“This collaborative effort continues to elevate Norton Neuroscience Institute to a national stage,” said Gregory E. Cooper, M.D., Ph.D., neurologist and director of Norton Neuroscience Institute Memory Center. “It’s an affirmation of what we’ve already done, while also incentivizing us to continue pushing the limits of dementia and Alzheimer’s care in our community.”

The program funds a dedicated nurse navigator, Deborah Lockridge, R.N., BSN, CCRC, at Norton Community Medical Associates – Preston, whose job is to collaborate with primary care providers at the practice to identify patients who are at high risk and may be experiencing early symptoms of cognitive decline. The goal is to more quickly connect those patients with treatment at Norton Neuroscience Institute Memory Center and provide personalized education and support services along the way. The hope is to more efficiently diagnose and treat Alzheimer’s disease and other forms of dementia in their earliest stages. If the pilot proves successful, this clinical pathway may be used as a worldwide model for future Alzheimer’s care.

“This grant enhances the comprehensive care services we offer here at Norton Healthcare,” Lockridge said. “We all agree having a point of contact who can answer questions, encourage patients and caregivers and point them in the right direction is going to be a tremendous benefit to our community. We will use this opportunity to develop a collaborative, easy-to-navigate care model that can be scaled not just throughout Norton Healthcare, but across the country.”

Alzheimer’s disease is growing into a worldwide epidemic. According to the National Institute on Aging, more than 6 million Americans currently are living with Alzheimer’s, and more than 13 million will be living with the disease by 2060. The current care model requires multiple medical providers to coordinate to ensure patients who are eligible for disease-modifying therapies receive them during the early window of opportunity, when they will most benefit.

Yet, there are pathways for prevention, early detection and accurate diagnosis that could change the course of the disease forever. For example, in August 2023, Norton Neuroscience Institute became the first site in Kentucky to administer disease-modifying therapies to patients with mild cognitive decline and mild Alzheimer’s disease. In addition to early treatment, Norton Neuroscience Institute is actively pursuing brain health and prevention strategies.

“We’re very proud of our memory program and what we’ve created so far, but we know there is still much work to be done,” Dr. Cooper said. “We won’t rest until we’ve tried to perfect our system to quickly identify, diagnosis and treat people at the earliest possible stages, when we believe we have the greatest chance to slow this disease in its path.”

The six pilot sites will serve as start-up incubators for the development of materials and best practices for the program’s long-term sustainability and expansion — without the need for external funding. The learnings and resources from the Brain Health Navigator program will be incorporated into Davos Alzheimer’s Collaborative’s Early Detection Blueprint.

The other sites included in the program are Dartmouth Health (New Hampshire), Memorial Healthcare (Owosso, Michigan), Sharp Rees-Stealy Medical Group (California), UC Health (Ohio) and Keck Medical Center of USC, part of Keck Medicine of USC (California). Patients can schedule an appointment by calling (502) 446-4664 or visiting NortonHealthcare.com/MemoryCenter.

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Key components of a brain health diet

1. Fruits and vegetables: Rich in antioxidants, vitamins, and minerals, these foods combat oxidative stress and support brain health. Leafy greens, berries, and cruciferous vegetables, like broccoli, are particularly beneficial. Berries, for instance, are linked to improved memory and cognitive function.
2. Healthy fats: Omega-3 fatty acids are crucial for maintaining brain health. They support brain cells and reduce inflammation. Older adults should include sources such as fatty fish (like salmon and mackerel), walnuts, flaxseeds, and chia seeds. Extra virgin olive oil is also an excellent source of healthy fats.
3. Whole grains: Whole grains provide a steady supply of glucose, vital for optimal brain function. Options such as oats, brown rice, quinoa and whole-grain bread can help sustain energy levels and support cognitive function.
4. Lean proteins: Proteins are essential for neurotransmitter production, influencing brain health. Older adults should focus on lean sources like poultry, fish, beans, lentils and low-fat dairy products, providing the necessary amino acids for cognitive support.
5. Nuts and seeds: Nuts, particularly almonds and walnuts, are high in vitamin E, which has been linked to lower rates of cognitive decline. A handful of nuts can serve as a nutritious snack that supports overall brain health.
6. Hydration: Staying well-hydrated is often overlooked but is essential. Dehydration can contribute to confusion and cognitive impairment. Older adults should aim for adequate water intake, considering their activity level and environmental conditions.

