Alzheimer's disease - Overview

Definition and Overview

Alzheimer's disease is a progressive and irreversible brain disorder that affects memory, thinking, and behaviour.

It is the most common form of dementia, accounting for 60-80% of cases.

Alzheimer's disease is a major public health issue, affecting millions of people worldwide, with a significant impact on individuals, families, and society as a whole.

Alzheimer's disease is caused by the build-up of abnormal proteins in the brain, including beta-amyloid plaques and tau tangles. These proteins disrupt the normal functioning of brain cells, leading to the death of neurons and the loss of brain tissue over time. The exact cause of this protein build-up is still unknown, but there are several risk factors associated with the development of Alzheimer's disease, including age, genetics, lifestyle factors, and certain medical conditions.

Symptoms of Alzheimer's disease can vary widely, but typically include memory loss, confusion, difficulty with language and communication, changes in mood and personality, and difficulty with everyday tasks.

As the disease progresses, individuals may experience more severe cognitive and functional impairment, ultimately leading to a complete loss of independence.

Alzheimer's disease is typically divided into three stages: early (mild) stage, middle (moderate) stage, and late (severe) stage.

In the early stage, individuals may experience mild memory loss and other cognitive difficulties, but are still able to function independently.

In the middle stage, symptoms become more pronounced, and individuals may require more assistance with daily activities.

In the late stage, individuals are typically bedridden and require around-the-clock care.

There is currently no cure for Alzheimer's disease, but there are several treatment options available to help manage symptoms and improve quality of life.

These include medications to help manage cognitive symptoms, behavioral and lifestyle interventions, and supportive therapies to help with daily activities and care.

Early detection and intervention are crucial for maximising the effectiveness of these treatments and improving outcomes for individuals with Alzheimer's disease.

In addition to medical treatment, there are several lifestyle changes that can help reduce the risk of Alzheimer's disease. These include regular physical exercise, a healthy diet, social engagement, and cognitive stimulation.

Caregiving for a loved one with Alzheimer's disease can be challenging, but there are many support resources available to help caregivers and families manage the disease.

Alzheimer's disease is a growing public health concern, with significant impacts on individuals, families, and society as a whole.

Continued research and awareness are essential for understanding the causes and risk factors of Alzheimer's disease, developing new treatments and therapies, and supporting those affected by this devastating disease.

The Significance of Alzheimer's Disease

Alzheimer's disease is a significant public health issue, with millions of people worldwide affected by the disease. It is the most common form of dementia and the sixth leading cause of death in the United States.

The significance of Alzheimer's disease is multifaceted, with impacts on individuals, families, healthcare systems, and society as a whole.

At the individual level, Alzheimer's disease can have a profound impact on a person's quality of life. Symptoms such as memory loss, confusion, and changes in mood and behavior can be distressing and lead to a loss of independence.

As the disease progresses, individuals may require increasing levels of care and support, placing a significant burden on family members and caregivers.

Alzheimer's disease also has significant economic impacts, both for individuals and healthcare systems. The cost of care for individuals with Alzheimer's disease is often high, and many families struggle to afford the necessary medical and support services. Healthcare systems must also bear the burden of caring for individuals with Alzheimer's disease, with costs projected to reach trillions of dollars in the coming years.

The impact of Alzheimer's disease extends beyond individuals and healthcare systems to society as a whole. As the population ages, the number of individuals with Alzheimer's disease is expected to rise, placing a strain on social welfare programs and the economy. The loss of productivity and income associated with Alzheimer's disease can also have significant economic impacts at the national level.

Addressing the significance of Alzheimer's disease requires a multifaceted approach that includes research, education, and support services. Continued research into the causes and risk factors of Alzheimer's disease is essential for developing effective treatments and interventions.

Education and awareness programs can help individuals and families better understand the disease and provide support and resources for those affected by Alzheimer's disease.

Support services, including respite care, counselling, and financial assistance, can help alleviate the burden on families and caregivers.

Enduring Powers of Guardianship in Western Australia: Key Insights and Considerations

An Enduring Power of Guardianship (EPG) is a legal document that plays a critical role in Western Australia's guardianship system.

It grants authority to a person chosen by an individual to make important personal, lifestyle, and treatment decisions on their behalf, should they become incapable of doing so themselves.

