We have recently highlighted some of the interesting ways in which medical and technological experts and policymakers across the globe are responding to dementia. With an aging population and the increasing prevalence of Alzheimer’s disease and other dementias, there is a growing need to focus on how to create a more dementia-capable society.
In instances where a individual living with dementia is no longer able to make decisions regarding their care, that responsibility falls to the individual’s substitute decision-maker. Substitute decision-makers may be required to make important and difficult decisions about the incapable person’s care, such as the use of caregivers and home support services.
Individuals who are tasked with making decisions regarding the care and companionship for people living with dementia may soon have a new option available to them. Reuters recently profiled Nadine, a humanoid robot developed by scientists at the Nanyang Technological University that may someday be used as a companion for individuals living with dementia.
According to the university, Nadine is a “social robot,” which means that she has a memory and personality of her own and is able to exhibit moods and emotions. Nadine currently works as a receptionist at the university, and could also serve as a personal assistant or companion to the elderly.
Nadine’s creator, Professor Nadia Thalmann of the Nanyang Technological University, has suggested that Nadine may be particularly useful as a companion for individuals who are living with dementia. She is quoted in Reuters as saying, “if you leave [individuals with dementia] alone they will be going down very quickly. So these people need to always be in interaction.”
With human-like features and emotional intelligence to boot, Nadine provides an interesting example of the creative ways in which technology could address the needs of people living with dementia. We recently highlighted another example: the story of “Paro” the harp seal, a Japanese automoton that was one of the earlier robotic inventions to be used in dementia care. However, it remains to be seen if this new technology will ultimately be put to use in individual and institutional care settings.
In the meantime, if you would like to see Nadine the humanoid robot at work, don’t miss this YouTube video of Nadine interacting with Professor Thalmann.
Thank you for reading and have a great weekend,
As many of our readers are likely aware, China’s prohibition against having more than one child per couple will expire at the end of the year. Since the late 1970s, most Chinese families have been limited to one child each. The one-child policy was created to help offset China’s rapid population growth rate that doubled China’s population to well over one billion during the twentieth century. As of January 1, 2016, however, after more than thirty years, Chinese parents will finally be able to have a second child if they choose to do so.
The change in Chinese policy has been triggered by what has been referred to as a “demographic time-bomb“. According to the United Nations, the number of individuals aged 65 and older in China will increase from 131 million to 243 million by the year 2030. Without an increase in China’s birthrate, there simply will not be enough people available to care for the elderly in the future.
The goal of the Chinese government in ending the one-child policy is to increase the country’s birth rate by approximately two million per year. Despite the end of China’s one-child policy, the additional births that will result may or may not meet the demands of the aging population. It is now expected that fewer parents than originally anticipated will take advantage of the new two-child policy, due to high costs of living in China’s urban centres and a small number of parents who have so far applied for an early exemption to the one-child maximum. If this is any indication of how many Chinese parents will choose to have a second child, it is unlikely that the population will rebalance itself before the numbers of Chinese residents over the age of 65 explodes.
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The increasing prevalence of Alzheimer’s disease and other dementias means that policymakers and various sectors – including the legal community — have to think about how to create a more dementia-capable society.
For instance, I recently blogged about DementiaHack, a Toronto-based hackathon designed to bring medical experts on dementia together with developers and designers to think of innovative technological products to address the needs of individuals living with dementia, caregivers and researchers.
For those who are interested in learning more about dementia, the Toronto Star recently ran an excellent series of articles about local and global responses to the increasing prevalence of dementia.
I found it particularly interesting to read about the lessons that can be learned from Japan’s experience, where dementia currently affects 4.62 million people. As the article notes, Japan’s health ministry and 11 other ministries and agencies implemented a strategy in 2012 to address the challenges of dementia. The government also introduced a long-term care insurance program in 2000 that requires residents to pay monthly insurance premiums after they turn 40. By contributing to the program, residents become eligible to access services such as dementia daycare.
Beyond governmental action on dementia, the Star also profiled the Dementia Support Caravan initiative in Japan, which aims to educate and empower people across the country to better support the needs of people living with dementia. And for a Canadian spin on the Japanese experience, be sure to check out this article about “Paro”, a robot that was inspired by a Japanese engineer’s encounter with a Canadian harp seal and that is now being used in dementia care.
The Toronto Star ended its series on dementia with an editorial calling on the provincial and federal governments to create a national strategy. It remains to be seen if policymakers will heed the call to action, but the series offers remarkable insight into how other countries are responding to the increasing prevalence of dementia.
