association. “Cognitive Screening and Assessment. Alzheimer's Association. “Medical Tests for Diagnosing Alzheimer's & Dementia.” National Institute on Aging. “Assessing Cognitive Impairment in Older Patients.” National Institute on Aging. “Cognitive Assessment Considerations: Understanding the Evidence.” National Institute on Aging. “How Is Alzheimer's Disease Diagnosed?” Montreal Cognitive Assessment (MoCA). Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Video Transcript [Answer 1026] Welcome and thank you for joining me. Today, we will talk about how to plan meals over time for people living with Dementia. Meal planning is important because Dementia can change how a person eats, feels about food, and remembers meals. Planning ahead can reduce stress and help your loved ones stay healthy and safe. How to Do Meal Planning for Persons With Dementia Start by keeping meals simple and familiar. Many people with Dementia feel comforted by foods they know well. Try to serve favorite meals from earlier in life. Use the same meal times each day, so eating becomes part of a routine. Routines help the brain feel calm and secure. Plan meals that are easy to chew and swallow. As Dementia changes the body, some foods may become hard to eat. Soft foods like eggs, soup, yogurt, cooked vegetables, and tender meats can help. Cut food into small pieces and avoid foods that are tough or sticky. Think about nutrition over time. Aim for balanced meals with protein, fruits, vegetables, and whole grains. If eating full meals is hard, offer small meals or healthy snacks during the day. Drinking enough water is also very important. Gentle reminders to drink can help. Watch for changes. A person with Dementia may eat less, forget to eat, or lose interest in food. Weight loss, choking, or changes in mood may be signs that meal plans need adjustment. Talk with a doctor or dietitian if you notice concerns. Make mealtime calm and pleasant. Reduce noise and distractions. Use plain plates that contrast with the food, so it is easier to see. Sit together and eat slowly. Planning meals is not about being perfect. It is about being flexible, patient, and kind. Small steps can make a big difference over time. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Video Transcript [Answer 1149] Welcome, and thank you for joining me. Today, we're going to talk about how to respond when a person living with Dementia no longer recognizes you. This situation can be very painful, but it is a common part of Dementia. It is caused by changes in the brain, not by a lack of love. Stay calm and gentle. Your reaction matters, even if you feel hurt. Try to stay calm. Use a soft voice and a friendly face. The person may not know who you are, but they can still feel your tone and emotions. Do not force recognition. Avoid saying, "Don't you remember me?" This response can cause stress or embarrassment. Instead, introduce yourself. You might say, "Hi, it's me, Sarah, your daughter." Keep it simple and kind. Focus on feelings, not facts. Even if the person does not remember your name, they can still feel comfort, safety, and connection. A smile, a gentle touch, or sitting quietly together can mean a lot. If the person believes you are someone else, it is often best not to correct them. Instead, go along gently and keep the interaction positive. The goal is not to correct memory, but to reduce fear and build trust. Using familiar cues, photos, music, or shared routines may help spark recognition or bring a sense of comfort, even if they do not fully recognize you. These can feel familiar and soothing. Take care of yourself. This experience can be emotional. It is okay to feel sadness, talk with others, seek support, and remember that your relationship still has meaning. Recognition may fade, but connection does not; your presence, kindness, and care still matter deeply. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Dementia Awareness Ribbon Alzheimer's Disease Prevalence Between 4.9 and 5.6 million individuals have some form of Dementia in the United States*, based on current estimates. Because the diagnosis of Alzheimer's disease can now be based on clinical measurements of Alzheimer's specific biomarkers, along with imaging and clinical signs and symptoms, the true prevalence of Alzheimer's disease among all Dementias in the US remains unclear. Although prevalence data using multiple criteria are still emerging, current estimates suggest that Alzheimer's disease represents approximately 60% of the Dementia burden. The underlying processes that cause Dementia represent a significant cause of mortality. In the US, estimates suggest that Dementia is the 6th leading cause of death in persons aged 65 or older. In the UK, Alzheimer's Disease and other Dementias were the leading cause of death in 2024, suggesting an increasing mortality risk in developed countries. What Goes Wrong in Alzheimer's Disease? Alzheimer's Disease is caused by a complex, progressive interplay of genetics, lifestyle, environment, and age-related brain changes that unfold over decades. While the exact trigger remains unknown, the disease is characterized by several hallmark brain changes and biological mechanisms. We