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Health

How Smartphones Are Revolutionizing Home Care For Alzheimer’s And Autism Patients

As technological innovation empowers consumers to take greater control over their lives, the health industry has taken particular advantage of emerging internet and mobile devices. The burgeoning mHealth industry — which involves using mobile devices to improve health care delivery and outcomes — has exploded in the last five years, allowing everyday Americans to access better information about medical conditions and provide better ongoing care to themselves and their families. Now, creative new apps are helping home care workers better assist Americans with Alzheimer’s and autism.

mHealth apps are particularly useful for monitoring patients with ongoing and chronic medical needs, since such programs provide a multitude of services to keep track of medication schedules, exchange notes with doctors and professional home care workers, and even track the patients themselves. That comes in handy for caretakers such as Laura Jones, who had to keep working full time to provide her 50-year-old Alzheimer’s-afflicted husband with health insurance:

Using Comfort Zone, which is offered by the Alzheimer’s Association starting at $43 a month, [Jones] was able to go online and track exactly where [her husband] was and where he had been.

Her husband carried a GPS device, which sent a signal every five minutes. If Jones checked online every hour, she would see 12 points on a map revealing her husband’s travels. She would also get an alert if he left a designated area.

Eventually, the tracking revealed that Jones’ husband was getting lost.

“He would make a big funny loop off the usual route and we knew it was time to start locking down on him,” she said.

Conveniences like that may be difficuly to pin a numerical value on — but they make an enormous pragmatic difference in the lives of real Americans. By being able to track her husband, Jones doesn’t have to entrust such care to a salaried full-time worker, and has the freedom to be more intimately involved in her husband’s care.

When it comes to conditions that tend to onset earlier in life, such as autism, mHealth apps can offer an interactive medium that makes it easier to engage with autistic children:

Lisa Goring, vice president of Autism Speaks, said tablets have been a boon to families with autistic children. The organization has given iPads to 850 low-income families. And the Autism Speaks website lists hundreds of programs — from Angry Birds to Autism Language Learning — that families have found useful.

Samantha Boyd of McConnellstown, Pa., said her 8-year-old autistic son gets very excited when the iPad is brought out.

“There’s no way he’d be able to use a keyboard and mouse,” she said. “But with the iPad, we use the read-aloud books, the songs, the flash card apps.”

Other popular applications include the inexpensive pillbox app “Balance,” which lets users schedule alerts for their complex treatment regimens, and CareGiver apps that let families find and monitor professional caregivers who serve their loved ones. Not only does this kind of technology empower consumers — it also cuts down on health care costs. Pillbox apps are particularly promising on this front, since noncompliance with treatment regimens is a major contributor to bloated U.S. health care spending. And overall, organizations like Allie Health World estimate that the use of mHealth could double access to health care services while lowering administrative costs through better data collections — even potentially reducing seniors’ health care costs by 25 percent.

Health

President Obama Launches $100 Million Initiative To Map The Human Brain

According to a White House press release, President Obama will follow through on his State of the Union call for a comprehensive map of the human brain by announcing $100 million in federal investments for the project on Tuesday morning. Funds for the project — dubbed the Brain Research through Advancing Innovative Neurotechnologies (BRAIN) Initiative — will be appropriated through the National Institutes of Health (NIH), the Defense Advanced Research Projects Agency (DARPA), and the National Science Foundation (NSF), and will be included in the FY 2014 budget that the president is set to release next week.

The project’s central component will be the Brain Activity Map, which seeks to “accelerate the development and application of new technologies that will enable researchers to produce dynamic pictures of the brain that show how individual brain cells and complex neural circuits interact at the speed of thought” in an effort to “explore how the brain records, processes, uses, stores, and retrieves vast quantities of information, and shed light on the complex links between brain function and behavior.” As President Obama explained during the State of the Union, such advancements could herald the key to unlocking pressing public health mysteries, including effective methods of curing brain injuries and degenerative diseases like Alzheimer’s.

That’s particularly significant in a time of rising dementia rates among Americans. A recent pair of studies released by the Centers for Disease Control (CDC) concluded that a combination of factors — including an aging population, more targeted early diagnosis efforts, and the failure to discover a viable cure — led to a staggering 68 percent increase in Alzheimer’s mortality rates between 2000 and 2010. The associated health care costs of that rise in the disease were $200 billion in 2012 alone, including $140 billion to government insurance programs such as Medicare and Medicaid. If the current trend holds, those costs could balloon to over $1 trillion by the year 2050.