Thank you for reading and have a great weekend.
Umair Abdul Qadir
Here are some sobering facts: according to the Alzheimer Society of Canada, 747,000 Canadians were living with Alzheimer’s disease and other dementias in 2011. If nothing changes in Canada, this figure is expected to rise to 1.4 million people by 2031.
Beyond the economic costs, dementia can put immense pressures on family caregivers. According to the Alzheimer Society, family caregivers spent 444 million unpaid hours in 2011 towards the care of someone living with dementia, a number that could rise to 1.2 billion unpaid hours per year by 2040.
Given the increasing prevalence of dementia, many sectors – including the legal community – are thinking about how to improve the quality of life for people with dementia and create a more dementia-capable society. For example, I recently came across an interesting event called DementiaHack, a hackathon that will be taking place in Toronto from November 7 to 9, 2015.
For those who are unfamiliar with the concept, a “hackathon” is an event that allows tech types – such as computer programmers and software developers – to work collaboratively on new projects over a short timeframe. Now in its second year, DementiaHack brings together leading medical experts on dementia with developers and designers, challenging them to develop new and innovative products to address the needs of individuals living with dementia, as well as family caregivers, institutional caregivers and researchers.
For this year’s event, hackathon teams will work intensively over the weekend to develop innovative solutions to the challenges of dementia. The weekend will culminate in science fair demos on Sunday, November 8. Then, on November 9, the hackathon finalists will show off their wares to an audience of potential investors and customers. The most successful teams will be eligible to receive a number of different prizes, including a grand prize that consists of a business trip to the United Kingdom to pitch their project at a health conference.
It is exciting to see the work that is being done to support the needs of people living with dementia. If you are interested in learning more about DementiaHack, visit their website for more information about this year’s event. And be sure to check out the Youtube video for the demonstration for last year’s grand prize winner, CareUmbrella, a project that used smartphones and Near Field Communication (NFC) tags to help improve the lived experience of people living with dementia.
Thank you for reading and have a great weekend.
Umair Abdul Qadir
Reaching the age of retirement and becoming eligible for government-funded pension benefits is a cause of celebration for many individuals. However, for Americans who wish to exercise their Second-Amendment right to bear firearms, turning 65 may not be as happy an occasion as it once was.
American citizens become eligible for full Social Security benefits upon reaching the age of 65. President Obama has recently announced plans to limit the ability of recipients of Social Security benefits to obtain and retain possession of guns.
If the proposed change is implemented, background checks conducted when individuals purchase guns will include a review of Social Security records. Further, firearm registries may be reviewed to ensure that certain recipients of Social Security in possession of guns are identified and their weapons are confiscated. The change in policy also impacts individuals who suffer from mental illnesses, who also receive social benefits.
President Obama has stated that the intention is to target individuals who fall under the federal firearm laws description of having “marked subnormal intelligence, or mental illness, incompetency, condition, or disease.” However, approximately 4.2 million American adults receive benefits through Social Security that are managed by another person. These people will be unable to purchase or possess firearms, despite the fact that not all of the individuals will fit into the target group of those whose access to guns is considered unsafe.
The issue in the proposed administrative change is that a person may receive assistance from another person in the administration of his or her affairs without having compromised mental capacities. Critics of President Obama’s plan insist that seniors are a vulnerable group of society who are most likely in need of guns to protect themselves due to age-related decline in physical strength and increased frailty. The inability to possess firearms is suggested to improperly compromise their constitutional right on the basis of age.
While this development in unlikely to affect the lives of Canadians, it is an example of the infringement of rights of the basis of age, whether or not justified by increased rates of cognitive decline, and it will be interesting to see whether the proposal withstands further review.
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Personal decision-making processes and consideration often evolve as an individual ages. Typically, old age is associated with a decline in cognitive ability and decision-making skills. Recent study results, however, raise the question of whether age-related cognitive decline really does impact our ability to make decisions relevant to management of affairs and estate planning.
A set of studies recently conducted by the University of Basel and the Max Planck Institute for Human Development suggests that older individuals are able to make simple decisions just as well as younger counterparts. Where the results of the study were differentiated was in respect of complex decision-making scenarios. The study credited the enhanced ability of the younger test subjects to make multifaceted decisions more easily than older participants to the association of aging with reduced “fluid” cognitive abilities.