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Foods to limit

While it’s essential to focus on brain health, limiting certain foods is equally important. Highly processed foods, sugary snacks and excessive salt can contribute to inflammation and cognitive decline. Reducing saturated and trans fats found in fried and processed foods can further benefit brain health.

Diet is only one tool

While your diet is critical to brain health, there are other lifestyle changes you can make to boost your brain health, prevent dementia and combat cognitive decline. These include:

• Getting adequate quality sleep
• Maintaining a healthy weight
• Addressing health conditions like high blood pressure, stress and diabetes 
• Getting regular checkups with your primary care physician
• Social interactions

Creating a brain-healthy diet doesn’t need to be complicated. Focus on variety and balance to ensure a wide range of nutrients for cognitive function. Regular meal planning can help older adults obtain the necessary nutrients to support brain health. Combined with physical activity and social engagement, a balanced diet can enhance the overall quality of life and mitigate risks associated with brain disorders like dementia and mild cognitive impairment.Norton Neuroscience Institute Memory Center Dementia Prevention Clinic can help you understand your possible risks for developing memory disorders, dementia, Alzheimer’s and other cognition-related conditions.

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The 18-month study of people with and without Alzheimer’s disease focuses on whether an imbalance in good and bad bacteria plays a role in development of Alzheimer’s disease-related dementia.

“This an exciting new line of research into the potential cause of Alzheimer’s,” said Shirish S. Barve, Ph.D., chief research scientist for Norton Neuroscience Institute and Norton Research Institute.

“We’re hoping what we learn in this study will help us develop effective prevention and treatment therapies for Alzheimer’s disease-related dementia,” said Dr. Barve, who is known internationally for his research on the connection between gut health and brain health.

READ MORE: Here are seven ways to keep your brain healthy

Gut bacteria potentially could affect brain health, because gut bacteria regularly communicate with the brain. The digestive tract and brain have evolved a high level of communication to help us get the nutrients we need, signal when we’ve had enough to eat and prevent digestion of dangerous substances.

Normally, beneficial bacteria in the gut prevent the overgrowth of bad bacteria. But lifestyle and environmental factors such as age, diet, high blood pressure, obesity, sleep and pollution can result in an imbalance, which can lead to inflammation.

READ MORE: Eating well means eating for brain health

In what is known as the gut-brain axis, nerves send signals back and forth and work in tandem with the immune system.

Researchers now want to learn if chronic inflammation may increase an individual’s chance of getting Alzheimer’s disease.

Inflammation is an important immune response that helps the body fight infection, injury and disease, but chronic inflammation can be unhealthy. Chronic inflammation can damage healthy cells, tissues and organs and has been linked to such chronic and life-threatening diseases as Type 2 diabetes and cancer.

Microglia are immune cells in the brain. These cells help maintain a healthy brain environment, looking for invaders and clearing away cellular debris. When they find something, they release inflammatory signals. In the aging brain, they are more likely to stay activated for longer than normal, an exaggerated response associated with Alzheimer’s and other neurodegenerative diseases.

Some research suggests that gut microbes may contribute to development of amyloid deposits in the brain. Amyloids are proteins that can collect into clumps or amyloid plaques that can interrupt brain cell activity and contribute to cognitive impairment.

Whether or not someone gets Alzheimer’s is linked to factors we don’t control and those we do. In addition to aging, genetics and a family history of the disease are the biggest risk factors for Alzheimer’s. Other factors, which may account for 40% of all cases, include physical activity, diet, smoking, education, staying socially and mentally active, and blood pressure.

Alzheimer’s has a devastating impact on millions of families. Some 6.9 million Americans have Alzheimer’s, affecting an estimated 1 in 9 people over 65 and 1 in 3 people over 85 in the United States. Symptoms, which worsen over time, include memory loss and cognitive symptoms such as difficulty thinking and confusion.

Currently, most patients are treated with cognitive enhancing medications that treat the symptoms of memory loss, but not potential inflammation. One type prevents the breakdown of an important chemical messenger for learning and memory. The other helps with chemical signaling in the brain. More recently, medications have been approved that remove abnormal protein from the brain, and slow the progression of Alzheimer’s disease.

Current clinical trials and studies led by Dr. Barve

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“We eat a lot of processed and fried foods in the South. We smoke more in the South. We exercise less in the South. So all of those things that lead to vascular disease also almost certainly increase our dementia risk,” said Gregory E. Cooper, M.D., Ph.D., chief of adult neurology and director of the Norton Neuroscience Institute Memory Center.