This practical tool provides a proactive approach in planning for future circumstances when decision-making capacity may become impaired.

In Western Australia, the EPG allows a competent adult with full legal capacity (the appointor) to designate another person (the enduring guardian) to make essential decisions on their behalf.

The scope of the enduring guardian's authority may include medical and lifestyle decisions, as well as day-to-day matters.

It is important to note that an EPG differs from an Enduring Power of Attorney, which is about financial and legal matters.

Understanding Enduring Powers of Guardianship

An Enduring Power of Guardianship (EPG) is a legal document that allows an individual to appoint a person they trust to make important personal, lifestyle, and treatment decisions on their behalf if they become incapable of making such decisions themselves.

This is particularly relevant for matters related to health and well-being, living arrangements, and personal services.

In Western Australia, an enduring guardian can only make decisions that the appointer has specifically authorized in the EPG document. The guardian's powers may be limited or broad, depending on the choices made by the individual creating the EPG.

They must act in the best interests of the appointer and must consider the appointer's wishes when making decisions on their behalf.

It is vital to choose an enduring guardian who can be relied upon to make decisions reflecting the appointer's values and preferences.

The nominated enduring guardian must be at least 18 years old.

The appointer can also choose to appoint more than one enduring guardian if they wish, to ensure a balance of opinions and representation.

The EPG only becomes effective if the appointer loses their decision-making capacity.

Before creating an EPG, it is essential to understand the key principles, legal obligations, and implications involved in granting an enduring power of guardianship.

Legislation and Governing Bodies

In Western Australia, the legislation governing enduring powers of guardianship is the Guardianship and Administration Act 1990. This act outlines the rights, responsibilities, and procedures related to enduring powers of guardianship, providing a legal framework for safeguarding the interests of individuals who are unable to make decisions for themselves due to incapacity.

The Public Advocate is an independent statutory officer appointed by the Western Australian Government to protect and promote the rights of individuals with decision-making disabilities. The Office of the Public Advocate takes an active role in promoting awareness and understanding of enduring powers of guardianship and related legislation among the public.

Another important entity in the area of enduring powers of guardianship is the State Administrative Tribunal (SAT). The SAT is responsible for making decisions regarding the appointment of guardians and administrators, as well as reviewing these appointments and considering any disputes that may arise in relation to enduring powers of guardianship.

Completing the Documentation

To formalize the EPG, you need to complete the required forms and declarations.

The process involves:

1. Filling out the Enduring Power of Guardianship Form, including all necessary sections such as the appointor's and guardian's details, the extent of the guardian's powers, and any conditions and limitations to those powers.

2. Having the form witnessed by 2 people, one of whom is authorised by law to take declarations.

3. Having the appointed enduring guardian(s) sign the Acceptance by Enduring Guardian Form, acknowledging their acceptance of the role and its responsibilities.

It is essential to follow these steps correctly, as any errors or omissions can render the EPG invalid, which may cause difficulties or delays in decision-making during a time of crisis.

Revoking or Amending an Enduring Power of Guardianship

There may be circumstances when someone might choose to revoke or amend their enduring power of guardianship.

An individual can choose to revoke their enduring power of guardianship voluntarily for various reasons, such as changing circumstances, relationships, or personal preferences.

Involuntary Termination

An enduring power of guardianship might be involuntarily terminated in specific situations, including:

• The enduring guardian's death.

• Upon the occurrence of a specific event mentioned in the enduring power of guardianship document that results in the termination of the guardianship.

• The appointment of a new guardian through an order of the SAT.

Dealing with Abuse or Misuse

In some cases, it may be necessary to apply to the State Administrative Tribunal for a review of the guardianship appointment. The tribunal has the authority to review, vary or revoke the enduring power of guardianship if it is determined that abuse or misuse has occurred.

By taking these steps, you can help protect the welfare of the vulnerable individual and ensure that their rights are respected throughout the guardianship process.

Key points

• In Western Australia, enduring powers of guardianship provide a valuable tool for individuals to plan for their future personal, lifestyle, and treatment decisions. By appointing a trusted person as their enduring guardian, adults with diminishing cognitive abilities can feel more secure and better prepared for any challenges they may face as their medical or mental conditions change.