know that the deposition and accumulation of fibrous proteins accompany irreversible brain damage. These insoluble proteins, called beta-amyloid, form plaques that disrupt cellular communication, alter how brain cells use energy, and promote cell death. The second hallmark of AD, also observed by Dr. Alois Alzheimer over 100 years ago under a microscope, is the neurofibrillary tangles of dead and dying neurons, composed of Tau, another brain protein. That's why medical professionals will often speak of the "plaques and tangles" of AD. The result is a slow and progressive decline in memory, thinking, and reasoning skills. Eventually, people lose the ability to swallow and breathe in a coordinated fashion. Even in the absence of other diseases such as kidney failure and cancer, Alzheimer's Disease is a terminal illness. What Are The Symptoms of Alzheimer's Disease? Alzheimer's Disease comprises a spectrum rather than a defined set of signs and symptoms. Slow progression, rather than a sudden change, is often the key to differentiating Alzheimer's behaviors from those associated with other kinds of Dementia. Life expectancy after an Alzheimer's diagnosis can be anywhere from four to 20 years. People who have Dementia often die from other causes such as cancer, kidney failure, and cardiovascular disease. The Alzheimer's Association lists the 10 warning signs of Alzheimer's Disease – the first of which is memory loss. After reading the list, you might think, "How are these behaviors different from what everybody does at one time or another?" The difference is the frequency and the ability to make self-corrections. Healthcare providers often use staging to describe the progression and severity of diseases such as cancer, kidney failure, and Dementia. The following staging criteria will help you understand your loved one's condition and plan for future caregiving needs. Mild or Early-stage Alzheimer's Disease In this first stage, people experience memory loss, difficulty remembering newly learned information, and have trouble completing complex tasks such as planning a family event. Personality changes, such as uncharacteristic anger and increasing difficulty finding the right words, getting lost, or misplacing items, are other common signs. With help, your parent, spouse, or sibling in this stage may still be able to live independently. Moderate or Mid-stage Alzheimer's Disease During this phase, people may confuse family members with close friends, forget personal history details such as where they went to school or where they were born, and need help with dressing and personal hygiene. Some people may become restless, suspicious of others, and confrontational. At this stage, your relative will need close supervision and assistance during the day, and perhaps a caregiver at night. Severe or Late-stage Alzheimer's Disease In the final stage, people lose the ability to speak coherently and need help with eating, dressing, using the bathroom, and walking. Eventually, late-stage Alzheimer's patients lose the ability to swallow and control their bladder and bowels. During this final stage, your loved one will need 24-hour care, either at home or in a Dementia care facility. For more information on Alzheimer's disease and how to manage care, please see the source material below and the related blog post, "Empowering Caregivers: Essential Tips for Supporting Individuals With Alzheimer's." Additional video to watch regarding new developments in Alzheimer's disease treatments: Leqembi & Kisunla: New Alzheimer's Treatments Explained | Dr. Armen J. Moughamian *Sources: CDC.gov: All about Alzheimer's JAMA Neurology 2025: US Burden of Disorders Affecting the Nervous System. 2025 World Health Organization Factsheet: Dementia. National Institute on Aging: What Causes Alzheimer's Disease? Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Video Transcript [Answer 1140] Welcome and thank you for joining me. Today, we're going to talk about Razadyne® (generic name for galantamine) and how it helps people living with Dementia. Razadyne is a medication used to help manage symptoms of Alzheimer's disease. Its generic name is galantamine. How does Razadyne work? Razadyne helps brain cells communicate by supporting a natural chemical in the brain called acetylcholine. Acetylcholine is important for memory, learning, and attention in people living with Dementia. Levels of this chemical become lower over time. Razadyne works in two helpful ways. First, it slows the breakdown of acetylcholine, so more of it stays available in the brain. Second, it helps brain cells respond better to this chemical. Together, these actions improve communication between nerve cells, which may support thinking and memory. What symptoms can it help with? Razadyne may help improve memory, attention, and the ability to manage daily tasks. Some people may also experience improvements in mood or behavior. It is important to remember that Razadyne does not cure Dementia, but it may help slow symptoms for a time. How is Razadyne taken? Razadyne is available as a pill, liquid, or extended-release capsule. It is usually taken once or twice a day with food to reduce stomach upset. Are there side effects? Some people may have nausea, vomiting, loss of appetite, or dizziness. These are often mild and may improve as the body adjusts. Why is medical guidance important? A doctor will decide whether Razadyne is right for your loved one and monitor how well it is working. Doses are usually increased slowly for safety and comfort. Razadyne is one tool that may help support brain communication and daily life for people living with Dementia. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Additional video to watch regarding new developments in Alzheimer's disease treatments: Leqembi & Kisunla: New Alzheimer's Treatments Explained | Dr. Armen J. Moughamian Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Video Transcript [Answer 1141] Welcome and thank you for joining me. Today, we're going to talk about Namenda®. Namenda is the registered trademark for a medication used to help manage symptoms of Dementia, especially in people with moderate to severe Alzheimer's disease. The generic name for Namenda is memantine. How does Namenda work? Namenda works differently from some other Dementia medications. It helps regulate a brain chemical called glutamate. Glutamate is important for learning and memory, but excessive levels can overstimulate and damage brain cells. Namenda helps balance glutamate activity. It protects brain cells from excessive stimulation, which may help them function better for longer. In simple terms, it helps keep brain signals from becoming too noisy or overwhelming. What symptoms can it help with? Namenda may help improve symptoms like memory, attention, and the ability to perform daily activities. It may also help reduce confusion and support clearer thinking. Some people also experience calmer behavior. It is important to know that Namenda does not cure Dementia, but it may help slow down symptoms and support daily function. How is Namenda taken? Namenda comes as a tablet, liquid, or extended-release capsule. It is usually taken once or twice a day, depending on the type. Are there side effects? Some people may experience dizziness, headache, constipation, or confusion. These side effects are often mild, but should be discussed with a healthcare provider. Why is medical guidance important? A doctor will decide if Namenda is right for the person and will monitor how well it is working. Sometimes Namenda is used along with other Dementia medications for added benefit. Namenda is one tool that may help support brain health and daily life for people living with Dementia. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Additional video to watch regarding new developments in Alzheimer's disease treatments: Leqembi & Kisunla: New Alzheimer's Treatments Explained | Dr. Armen J. Moughamian Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Video Transcript [Answer 1021] Welcome and thank you for joining me. Today, we're talking about how to respond to hurtful remarks made by someone living with Dementia. These comments can feel painful, but it's important to remember that they are usually symptoms of the underlying disease or disorder, not the person. Why Can People Living With Dementia Make Hurtful Remarks? Changes in the brain can cause confusion, frustration, or loss of social filters, leading someone to say things they never would've said before. Moreover, circumstances, the environment, your presence, and the other person's perspective on the situation may trigger responses beyond the person's control. A common symptom for someone living with Dementia is increased impulsiveness. How to Handle Hurtful Remarks The first step is to stay calm. Take a deep breath and remind yourself that words are just words, and that the person living with Dementia may no longer have the ability to express themselves as they once did. Do your best not to argue or correct the person, as this can make the situation worse. Instead, focus on the feelings behind the words. A hurtful remark often comes from fear, anger, or discomfort. For example, if they say something unkind, you might respond with reassurance: "I love you," "I'm here for you," or "You're safe with me." Redirecting attention can also help. Gently change the subject to something comforting, like a favorite song, a pleasant memory, or a simple activity. Sometimes distraction is the best way to ease tension. It may also help to step away briefly if the remark feels too upsetting. Caring for someone with Dementia is challenging, and protecting your own emotional health is essential. Later, talk with family members and others to share your feelings with people who understand. It can make the burden lighter. Remember, it is the illness speaking, not your loved one's true heart. Responding with patience, kindness, and compassion can make these difficult moments easier. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Video Transcript [Answer 1005] Welcome and thank you for joining me. Today, we're going to talk about how and why Dementia changes behavior over time. Dementia is caused by diseases that damage brain cells. As these brain cells stop working, the parts of the brain that control memory, judgment, mood, and movement begin to change. These changes can lead to new or unusual behaviors. Why do these behaviors happen? Current research shows that as Dementia progresses, different areas of the brain become affected. When the area that controls memory is damaged, a person may repeat questions or forget familiar people. When the part that manages judgment changes, they may make unsafe decisions or seem unaware of danger. Damage to the emotional centers of the brain can lead to anxiety, anger, sadness, or fear. These behaviors are not intentional. They happen because the brain is trying to make sense of a world that feels confusing or unfamiliar. A person may pace because they feel restless, shout because they are scared, or resist care because they do not understand what is happening. How does behavior change over time? Research shows that behaviors can shift as Dementia moves from early to middle to late stages. Early on, people may hide symptoms or become easily frustrated. In the middle stages, confusion increases, and behaviors like wandering or seeking, agitation, or sleep changes may appear. In the later stages, communication becomes harder, and behaviors may include withdrawal, changes in eating, or increased restlessness. How can caregivers help? Understanding the cause behind a behavior is key. A calm voice, simple explanations, familiar routines, good lighting, and reducing noise can help lower stress. Medical providers can also help identify pain, infections, or medication needs that may affect behavior. Behavioral changes are signs of the underlying condition, not of the person. Compassion and patience can make each day safer and more peaceful. More information on the signs and symptoms of Dementia can be found in our related blog post, 22 Clues™ to the Dementias, and in our publication: The Big Umbrella™. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Welcome and thank you for joining me. Today, we're going to talk about what to ask healthcare providers if you are worried that a person may have Dementia. Noticing memory loss, confusion, or changes in behavior can be frightening. Asking the right questions can help you get clear answers and the right support early. Start with the basics. Ask the provider, "Could these changes be signs of Dementia or could something else be causing them?" Many conditions, such as infections, depression, vitamin problems, sleep issues, or medication side effects, can look like Dementia, but may be treatable. Ask about testing. You can ask what tests providers will perform to understand what's happening. Healthcare providers may suggest memory tests, blood work, brain scans, or hearing and vision checks. These tests help rule out other causes and guide next steps. Ask about diagnosis and stages. If the diagnosis is Dementia, ask what type of Dementia it is and what stage the person is in. Different types of Dementia can affect people in different ways. Knowing the stage helps with planning, care, and support. Ask about treatment and support. You might ask, are there treatments or medications that can help with symptoms? Also, ask about non-medical support, such as therapy, community programs, education classes, or caregiver resources. Ask about what to expect. It's important to ask what changes we might see over time, and how we can prepare. The answers help families plan for safety, legal matters, and daily care needs. Don't forget caregiver questions. Ask what support is available for family and caregivers. Caring for someone with Dementia is a journey, and you do not have to walk it alone. Speaking up, asking questions, and staying informed can make a real difference. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Video Transcript [Answer 1009] Welcome and thank you for joining me. Today, we're going to talk about how technology can be used to support memory. In general, technology can help make daily life easier, safer, and more organized. Many tools are simple to use and can support both the person and their caregivers. Simple reminder tools are often the most helpful. Digital clocks that show the day, date, and time can reduce confusion. Alarm clocks or phone reminders can help with taking medications, eating meals, or attending appointments. These reminders provide gentle guidance throughout the day. Smartphones and tablets can also be useful. Calendar apps, Note-Taking apps, and voice reminders allow people to hear instructions rather than read them. Some apps are designed specifically to support memory and use large buttons, clear text, and pictures. These tools can help people remember names, routines, and daily tasks. Voice-activated devices such as smart speakers can answer simple questions like "What day is it?" or "What's next on my schedule?" They can also play their favorite music, which research shows can improve mood and help trigger memories in people living with Dementia. Safety and tracking tools are another form of memory support. GPS watches or locator devices can help find someone who becomes lost due to critical wandering. Medication dispensers with alarms can release the right pills at the right time, reducing mistakes. Visual supports are also important. Digital photo frames that show labeled family photos can help with recognition. Short video messages from loved ones can provide comfort and reminders. When choosing technology for memory support, keep it simple. Introduce one tool at a time and practice together. The goal is not perfection. It is support, comfort, and independence for as long as possible. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