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Health

As More Americans Die From Alzheimer’s, Annual Treatment Costs Could Top $1 Trillion By 2050

According to Reuters, a pair of new studies by the U.S. Centers for Disease Control (CDC) and the Alzheimer’s Association find that a combination of factors — including an aging population, more targeted early diagnosis efforts, and the failure to discover a viable cure — have contributed to a sharp rise in recorded American deaths from Alzheimer’s disease.

While death rates for other common ailments such as cancer and heart disease have fallen significantly, Alzheimer’s has steadily killed an increasing number of Americans, with the risk of death rising by 39 percent between 2000 and 2010 and actual mortality rates rising by a staggering 68 percent over the same time period:

“Compared with other selected causes, Alzheimer’s disease has been on the rise since the last decade,” the CDC’s National Center for Health Statistics said, adding that “mortality from Alzheimer’s disease has steadily increased during the last 30 years.”

“The Alzheimer’s epidemic is clearly an urgent issue that needs to be addressed,” the Alzheimer’s Association, which advocates for patients and helps fund research, said in a statement accompanying its annual report. [...]

The U.S. Department of Health and Human Services last year released a national action plan to address Alzheimer’s following a 2011 law signed by President Barack Obama requiring federal agencies to coordinate their research and accelerate efforts to target the disease. The president also highlighted the issue in his annual address to lawmakers in January.

Additionally, the Food and Drug Administration last month issued guidelines to make it easier to test potential treatments in patients earlier when there may be a greater chance for them to work.

One factor that is likely contributing to the ballooning mortality rate is increased recognition of Alzheimer’s as a cause of death, rather than more vague reasons such as “natural causes” or “old age.” But researchers and lawmakers are also stressing that early intervention and treatment may be the only way to effectively grapple with the ailment, since efforts to develop a working cure have mostly fallen short.

The full scope of the crisis becomes even clearer considering the health care costs associated with the chronic condition. According to the new reports, treating Americans with Alzheimer’s and other degenerative illnesses cost $200 billion in 2012, “including $140 billion in costs to the government’s Medicare and Medicaid health insurance programs.” These costs are estimated to balloon to a sky-high $1.1 trillion per year as an increasing number of Baby Boomers and future elderly Americans fall victim to the disease.

The Obama Administration is well-aware of this ongoing public health crisis, encouraging more robust research into Alzheimer’s prevention and early treatment. In fact, the president expounded on this during his most recent State of the Union address, announcing a national goal of “mapping the human brain” in the same manner as scientists have mapped the human genome. Unfortunately, congressional budget disputes could leave lofty initiatives like that in limbo, as the sequester cuts will cut back on national research and innovation spending — which is already half of what it was in 1962.

NEWS FLASH

Report: Former NFL Players Four Times More Likely To Die Of Brain Diseases | After studying over 3,000 former professional football players, U.S. government researchers found the death rate from Alzheimer’s or Lou Gehrig’s disease among retired NFL players is four times higher than the rate for the general U.S. population. The researchers suspect their findings may illustrate the long-term consequences of the multiple concussions that NFL players sustain throughout their careers in football, but they cannot establish causation without more data. According to the study, the players in the wide receiver, running back, and quarterback positions accounted for most of the deaths from the two brain diseases — which makes sense, the lead researcher explained, because they experience more “high-speed collisions” than players in other positions. Just this morning, the NFL announced its plans to donate $30 million to concussion research amid increasing controversy surrounding the league’s response to the issue of concussions among their players.

Alyssa

‘Justified’ Open Thread: Fathers and Sons

This post contains spoilers through the third season of Justified.

“He didn’t know it was a state trooper. He just saw a man in a hat pointing a gun at Boyd.”

There’s a lot to discuss in the season finale of Justified, an outstandingly strong episode of television that significantly redeemed the overstretched season that came before it—Jere Burns Emmy-worthy performance as Wynn Duffy, the sociology of Noble’s Holler, the question of what Raylan’ll be like as a mostly-absent parent. But for me, the third season of Justified comes down to precisely this shattering question: what happens when parents and children fail to fulfill their obligations to each other and replace the unsatisfying partner with a more compelling one? It’s one that takes on bitter connotations in Harlan, but that, for an anti-hero melodrama, has surprising resonance for a country only beginning to come to terms with a rising dementia epidemic.

There’s no question that Arlo hates his son, and Raylan doesn’t have much use for his father, even if Arlo took a moment to apologize to Raylan at the moment of his transition from free man to soon-to-be convict. Even that admission comes less out of charity and repentance than Arlo’s desire to quiet his own raging mind. “Not an easy thing for me to say,” he admits to his son, before explaining the delusion that lead him to it. “But she insisted. I know she always was your favorite…But you don’t know how she can nag.” But Raylan hates his father, too, telling Limehouse after the latter man addresses him as Mr. Givens that he’s “Deputy Marshal. I’m not my father and I don’t care to be confused with him.”

