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How Estate Planning Prepares for Unexpected Medical Events

Estate planning is more than the distribution of property after a person dies—in fact, a large part of an estate planning attorney’s practice concerns helping people prepare for unexpected medical issues. A recent article from Merrill Foto News, “Know Your Legal Rights: Advance Care Planning Paves The Way For Future Medical Decisions,” explains what steps should be taken.

Anyone over 18 should have certain advance care plan documents in place, although these documents become even more critical as one reaches their later years. People who have been admitted to the hospital for emergency care, treatment for illness, or surgery all need someone else to speak with medical personnel on their behalf.

Having an Advance Directive, which is also known as Health Care Power of Attorney in some states, is necessary for another person to be able to be involved with your medical care. The healthcare law has become very restrictive, and simply being a person’s spouse or child may not be enough to allow you to make critical decisions on their behalf.

It’s best to name two people as your health care power of attorney—a primary and a backup in case the primary is unable or unwilling to act. If you and your spouse are both in a car accident, for instance, you’ll need someone else to advocate for both of you.

Who to name as your agent depends upon your situation. If your adult children live nearby, one of them may be the best choice if they can be counted on to follow your wishes. If no family is nearby, naming a trusted friend may work, unless you and the friend are both elderly. What would happen if your friend predeceased you or was unable to come to the hospital in the middle of the night? Your estate planning attorney can discuss your situation and help you determine the best candidates.

While many fill-in-the-blank Health Care Power of Attorney documents are available, it’s best to have one prepared by an estate planning attorney to reflect your wishes.

Your feelings about artificial life support also may have changed. Before COVID, people often said they didn’t want to be put on a respirator. However, respirators now save lives. Your wishes to be kept alive in the presence of different kinds of medical evidence may have changed from ten years ago. What if your heart is still working and a brain scan shows evidence of mental activities? Progress in medicine has led to more complex questions and answers about patients’ prognoses; you want a healthcare power of attorney document to reflect your wishes, given advances in medicine today.

Your feelings about healthcare decisions may have changed over time, so healthcare directives and an estate plan should be updated similarly to reflect changes in your life and circumstances.

Reference: Merrill Foto News (July 25, 2024) “Know Your Legal Rights: Advance Care Planning Paves The Way For Future Medical Decisions”

What Is Hypertensive Chronic Kidney Disease and Glomerulonephritis?

Unlike an acute kidney injury (AKI), where the loss of kidney function may be reversible, chronic kidney disease is “progressive.” That means it gets worse over time. The damage to your kidneys causes scars and is permanent. Among the diseases that can cause CKD are diabetes, hypertension, glomerulonephritis and polycystic kidney disease. This post looks at glomerulonephritis.

Very Well Health’s recent article, “Causes and Risk Factors of Chronic Kidney Disease,” explains that glomerulonephritis is a group of diseases that cause inflammation of the glomeruli and nephrons. Glomerulonephritis usually affects both kidneys and can happen alone or as part of another disease.

While it’s often hard to pinpoint what triggered the inflammatory response, the causes can be broadly broken down as follows:

  • Focal segmental glomerulosclerosis, a group of diseases that cause the selective scarring of glomeruli
  • Autoimmune disorders, which either damage the kidneys directly (IgA nephropathy or granulomatosis with polyangiitis) or trigger whole-body inflammation that indirectly damages the kidneys (such as with lupus); and
  • Inherited disorders like polycystic kidney disease, which causes the formation of cysts in the kidneys; Alport syndrome, which damages the blood vessels of the kidneys; or Goodpasture syndrome, which damages kidney membranes.

In some cases, the cause of glomerulonephritis is never found. There are also other, less common causes of CKD in adults and children. They include the following:

  • Heavy metal poisoning, including lead poisoning;
  • Hemolytic-uremic syndrome, in which ruptured red blood cells block renal filters (occurs exclusively in children);
  • Hepatitis B and hepatitis C, both of which are associated with glomerulonephritis and renal vascular inflammation;
  • Interstitial nephritis, inflammation of the kidney tubules often related to the long-term use of analgesics or antibiotics;
  • Pyelonephritis, a bacterial infection of the kidneys;
  • Prolonged urinary tract obstruction, including an enlarged prostate, kidney stones and certain cancers;
  • Recurrent kidney infections; and
  • Reflux nephropathy, the backing-up of urine into the bladder.