February 8, 2025 These past few weeks, I've had several patients and families consult me about hospice and some end-of-life care planning. These encounters along with what I've seen over my years of practice highlight how much confusion and misunderstanding there is about hospice. So, I decided to write down the conversations I've had with patients & families to clarify a couple of things & clear up some common myths. These are the questions & concerns I've heard most frequently so I hope they can help you as you navigate this option. #1 Hospice is a model of care along with a philosophy of care. Its aim is to provide symptom control, peace, comfort, & dignity to a patient who is experiencing an illness with a limited life expectancy. #2 Hospice is a benefit under Medicare Part A. Once a patient transitions into hospice care, they tap into their Medicare Part A Hospice benefit to provide coverage for the care. #3 Yes, a physician does need to certify that a patient's life expectancy is 6 months or less, BUT THAT DOES NOT MEAN THAT "THIS IS IT." The way I look at it as a physician is asking myself if I would I be surprised if the patient in front of me passed away in the next 6 months. If I say, "yes" to myself (yet another instance of me talking to myself, but that's another topic), then perhaps this patient is not ready or appropriate for hospice care yet. If I say "no" to myself, then maybe this is a path to explore further. All this being said, 6 months is not a time stamped or carved in stone. Many patients enrolled in hospice, especially at home or in a facility, have been on the hospice program for much longer, sometimes a year or two. Basically, what you're certifying is that the patient in front of you has a diagnosis that is life limiting and you are expecting a trajectory of decline. In face of this situation, the patient/family has elected to aggressively pursue care that prioritizes their comfort, pain & symptom control, dignity, & peace. #4 Routine labs, x-rays/imaging, diagnostic studies, physical therapy, etc. usually will not be covered under the hospice benefit. Remember, the goal is comfort, peace, & symptom control. If a patient is experiencing something causing him/her discomfort, treatments are provided to help them with this. We're not looking for the cause, but for a way to provide them comfort. Similarly, therapies are usually not covered. The only exceptions may be for a very limited number of visits focused on a goal that might make the patient more comfortable, e.g. working with the caregivers to understand mobilizing them out of bed into a wheelchair to spend time in a different location during the day. #5 Medications are covered under the hospice benefit, but mainly the ones related to the qualifying diagnosis and those aimed to provide comfort or symptom control. Upon enrollment, the hospice team will review the medications with the patient & family and let them know which ones would be covered and which ones will not. Again, remember, the goal on hospice is not curative or prevention, but to optimize symptom control, peace, comfort, & dignity. #6 All hospice agencies have social workers, chaplains, & bereavement specialists to work with the patient & family. These individuals are extremely helpful for things like logistics, planning, and most importantly, how to have certain delicate conversations or navigate spiritual care. For example if a patient has young children or younger adults involved, these individuals can help them understand what's going on, at their level. Hospice also provided bereavement support for the first year after a patient's death. #7 Hospice care can be provided at home, in a facility (assisted living/skilled nursing), or (less frequently these days) in a hospital. At home, hospice will provide nursing care and supervision, an aide, medications, equipment, oxygen, and other providers (social workers, chaplains, etc.) to support the patient's care there. It will not provide 24/7 aide care though. The aide from hospice is usually there for 1-2 hours about 4-6 days per week. The family/caregiver is responsible for the remainder of the time, and hospice at home requires family/caregivers/aides to be present 24/7 who are willing and able to assess the patient's situation and provide certain treatments if needed. The hospice aide can help with some basic care and companionship, but cannot clinically triage patients or administer medications. Additionally, the patient's care giver team must be able to arrange this level of care for hospice to be appropriate for the home situation. In an assisted living or skilled nursing (nursing home) environment, hospice services can be provided as at home. However, because the patient is in a facility, aides and sometimes nursing care can be provided. The key thing to remember is that in a facility, the care provided by hospice is covered