A study published in 2022 in JAMA concluded that obesity is the biggest dementia risk factor that we can control. Obesity is linked to Type 2 diabetes, which in turn increases the risk of cardiovascular disease, diabetic nephropathy (kidney disease), peripheral vascular disease, stroke and dementia, according a study published in the International Journal of Molecular Sciences in 2022.

Data presented to the 2021 Alzheimer’s Association International Conference forecast 6.8 million more dementia cases between 2019 and 2050 due specifically to smoking, high body mass index and high blood sugar.

Dementia is a condition causing impairments in brain function such as memory loss, disorientation and difficulty with thinking and making decisions. Once these symptoms affect your ability to carry out everyday activities, it’s time to talk to your health care provider. Alzheimer’s disease is the most common type of dementia, according to the Centers for Disease Control and Prevention. Dementia mostly affects older adults, but it is not a normal part of healthy aging.

READ MORE: Eating well means eating for brain health

Dementia prevention, or at least risk reduction, steps include a Mediterranean diet or the related MIND diet. According to Dr. Cooper, regular exercise, mental stimulation and social interaction are among the healthy lifestyle choices that can decrease your risk for developing dementia. Improved sleep habits also can help.

“We don’t have all the proof we want, but there is building evidence that there are things that we can do that will meaningfully reduce our risk of dementia,” Dr. Cooper said. “I don’t know that I can point to one single factor. Just good general health: That probably would be the single most important thing in my mind. It is often said that what is good for the heart is good for the brain, and that’s really true.”

READ MORE: Here are seven ways to keep your brain healthy

According to Dr. Cooper, education about dementia prevention and eventual treatment can be very important.

“We would like to stop the disease before it ever starts,” Dr. Cooper said.

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Delaying, if not avoiding, dementia symptoms can be achieved by improving education about dementia among those who have a condition that could increase their risk.

“If I already have an illness, but I’m more educated, or my family members are more educated, that helps me manage the disease better and, in that sense, delays or prevents disability. So it doesn’t reverse the disease necessarily, but it helps me avoid or delay some of the problems down the road,” Dr. Cooper said.

Preparing for a ‘tsunami’ of dementia

The data presented at the Alzheimer’s Association International Conference forecast global cases of dementia will nearly triple by 2050, from an estimated 57.4 million in 2019 to 152.8 million in 2050 as the overall population ages.

“We’ve seen this coming for a long time, but it still causes me a lot of anxiety,” Dr. Cooper said. “We’re struggling to take care of the people with dementia already, and I’m worried that we’re not really prepared for the oncoming numbers. Some people have described it as an oncoming tsunami, and I think that’s true.”

It’s time to start preparing more effectively to diagnose, evaluate and care for these patients, according to Dr. Cooper.

The researchers also found more people are dying from Alzheimer’s.

From 1999 to 2019, the Alzheimer’s death rate increased from 16 to 30 deaths per 100,000 people, an 88% increase. In the United States, there’s a disparity in death rates between rural and urban areas. For example, in the East-South-Central region of Alabama, Kentucky, Mississippi and Tennessee, the death rate was 274 per 100,000 people 65 and over, more than three times the mid-Atlantic region.

“We need to do a better job of finding that health care from a patient standpoint and providing that health care from a clinician standpoint,” Dr. Cooper said.

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Researchers are working to determine the causes of progressive memory disorders such as Alzheimer’s disease. Certain genetic risk factors have been identified. For example, if you have a parent or sibling diagnosed with Alzheimer’s disease, your risk for dementia may be double that of a person without a first-degree relative with dementia.

Although we cannot change our genes, fortunately, there are risk factors you can control. Addressing these risk factors can improve cognitive function and brain health while reducing a person’s risk for dementia and serious cognitive decline.

• Increase physical activity and exercise regularly
• Quit smoking
• Reduce alcohol consumption
• Avoid social isolation
• Continue learning new knowledge and skills
• Avoid air pollution

READ MORE: Here are seven ways to keep your brain healthy

Several conditions, if left untreated, can lead to impaired brain function and increase the risk of dementia.

• High blood pressure (hypertension)
• Diabetes
• Hearing impairment
• Poor mental health and depression
• Head injury
• Obesity

“There’s an increasing body of evidence that addressing multiple factors under our control can meaningfully reduce a person’s risk of developing dementia,” said Kenneth Gregory Pugh, M.D., a geriatrician who specializes in dementia and cognitive disorders at Norton Neuroscience Institute Memory Center.