Much of this episode is an illustration of how Raylan’s abrogated any duties he might have been expected to carry out as a son. Raylan hasn’t had much idea where his father is, much less that it’s Boyd Crowder keeping track of whether his father takes his medications. “I been trying,” Arlo tells Boyd fretfully when called to account for whether he’s sticking to the schedule. “But she hides ‘em where I can’t find ‘em…Thinks it’s funny watching an old man chase around his pills.” And even when it’s suggested that Arlo, in his dementia, might have let one of Boyd’s crimes slip, Boyd behaves more like a caretaker than a man bent on vengeance. “I want you to take one of these pills in front of me. Go on,” he tells Arlo, a father and a child switching places, two criminals reduced to vulnerable patient and patient caretaker.

And what Raylan ultimately doesn’t get, ruminating on the rotten apple and the barrel later (Boyd’s “Well, Raylan, I think even in a little town like Harlan, the apple barrel is obsolete,” and Raylan’s weary “But the expression ain’t, because of the truth contained therein” is one of many great poetic moments in this season, one of the few of television that could without question qualify for literary awards.) is that Arlo’s evil is ultimately less consequential than the opportunity he afforded Boyd. “I’ve connected to Arlo in ways I was never given a chance to do with my own family,” Boyd explains. Whether he’s a coot, a criminal, or simply a sick old man, Arlo afforded Boyd the opportunity for tenderness and for mercy. And Boyd could see what Raylan, who believes that “Arlo’s a criminal, never been anything else,” could not: a man who responded to care and to be treating as if he had something of value left to offer.

That Arlo responded to Boyd’s care, and that ultimately he would have killed for him, is ultimately less proof of his hatred of Raylan than of Raylan’s demotion to mere mortal status in the eyes of the man who bore him. It’s not that Arlo had a clear choice between Boyd and Raylan and chose Raylan. It’s that he chose Boyd as his son against all other men. In that moment, Raylan was indistinguishable from the mass of men. And whether you’re a deputy marshal or an ordinary person caring for an aging parent, that’s the ultimate nightmare of watching a person you love vanish into dementia.

Alyssa

‘Justified’ Open Thread: Lion in Winter

This post contains spoilers through the April 3 episode of Justified.

There’s a lot of ridiculously fine writing going on in this episode of Justified, whether it’s Boyd telling Arlo “Arlo, I’m not saying you’re a lion in winter, but your roar ain’t what it used to be,” or Wynn asking Quarles indignantly “Are you smoking Oxycontin in my motorcoach?” But for all the wealth of language and character that’s present in this episode, it’s also proof to me of the signal failure of this season of Justified: there’s far too much plot, and not enough sense of what the emotionally richest strains of it are.

In fact, I think the show’s devoted time in inverse proportion to the strength of the characters and the themes. Quarles’ dissolution isn’t unpowerful, but he’s a monster more than he is a man, a disappointed gangster who tortures rentboys and has discovered Oxy, reducing him to snorting crushed pills in a trailer and carrying on conversations that operate at the level of “You ever seen Platoon?” “That movie with the old people who go to outer space?” It’s a fine performance, but the character’s contrived to the point of grotesque. And while there’s a marvelously operatic sense of Theo Tonen’s power—as Wynn puts it, “Does he sound like the kind of man to which would you like to say, ‘I’m sorry, but he escaped from a diseased whore factory up in inbred holler?’ But it feels wasted on a character who, I assume, is here one season, gone the next.

I feel that way particularly strongly given how rich Noble’s Holler, with its internal power struggles, its relationship to abused women, and its role as an informal financial center is as a setting. Ellstin Limehouse is a marvelous character, and if we’re not going to get a show that’s told through his eyes (which are quite sharp at assessing Harlan, as in his explanation of Boyd’s modus operandi: “Blow up something on one end of town, and when all eyes are there, hit the bank.”), I still wish he’d been the titan this season.

But the two people who have gotten the shortest shrift at the expense of the show’s core emotional development are Ava and Arlo. Ava’s emergence as a kingpin in her own right is a fascinating development, in terms of the balance of power in her relationship with Boyd, the role for a prominent criminal woman left open by Mags Bennett’s death, and what it means to have a woman running hugely vulnerable hookers in a region where sex work is easily blunted by powerful drugs. Similarly, Arlo’s decline could have been the story that bound all the character’s together. Whether it’s his and Limehouse’s history, the brokenness of his relationship with Raylan and Boyd’s decision to step in as his surrogate son, and his own titanic sense of pride in the meager field of knocking over Harlan banks, he could have been the central thread of the season. It’s easier, and richer, and ultimately more important and touching to chronicle the ravages of dementia than to invent a flamboyant, out-of-town gangster. It’s unfortunate to see Justified go for flash, instead of for the gut.