Decline in fluid cognitive abilities has been linked to an inability to understand the consequences of making a particular decision when similar situations have not previously been experienced and determining the most likely results of a certain course of action requires research and learning.
The results of the study do not take into account the prevalence of age-related conditions that do contribute to compromised mental capacity and decision making with age. Approximately 15% of Canadians aged 65 or older live with Alzheimer’s disease and other forms of dementia.
Although there is a presumption of mental capacity, in estate litigation, old age is often considered as a factor in determining whether a person was likely to have possessed mental capacity to execute certain documents or conduct certain transactions at a relevant time. It is important to remember that, just because a person is elderly, this does not in any way mean that he or she lacks the cognitive ability to make valid decisions, and may even be as capable of doing so as a younger person.
Have a great weekend.
An amendment to legislation with respect to the management of affairs on behalf of incapable people is currently being implemented in Oklahoma in an effort to protect the interests of the aging population.
Senate Bill 109 is being introduced on November 1, 2015 to allow a person to be subject to attorneyship and court-ordered guardianship at the same time. As it currently stands, the appointment of a guardian in Oklahoma automatically revokes any powers of attorney executed by that person, meaning that if a guardian is appointed in respect of personal care, no power of attorney (whether in respect of property or personal care) remains valid.
The update was proposed in light of situations in which a person has executed a power of attorney for property, but no such document is executed in respect of personal care. Prior to the amendment, the appointment of a guardian of personal care terminates the appointment of both attorneys for personal care and attorneys for property. Most common in Oklahoma are scenarios in which an attorney for property attempts to sell an incapable person’s property, but runs into problems when no attorney for personal care had been appointed to assist in determining new living arrangements after the sale of the property.
In Ontario, the appointment of a guardian pursuant to the Substitute Decisions Act similarly terminates the appointment of an attorney chosen to act in the same respect. However, in circumstances where an attorney is appointed in one domain only, the Court may appoint without disrupting the management by an attorney of the other aspect of decision making.
Ideally, when planning for one’s incapacity, both a power of attorney for property and a power of attorney for personal care should be executed. Often, the focus on incapacity planning is on financial matters and risks to leave a person’s personal care in limbo if capacity issues emerge later in life. While a guardianship application may be an option, the delay and expense in securing an appointment as guardian may not be in the best interests of the person.
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Neglected oral health is an overlooked form of elder abuse. According to Dr. Natalie Archer, a dental surgeon specializing in the care of elderly patients, a great number of older adults are currently suffering from terrible abuse and neglect related to oral hygiene. Dr. Archer is certainly well placed to make such an observation. For ten years, Dr. Archer has practiced mobile Geriatric Dentistry throughout Ontario in over 135 Long Term Care facilities, nursing homes, hospitals and independent residences.
Recent statistics suggest that nearly one third of older adults have untreated tooth decay and 50 per cent of those over 75 years of age have root decay. Dental elder abuse or neglect occurs when a person or system (retirement home or hospital) fails to provide necessary dental care for an older adult. Not only does such neglect cause discomfort and pain, but recent studies seem to suggest that it can contribute to illness and even preventable death.
Many elderly individuals are faced with unique challenges when it comes to dental care. Unfortunately as we age, we often become reliant on others to assist with various aspects of our day-to-day lives. One of these aspects is dental care. The elderly often become reliant on others to ensure their mouths are cleaned, either because of arthritis, which makes it difficult or impossible to brush their own teeth, or as a result of dementia which tends to result in those individuals forgetting to brush their teeth. In many cases seniors are also unable to get to the dentist. Many don’t have drivers’ licenses and it seems older adults lose a lot of their freedom when they move into a retirement home and particularly once dementia sets in. Their loved ones and/or caregivers are often busy, and unfortunately, dental care is not always seen as a priority.
In January of 2014, in an effort to bring the issues of dental health and elder abuse awareness to dentists, seniors and the broader community, Dr. Archer launched the Dental Elder Abuse Response Project (D.E.A.R.). Together with co-founder, Laura Tamblyn Watts, a lawyer and senior fellow at the Canadian Centre for Elder Law, and the support of the Federal government, the D.E.A.R. project is creating senior peer-trained workshops, online videos, brochures and checklists to provide practical, hands-on material on how to recognize and prevent dental elder abuse and neglect in the Greater Toronto Area.
The D.E.A.R. project is the first of its kind in Canada. Working with dentists, hygienists, seniors, caregivers and community organizations, the D.E.A.R. Project is “Taking the Bite out of Elder Abuse”.
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