• When creating an enduring power of guardianship, it is essential to understand the legal requirements and implications associated with this process. The A Guide to Enduring Power of Guardianship in Western Australia is a helpful resource offering comprehensive information about this topic.

• Furthermore, it is crucial to carefully consider the person or persons selected to act as the enduring guardian. They should be someone trustworthy, reliable, and capable of making decisions that align with the individual's best interests and personal preferences. Open communication and ongoing discussions between the appointor and their chosen guardian are vital in ensuring that the guardian understands and respects the individual's wishes.

• In summary, enduring powers of guardianship play a crucial role in safeguarding an individual's autonomy and promoting their long-term wellbeing. By making informed decisions and seeking professional advice if needed, adults in Western Australia can be confident that they have made the necessary arrangements to maintain control over their personal circumstances and protect their quality of life.

Cognitive fluctuations in dementia: A closer look🔍

A crucial aspect of dementia care is understanding and managing ▶ cognitive fluctuations, which are changes in a person's cognitive abilities and levels of awareness.

Dementia is a progressive neurological condition that encompasses various forms such as Alzheimer's, vascular dementia, Lewy Body dementia, and frontotemporal dementia.

The Australian Institute of Health and Welfare estimates that there were ▶ 219,000 Australians with dementia in 2020. This number is on the rise.

Cognitive fluctuations can be influenced by factors like:
1️⃣ environment,
2️⃣ fatigue,
3️⃣ medications, and
4️⃣ time of day.

For example, ▶ sundowning is a common phenomenon where individuals experience increased agitation or confusion during late afternoon or evening hours.

The neurobiology underlying cognitive fluctuations is not yet fully understood, but it is known that dementia results from damage to brain cells and their connections. In Alzheimer's disease, this deterioration begins in the memory centers of the brain and gradually spreads to regions governing attention and awareness.

Disruptions in the brain's "default mode network" can also lead to changes in cognition and self-awareness.

Behavioural interventions, such as music therapy, can temporarily improve mood and memory for those living with dementia.

When interacting with a loved one experiencing cognitive fluctuations, it's important to:
➡ communicate effectively using short sentences,
➡ maintain eye contact,
➡ minimise distractions, and
➡ listen calmly to their concerns.

Although some drugs show promise in slowing memory decline, further research is needed to better understand and treat dementia.

If you are facing guardianship issues related to dementia, I am a specialist guardianship lawyer and can help.

Understanding Schizophrenia: Dispelling Myths and ▶ Promoting Awareness

As a guardianship lawyer with experience in assisting families of schizophrenia patients, I want to raise awareness about this complex mental health condition that affects ▶ approximately 1% of the Australian population.

Schizophrenia is characterized by symptoms such as:
1️⃣ psychosis,
2️⃣ delusions,
3️⃣ hallucinations,
4️⃣ thought and behavioural disorganization, and
5️⃣ “negative symptoms” such as flat affect and loss of interest and motivation.

Proper treatment is crucial, as the World Health Organization estimates that ▶ one-third of people with schizophrenia can experience complete remission with the right approach.

It's essential to recognise that the ▶ hallmarks of schizophrenia vary from person to person, but often include impaired daily functioning and grossly disorganised and catatonic behaviour.

According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), a ▶ formal diagnosis requires the presence of at least two major symptoms for a significant period within one month.

Though rare, childhood onset schizophrenia affects around 0.4% of kids aged 5-18, and symptoms may manifest differently in children and adolescents compared to adults.

Some common risk factors for schizophrenia include family history, environmental factors, brain chemistry, and brain anatomy.

Treatment for schizophrenia typically involves a combination of medications, evidence-based psychotherapy, lifestyle changes, supportive housing, ongoing care from a clinical team, and community/family support.

It's crucial to address the ▶ stigma surrounding schizophrenia, as misconceptions about the condition can exacerbate symptoms and hinder treatment-seeking behaviour.

By raising awareness about schizophrenia and dispelling myths, we can promote understanding and empathy for those affected by the condition and their families.

This knowledge can also assist in making informed decisions regarding ▶ guardianship and administration orders, to ensure the best possible support and care for individuals living with schizophrenia.