Alyssa

‘Justified’ Open Thread: Rotten Country

This post contains spoilers for the February 21 episode of Justified.

If shows like the Law & Order franchise hammer home how easy it is to get lost in the big city, or to hide yourself in it if you’ve got wickedness in your heart, Justified last night felt like it was making a reverse and perverse case for the ability of rot to flourish in the country. Limehouse’s holler is still the most fascinating place the show’s taken us this season, a little fiefdom anchored by history, tradition, and an absolute refusal to be uprooted by racism. But Delroy’s entrance onto the scene is a reminder that you don’t have to have good intentions to build an enclave. And Arlo’s reappearance in his son’s life at the time when Raylan needs him least is a reminder that neglect to relationships is not determined by geography.

Let’s take Delroy first. There’s no question that he’s a smooth talker, telling Ellen May “My parents raised me in a commune of sorts. I wouldn’t call it hippie, exactly. Mostly dope farmers. But strangely, we were a family. Looked after each other. Just like we do here…It ain’t easy looking after you girls. There’s doctors, and clothing and food, what-not. Porn don’t nearly pay the bills. It’s those pills that keep the roof over our heads…Like everyone else, you must be willing to make a sacrifice,” before sending her back into a situation that nearly got her killed. He may be a pimp, but telling Ellen May “It pains me to do this to you, truly. But you have to learn accountability, just like I had to,” before beating her viciously makes him sound more like a cult leader than a hustler. Ugly things can flourish in isolation, particularly when someone’s willing to pray on people who are exceptionally isolated, like J.J., who corrects Ava’s memory of her, reminding the other woman that Ava remembers her from “Middle school. I never made it to high school.” Justified can be a bit talky this season, but in moments like this when it hammers home the importance of education and the isolation of rural poverty, it delivers tremendous sermons with very few words.

Limehouse may rule his holler with a similarly iron fist, but at least he goes to the trouble of articulating and grounding a code. “Gold chains and champagne and hoes and shit,” he lectures a deputy who’s getting all Emiliano Zapata on him. “Oh, son. We have survived in these hills for 15 decades by staying among ourselves.” I can imagine that Limehouse will wield terrible violence before this season is over, but so far, his game of only giving when he’s got first, his insistence that “The people who bank with me are the ones who have access to the things I know” is a form of insurance. The question becomes what happens when people like Dickie Bennett stop trusting the bank. And while Noble’s Holler has held on to its independence by not challenging white folks directly, amassing power can invite investigation, and as we’ve seen in earlier episodes, interdiction.

Then, there’s Arlo. Alan Sepinwall pointed out that if Arlo’s not faking, “the idea of Raylan having to care for the father he despises — wondering all the time how serious his condition really is — could yield some terrific material,” and I tend to agree. It would be fascinating to see FX become the first network to seriously examine the relationship between middle-aged people and their aging parents, particularly when those adults are under severe pressure. But even if that doesn’t turn out to be the case, Raylan’s relationship with Arlo isn’t something he can bury in the backwoods. Whether it was Arlo’s continued criminality or Quarles’ determination to ferret it out, some things can’t stay dead and buried, even in the backcountry.

Alyssa

Week of Anarchy: Consider Gemma

Over the past couple of weeks, I’ve watched all four seasons of Sons of Anarchy. And while shotgunning the show’s episodes may not be for the faint of heart (so much grotesque violence!), it’s given me a lot to think about with the show. So every day this week, I’ll be considering another aspect of life in Charming, California.

Since you’re probably not one of the (very few) people who are watching Enlightened, HBO’s excellent, if uncomfortable show about a corporate drone who has a breakdown, followed by an epiphany, and begins living out her principals in all sorts of hilariously awkward ways, you probably don’t get the joke in the title of this blog post. But the Enlightened episode “Consider Helen” was one of the most impressive things I’ve seen on television in a while: a quiet day spent with the mother of the main character, who is grappling with private and unresolved griefs her daughter is too self-involved to acknowledge or understand. All of which is a long way of saying that until that episode of television, and until I started watching Sons of Anarchy, I don’t think I realized how thirsty I was for the perspectives of older women on television. Enough with the women who are meant to reflect me now or in ten years. I want a sense of the women I’ll become, the grand crones and the quiet ones, too.