READ MORE: Eating well means eating for brain health

Research opportunities are available to help you understand your risk. Participation varies, from online surveys to clinical trials of innovative medications. Learn more about research opportunities at NortonResearchInstitute.com.

Types of memory loss

There are various types of memory loss in addition to dementia and Alzheimer’s disease. While dementia disproportionately affects older adults, it is not a normal part of aging. Healthy aging can mean it takes you longer to process thoughts, and doing multiple things at the same time (multitasking) may become more difficult. But even with aging, routine memory, skills and knowledge should not deteriorate — and sometimes actually improve with age. Forgetting names or where you left your phone is normal. Storing your phone in the freezer would be cause for concern.

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• Subjective cognitive impairment is when an individual noticesworsening of thinking abilities, including memory, but the decline cannot be verified by standard memory and cognitive tests.
• Mild cognitive impairment (MCI) describes memory or thinking issues greater than what would be typical for your age. With MCI, however, you remain independent, able to take care of yourself and carry out normal daily activities.
• Dementia is characterized by progressive or persistent loss of intellectual functioning, especially impairment of memory, abstract thinking and language. It often is accompanied by changes in mood or personality. This is due to pathologic changes occurring within the brain. The most common forms of dementia include Alzheimer’s disease and vascular dementia, among others. Dementia results in the inability to perform normal daily activities required to remain independent.

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Dementia also can cause personality changes, such as agitation or aggressive behavior, and changes in sleep patterns like insomnia that make caring for people with dementia difficult.

Over time, someone with dementia will be less and less able to function independently and their care will become increasingly demanding.

Some memory care providers and assisted living facilities have special memory care units designed to care for individuals with Alzheimer’s or other types of dementia. Deciding to place a spouse or other family member with dementia into memory care is one of toughest decisions you can make.

What are the signs it’s the right time for memory care?

This question can be broken down into two central issues: the health and safety of the person with dementia and the safety and well-being of the caregiver.

Here are some helpful questions to ask when considering the health and safety of the person with dementia:

• Is the person becoming unsafe in their current home?
• If so, is care at home an option to give them the support they need?
• Could other options short of a memory care unit, such as assisted living, provide the necessary care?
• Would the structure and social interaction of a memory care unit benefit the person with dementia?

Caring for someone with dementia can be physically, emotionally and psychologically demanding for caregivers. Caregivers should ask themselves the following questions when considering memory care for their loved one:

• Am I becoming a stressed, irritable and impatient caregiver?
• If so, would some respite care provide enough of a break to continue as caregiver? 
• Are my loved one’s care needs beyond my physical or emotional abilities?
• Am I neglecting responsibilities at work, to my family or to myself?
• Is my physical or mental health at risk?

It’s important to think about these questions in advance before there is a crisis so you can have a plan in place.

No matter what decision you make, the result presents challenges. Memory care centers offer professional, 24-hour staffing, ensuring your loved one is safe and cared for, and alleviating the concerns of caregivers. At the same time, memory care providers are not family, and the person with dementia is uprooted and placed in an unfamiliar environment. 

Making the decision to move a loved one to a memory care unit is painful, but it is not always possible to keep the person at home while continuing to provide the level of care they need.

Placing a loved one in a memory care unit does not mean your relationship as caregiver ends. Think about ways you can still be involved in their care. Consider how you can help make the person with dementia feel comfortable, safe and content in their new home.

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When the memory loss involves repeatedly asking the same question, having trouble naming objects, or changes in personality, these may be signs of dementia.

Dementia is persistent and progressive, meaning it will get worse with time.

“I know how challenging it can be for caregivers to help someone with memory loss,” said Tammy Evanow, APRN, a psychiatric nurse practitioner at Norton Neuroscience Institute. “When a loved one is losing their memory, there are things you can do to help every step of the way.”

First, if you see signs of dementia, have a conversation. Pick a place where the person feels comfortable. Be gentle but straightforward.

When raising the issue, try the following:

• Say you have noticed changes and ask if your friend or family member has noticed them as well.
• Give an example of something the person has done that worries you and ask if anything else like that has happened.
• Ask if they are willing to see a health care provider to get checked out and offer to go with them.

“Let your loved one know that the sooner you both know what’s causing these problems, the sooner they can be addressed,” Tammy said.

As dementia progresses, a person with the condition may have trouble remembering recent conversations or events. They may not be able to retrieve the memory or may not have stored the information in the first place.