by Medicare Part A Hospice benefit, BUT, the patient/family is responsible for paying room & board privately. Hospice in an "inpatient hospice facility" is becoming more rare, but many hospice agencies have agreements with local hospitals to provide inpatient care when/if needed. There are a few big caveats to this that you need to be aware of when it comes to "inpatient hospice." Inpatient hospice is really meant for critical situations- when a patient's symptoms cannot be controlled at home and the patient needs more aggressive interventions (e.g. intravenous dosing of medications, very frequent adjustments of medication regimens with nursing oversight). Alternatively, this can apply if a patient has already been admitted to hospital for some illness and decides to transition their care to hospice. In both situations, hospice usually expects care to last in the hospital for 3-5 days. In that time span, if the patient stabilizes or can be controlled on a regimen that can be managed at home or in a facility, the plan would be to transition him/her there. Naturally, the other outcome in those 3-5 days would be death. Inpatient hospice is not meant to be a long-term option for hospice care. All sites of hospice care are managed by the hospice agency's team and a nurse will be on-call 24/7 to help with any questions or concerns. Many times, at home or in a facility, if a concern comes up during the "after hours," the nurse will make an effort to come see the patient as soon as possible the next day to reassess the situation. All hospice teams also have a physician who helps oversee the care and provide guidance. #8 Hospice can be a a very helpful, comforting, & pleasant way to face a terminal illness or condition. Quite often, patients/families go crashing into hospice at very rapid speed and this can be overwhelming and discombobulating (one of my favorite words, again, another topic). The earlier the hospice team is involved in the care, the better it is for all as they have the time to get to know the patient and their loved ones and vice-versa. Dr. Arun S. Rao, a fellowship-trained & board-certified geriatrician with over 20 years of experience is the founder & CEO of Geriatrics Planning & Solutions, Inc., a direct-pay house call service for older adults that provides medical care management and consultations. Dr. Rao is a member of the Advisory Council at the Dementia Society of America. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.

Click here for Spanish Click here for French Video Transcript [Answer 1157] Welcome, and thank you for joining me. Today, we're going to talk about how to support nutrition over time for people living with Dementia. As Dementia progresses, eating habits and appetite often change. With simple caring steps, we can help maintain good nutrition and overall health. Offer regular meals and snacks. People living with Dementia may forget to eat or may not feel hungry. Offer small meals and snacks throughout the day instead of three large meals. This approach can make eating easier and more appealing. Choose nutrient-rich foods. Focus on foods that provide energy and strength. Include proteins like eggs, fish, beans, and yogurt. Add fruits, vegetables, and whole grains when possible. If appetite is low, choose higher-calorie healthy options like smoothies or soft foods. Make food easy to eat. As skills change, offer foods that are soft, easy to chew, and simple to handle. Cut food into small pieces and avoid hard-to-chew items. Support hydration. Drinking enough fluids is very important. Offer water, milk, juice, or soup often. Some people forget to drink, so gentle reminders help make mealtime pleasant. A calm, quiet space helps focus. Sit together, make eye contact, and keep a relaxed pace. Mealtime should feel safe and enjoyable. Watch for changes. Notice weight loss, poor appetite, or trouble swallowing. These may need medical attention. A healthcare provider or dietician can offer guidance. Keep routines consistent. Serve meals at the same time each day. Familiar routines help reduce confusion and support better eating habits. Be patient and flexible. Tastes and preferences may change. Follow the person's lead and adjust as needed. The goal is nourishment, comfort, and dignity. Supporting nutrition is an ongoing process with attention and kindness. We can help people living with Dementia stay as healthy and comfortable as possible. On behalf of the Dementia Society of America®, thank you again for joining me today. Stay informed, stay healthy, and take care of yourself. Disclaimer: Dementia Society of America (DSA) provides educational content only and does not offer medical advice. Always consult a qualified healthcare professional before making changes to your medical care. DSA content is created by both human and computer-generated means and is reviewed for accuracy; however, errors may occur. Views expressed by third-party contributors do not necessarily reflect those of DSA. Unless expressly stated, DSA does not endorse or guarantee any third-party products, services, organizations, or external content. All DSA content is copyrighted and/or trademarked and may not be used without written permission.