One of the things I appreciate most about Sons of Anarchy is the way Gemma is allowed to have specifically female problems, and to have those problems treated as if they’re on a level with the hurts and angers of Jax, Clay, and the other members of the club. When, in the first season, when Cherry shows up in Charming after sleeping with Clay, and Gemma breaks her nose with a skateboard, the show could have decided to treat Gemma as ridiculous, as if she’s overreacting. Instead, we get that very funny scene of her and Clay hollering at each other in jail, Gemma refusing to be bailed out. Both halves of this late-middle aged couple are acting as if they’re teenagers. They are equals in their absurdity, both permitted to feel overpowered by their reactions to each other.

Similarly, after Gemma is raped (a plot that I think is handled better than almost anything else in the series), Sons of Anarchy deals with her sexual anxieties respectfully and in a way that insists that rape victims shouldn’t be treated as marked by their experiences. It’s terribly, terribly sad to hear Gemma tell Tara that “Clay’s never gonna… want to be inside something that’s been ripped up like me…Love don’t mean shit. Men need to own their pussy. His has been violated. He’ll find another. It’s what they do.” But the show insists she’s still wanted, first in Tig’s advances towards her in the wake of the attack—Sons of Anarchy probably spends more dialogue insisting that Gemma is attractive than any other individual character—and in her eventual reconciliation with Clay.

It’s tremendously moving to see Clay exceed her expectations of him, not just having sex with her again but seducing her, clearing off her office desk and declaring as only Ron Perlman can, “I want my wife.” Her hurt and recovery are couched in the language of ownership: neither Charming nor the MC are exactly feminist paradises. But even when Gemma puts off telling Clay and Jax about the fact that she was attacked to avoid hurting them and destabilizing the club, both of the men in her life make her recovery a priority when she finally does tell them. Later in the series, she may be marginalized as just an Old Lady, beaten for daring to step beyond that role, but at least in that moment, her husband and her son can elevate her recovery.
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Alyssa

Mental Illness As Magic In ‘Gingerbread Girl’

We’ve talked a lot about mental illness and Homeland here, and as a corollary (and possible pick-me-up), I wanted to recommend Paul Tobin and Colleen Coover‘s Gingerbread Girl.

The short graphic novel follows Annah Billups, a 26 year old who insists that she has a missing sister. And not just any sister: her Penfield homunculus, which she says her father removed from her brain during her parents divorce, grew into a full-sized sister for her, and who subsequently appeared, only to seem to be avoiding Annah in the city where she lives and loves. As a result of that surgery and loss, Annah claims to feel things less, both physically and emotionally, an excuse for her to behave less than admirably. She schedules two dates for a single night and goes out with the woman who shows up first, is sexually manipulative, and often generally inconsiderate. But she’s still charming and compelling: damage is not incompatible with charisma, and in fact, the two can go together quite handily.

So is Annah insane? It’s never clarified: a Penfield homunculus is, of course, a way of illustrating brain functions rather than a real thing. But the story of her missing sister Annah has a certain magical quality to it that’s a lovely representation of the divorce from self. Annah wants to feel normal and whole again, but Ginger doesn’t want to see her, she dashes around corners and runs out of stores. And while Homeland gives us a Cassandra rendered explicable and admirable to us even as she’s stigmatized by the people around her on-screen, Gingerbread Girl is told significantly from the perspective of the people Annah hurts and loves, from the people (and in several cases animals) she encounters along the way, who are more inclined to be charitable with her than we might be.

It’s also a good way of illustrating the challenges of treatment. It’s one thing to massively reset your brain with ECT therapy. It’s another to have a problem that’s magical rather than scientific. We’re making advances in brain science, but we’re still not far enough along for true cures to depression and dementia, as in Rise of the Planet of the Apes to seem like the provenance of fantasy or science fiction.

NEWS FLASH

Christians Rebuke Pat Robertson For Advocating Divorce From A Spouse With Alzheimer’s | Right-wing television evangelist Pat Robertson is under fire after he told his “700 Club” viewers that divorcing a spouse with Alzheimer’s is perfectly fine because the disease is “a kind of death.” “I know it sounds cruel,” he said, “but if he’s going to do something, he should divorce her and start all over again.” Now, many in the Christian community are joining the Alzheimer’s Foundation of America in rebuke of his remarks. Comments on Christianity Today’s news blog were “nearly universal in their criticism,” blasting the comments as “irresponsible, callous,” “Un-Christlike; unbiblical; [and] dead wrong!” One of Kentucky’s Southern Baptist Theological Seminary deans Russell D. Moore wrote in the Baptist Press News, “This is more than an embarrassment. This is more than cruelty. This is a repudiation of the Gospel of Jesus Christ.” Robertson has yet to respond.

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