It’s not helpful to tell someone with dementia that they are repeating themselves or have heard the information already. Try not to become frustrated. Do what you can to maintain body language that is warm and encouraging.

How to help

• Encourage the person to use a journal or calendar to record events and conversations.
• Give simple answers to questions and repeat your answers as many times as you need to. You also can write down your answers.
• If the person is unlikely to remember whether they’ve done something, ask questions that give context. For example, “It’s been a while since you ate lunch. Are you hungry?”

As the dementia progresses further, remembering names and words becomes more difficult. The person may even forget the names of people they have known for a long time. They might also confuse words or forget the meanings of words. Try some of these strategies:

• You can help with names by identifying people who are present. For example, you could say, “Your granddaughter Emma is here.”  A memory book with photos and information about people can be a valuable reference.
• When someone with dementia has difficulty finding a word, be patient and give them time to express their thought. Do your best to understand what they are trying to say, based on the context.
• If the person doesn’t understand a word you are using, trying putting it in context. For example, if they can’t place the word “key,” you could call it “the thing to open the door.”
• If the person with dementia is at risk of getting lost while going out alone, go with them or make sure they have some form of identification when they go out.
• If the person does not recognize you, remember that it isn’t personal. Focus on communicating in the moment.
• Even without words, there are many ways to communicate and maintain an emotional attachment. Your tone of voice, your body language and your facial expressions all help the person to understand you and feel more comfortable. 

The Norton Neuroscience Institute Memory Center has caregiver support services, including a memory caregiver support group, education opportunities and classes, such as the Scrapbooking for Memory Workshop.

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Dementia refers to any loss of mental functioning that is not part of normal aging. This includes not only losing your memory, but issues with thinking, learning and reasoning.

“There are many facets to dementia. People with dementia could start having issues communicating or paying attention, or having issues with their judgment, or becoming disoriented,” said Rachel N. Hart, D.O., geriatric medicine specialist with Norton Neuroscience Institute.

Together, these changes can affect someone’s ability to function and could mean losing the basic skills necessary for daily living.

Dementia with Lewy bodies is one example of dementia that initially presents without memory loss. It is progressive, like Alzheimer’s disease. Initial symptoms include difficulty paying attention and remaining alert, and recurrent visual hallucinations.

Hallucinations and misinterpreting visual signals are common issues in people with dementia. For example, someone who has dementia with Lewy bodies might see a shadow on the ground and think it’s a hole.

In addition to changes in the ability to process information and think, dementia also can result in changes in mood and behavior.

Frontotemporal dementia, or FTD, is a type of dementia typically occurring in people under the age of 65. Initially it causes changes in behavior, rather than memory loss.

FTD can result in obsessive or socially inappropriate behaviors, swearing, a lack of personal hygiene, and an increased interest in sex. People with FTD also can show a lack of empathy, indifference, decreased self-awareness and a lack of judgment.

Like FTD, frontal variant Alzheimer’s disease, or fvAD, is an atypical dementia and shows early symptoms that are behavioral, rather than related to memory. This includes socially inappropriate behaviors, loss of motivation to do things they used to enjoy, lack of empathy, and repetitive or obsessive behaviors.

People with fvAD, which affects about 1 in 50 people with Alzheimer’s, also may struggle to follow a series of simple steps, become easily distracted and have other symptoms related to “executive function.” They also may become fixated on a single thought or object, or have difficulty holding more than one piece of information at a time.

Vascular dementia, which is also called vascular cognitive impairment, often occurs as a result of strokes, which can block major blood vessels in the brain. Depending on which part of the brain is affected, vascular dementia can cause changes in mental abilities other than memory. This can include difficulty following directions, disorientation, and trouble speaking or understanding speech.

Like other forms of dementia, vascular dementia can begin as a mild condition and worsen over time. It also can occur at the same time as Alzheimer’s and dementia with Lewy bodies.

Vascular dementia is diagnosed with a brain scan along with other medical information, such as a history of uncontrolled diabetes or smoking. FTD and other atypical dementias can be diagnosed using brain imaging, such as MRI or positron emission tomography scan, and more comprehensive cognitive testing called neuropsychology testing.

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The drug from Eisai Co. Ltd. and Biogen has been especially effective in the early stages of buildup and is now available for mild cognitive impairment due to Alzheimer’s disease.

How effective is lecanemab for treating Alzheimer’s disease?