In addition to known causes, CKD can often be idiopathic, meaning the cause can’t be found.

Reference: Very Well Health (July 25, 2021) “Causes and Risk Factors of Chronic Kidney Disease”

How Do I Care for a Loved One with Arthritis?

Those with arthritis know how stiffness and pain can restrict the ability to move and function properly.

VeryWell Health’s recent article entitled, “Caring for Someone With Arthritis,” says there are some things that you can do (or keep in mind) when caring for someone with arthritis. These may include the following:

  • Understand their condition. Have a clear understanding of your loved one’s arthritis condition. This can help you see where they may need help. For example, suppose an individual has rheumatoid arthritis that affects their hand and upper extremity movement. In that case, they may need assistance opening bottles and jars or managing fine motor tasks, like handling medication.
  • Keep lines of communication open. Talking with your loved one about arthritis is a great way to understand how it impacts them. You should also share your feelings about caring for them with someone, since providing care and helping someone consistently may take an emotional toll on you.
  • Know when to help and when to stand back. Most people with arthritis want to remain as independent as possible. Therefore, be sure your loved one has the opportunity to be as functionally independent as possible and know that they will ask for assistance when needed.
  • Help manage medication. Sometimes managing arthritis means managing various medicines. If your parent has difficulty keeping drugs and dosages straight—or if they physically have difficulty handling medicine—be ready to assist.
  • Help with managing assistive devices. Some people with arthritis need assistive devices, like canes or walkers, to get around. Sometimes using these can be hard to use. You may help by learning how their assistive device should be used and how to operate it properly.
  • Encourage and help with exercise. Exercise has proven to be beneficial for many with arthritis. Movement helps keep joints lubricated and muscles strong, and exercise can help maintain or improve functional mobility.

Know that your family member may have times when your care and assistance are welcomed and when they want to do it alone. Stay flexible in your care and provide help when necessary and when it is welcomed.

Reference: VeryWell Health (May 29, 2022) “Caring for Someone With Arthritis”

Is Low Bone Mineral Density Linked to Dementia?

In a study of community-dwelling older adults, every standard deviation lower BMD at the femoral neck was linked with a 12% higher risk for developing all-cause dementia, says Mohammad Arfan Ikram, MD, PhD, of Erasmus University Medical Center in Rotterdam, The Netherlands, and colleagues.

MedPage Today’s recent article entitled, “Osteoporosis: Another Dementia Predictor?” says that each standard deviation lower for femoral neck BMD was also linked with a 14% higher risk for Alzheimer’s disease during the 11-year follow-up, the group wrote in Neurology.

When the researchers looked at only the first decade of follow-up, older adults falling into the lowest group of BMD in the femoral neck had a twofold higher risk for dementia than those in the highest tertile. In the first 10 years, those in the lowest tertile for trabecular bone score and total body BMD also saw a significantly higher risk for developing all-cause dementia. However, when expanding to the entire follow-up period, only low femoral neck BMD was still significantly connected with dementia onset.

“Low bone density and dementia are two conditions that commonly affect older people simultaneously, especially as bone loss often increases due to physical inactivity and poor nutrition during dementia,” noted Ikram. “However, little is known about bone loss that occurs in the period leading up to dementia. Our study found that bone loss indeed already occurs before dementia and thus is linked to a higher risk of dementia.”

“Previous research has found factors like diet and exercise may impact bones differently as well as the risk of dementia,” Ikram added. “Our research has found a link between bone loss and dementia, but further studies are needed to better understand this connection between bone density and memory loss.”

“It’s possible that bone loss may occur already in the earliest phases of dementia, years before any clinical symptoms manifest themselves,” he explained. “If that were the case, bone loss could be an indicator of risk for dementia and people with bone loss could be targeted for screening and improved care.”

The researchers also noted that prior data suggested a link between low femoral neck BMD with structural brain changes, which may be a major driver of elevated dementia risk. These changes include declined white matter volume, increased white matter hyperintensity volume, the occurrence of silent brain infarction and progression of parenchymal atrophy.

In addition, it’s possible that these individuals experienced some loss of cognition that subsequently lead to poorer dietary nutrition and lifestyle habits.

Reference: MedPage Today (March 22, 2023) “Osteoporosis: Another Dementia Predictor?”

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