Lecanemab had been accepted for accelerated approval by the FDA. Results from the Clarity AD phase 3 clinical study showed disease progression slowed by 26% after 18 months in those who received lecanemab infusions every other week.

“This is a very significant step forward for our field. Lecanemab is the first medication with solid evidence that it is really modifying the course of this disease and, at least as many of us think, treating the underlying causes of this disease” said Gregory E. Cooper, M.D., Ph.D., neurologist and director of the Norton Neuroscience Institute Memory Center.

Scientists believe buildup of beta-amyloid plaque in the brain could be responsible for damaging and killing nerve cells. Most researchers believe plaques somehow play a critical role in blocking communication among nerve cells and disrupting processes cells need to survive.

According to the Alzheimer’s Association, more than 6 million Americans are living with the disease. It’s one of the top 10 leading causes of death in the U.S., and the fifth leading cause of death among adults ages 65 or older. While lecanemab is not a cure for people with Alzheimer’s disease, research shows it slows the progression of the disease significantly. For a disease that has been untreatable in the past, the new drug is especially promising.

Access to the new Alzheimer’s drug and next steps

Lecanemab is indicated for those with very early or mild Alzheimer’s disease. An assessment of medical history, MRI and minor blood work are required to determine whether a patient is eligible. Additional testing such as a spinal fluid examination, through a positron emission tomography (PET) scan, and a genetic test can determine the risk of amyloid-related abnormalities appearing in diagnostic imaging tests such as MRIs.

Lecanemab is given by IV infusion every two weeks in an infusion center. The infusion is administered in less than an hour, with extended careful monitoring afterward. Home infusions may be an option after an initial series of center-based infusions. Repeat MRI scans can be completed three to four times during the first year to monitor for any side effects.

Is lecanemab safe?

There are some potential risks to the drug. A quarter of patients will experience a mild reaction to the infusion. Symptoms might include fever, headache, rash, nausea or abdominal discomfort. These symptoms usually can be controlled with over-the-counter medications such as acetaminophen or antihistamines, if necessary.

If you think you may be a candidate for lecanemab, contact your neurologist to discuss eligibility.

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What interferes with decision-making?

There are many conditions that affect decision-making ability.

“Neurodegenerative diseases such as dementia or Alzheimer’s disease, traumatic brain injury, psychiatric illnesses such as schizophrenia, bipolar disorder, and major depression can compromise memory and impair capacity to make decisions,” said Rachel N. Hart, D.O., geriatric medicine and memory care physician with Norton Neuroscience Institute Memory Center. “Maybe the most difficult part of the process is just that: It’s a process, and it doesn’t just happen overnight. The individual might have some sense of their own decline, or they may brush it off as a little forgetfulness.”

How do I know my loved one is having trouble making decisions?

“Sometimes financial capacity is the first clue someone’s decision-making capability is declining,” Dr. Hart said. “Not paying bills such as a mortgage or an electric bill can have serious consequences now and down the line.”

People with decreased mental capacity often become the targets of financial scams. If your loved one is not making good choices for themselves with regard to finances, health and basic needs, that is a sign they may be in cognitive decline.

“If someone is choosing not to address a serious health issue, we have to do our best to protect them from consequences of bad decisions,” Dr. Hart said.

When should I seek professional help?

If you see any troubling behaviors or just have a feeling that something is off with your loved one’s behavior, ask a doctor to perform or make a referral for a cognitive assessment.

“There are many ways we can help someone with dementia or a memory disorder,” Dr. Hart said. “Lifestyle adjustments, geriatric physical rehabilitation, house calls and in-home care, to name a few.”

You or your loved one may want to consider creating or updating the following:

• Living will – A living will is a document that describes the medical treatments someone would and would not want to be used to keep them alive. It includes preferences for other medical decisions, such as pain management or organ donation.
• Power of attorney – A medical or health care power of attorney is a type of advance directive in which a person is named to make decisions for you when you are unable to do so. In some states this directive also may be called a durable power of attorney for health care or a health care proxy.
• Do not resuscitate  – You don’t need to have an advance directive or living will to have do not resuscitate (DNR) and do not intubate (DNI) orders. To establish DNR or DNI orders, tell your provider about your preferences. The provider will write the orders and put them in your medical record.
• Medical order for scope of treatment (MOST) – This outlines someone’s wishes for health care in an emergency, including directions about life-sustaining measures, intubation breathing machines, antibiotic use and feeding tubes.

There are many local resources for patients and their caregivers, including classes, information sessions and more.

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