Understanding the Role of Limited Administrators as Litigation Guardians in Western Australia

Introduction

Navigating guardianship matters can be a complex and sensitive process, particularly when supporting individuals who are unable to make reasonable judgments due to mental or physical incapacity. In this article, we will discuss the role of Limited Administrators as Litigation Guardians in Western Australia, as guided by the Guardianship and Administration Act 1990 (WA). We will also explore a real-life case example to illustrate the importance of Limited Administrators as Litigation Guardians, and how they can provide crucial assistance in protecting the legal and financial interests of vulnerable individuals.

Understanding Limited Administrators as Litigation Guardians

In Western Australia, the State Administrative Tribunal has the authority to appoint substitute decision makers, such as Limited Administrators, for individuals who lack the capacity to manage specific legal and financial affairs. Limited Administrators can be appointed as Litigation Guardians to act on behalf of individuals involved in legal proceedings, ensuring their best interests are upheld throughout the process.

Key factors to consider when appointing a Limited Administrator as a Litigation Guardian include:

1. Legal proceedings: The individual concerned is involved in legal proceedings and lacks the capacity to make decisions or give instructions.

2. Settlement decisions: The individual concerned is required to make a decision regarding the settlement of a legal claim and is unable to make an informed decision due to their incapacity.

3. Limited scope: The individual's incapacity is restricted to a specific area of their legal or financial affairs. A Limited Administrator can be appointed to manage only those aspects, allowing the individual to manage their other affairs independently.

4. Duration: In cases where the individual's incapacity is temporary or expected to improve over time, a Limited Administrator can be appointed for a specific period, ensuring their legal and financial affairs are managed effectively during their period of incapacity.

Case Example: Jane's Story

To illustrate the importance of Limited Administrators as Litigation Guardians, let's take a look at Jane's story. Jane, a 35-year-old single mother, was suffering from severe depression that significantly impacted her ability to make informed decisions. At the same time, she was involved in a complex legal dispute, which required her to make crucial decisions and give instructions to her legal team.

With the approval of the State Administrative Tribunal, a Limited Administrator was appointed as a Litigation Guardian to act on Jane's behalf during the legal proceedings. The Limited Administrator's role was specifically tailored to:

1. Provide instructions to Jane's legal team on her behalf.

2. Make critical decisions regarding the settlement of Jane's legal claim.

3. Ensure that Jane's best interests were upheld throughout the legal process.

In Jane's case, the Limited Administrator's appointment was temporary and focused solely on the legal dispute. This arrangement allowed Jane to maintain control over other aspects of her life while ensuring her legal and financial interests were protected during her time of incapacitation.

Conclusion

This case highlights the importance of the guardianship jurisdiction in Western Australia and the value of Limited Administrators as Litigation Guardians. By understanding the available options and resources, legal professionals and families can work together to support and protect the rights and interests of those who may be unable to do so themselves. It is crucial to consult with an experienced lawyer in the guardianship jurisdiction to ensure that the application process is correctly followed, and the best interests of the person concerned are upheld.

The Evolution of Guardianship Law: A Historical Overview

Introduction

Guardianship law, an essential aspect of legal systems across the globe, has evolved significantly over the centuries to protect the rights and interests of individuals who are unable to manage their own affairs. This article provides a comprehensive overview of the history of guardianship law, tracing its origins in ancient civilizations and its development in response to societal changes and ethical considerations. We will also discuss the challenges and future implications of guardianship law in an increasingly interconnected world.

Origins in Ancient Civilizations

The concept of guardianship dates back thousands of years to ancient societies such as the Roman Empire, where the role of a guardian, or "tutor," was established to protect the interests of minors and those deemed incapable of managing their own affairs. Similarly, the Babylonian Code of Hammurabi, one of the earliest legal codes, contained provisions for guardianship that recognized the importance of protecting vulnerable individuals.

In ancient Greece, guardianship law evolved to cater to the needs of the time, with guardians appointed for orphans, unmarried women, and individuals with cognitive impairments. The role of the guardian was to manage property, finances, and legal affairs, ensuring that the best interests of the person under guardianship were preserved.

Development in the Middle Ages and Early Modern Period

During the Middle Ages, guardianship law continued to evolve in response to societal changes and religious influences. In the English common law system, for instance, the concept of "wardship" was introduced, wherein the Crown held the responsibility of managing the estates of minors and those deemed unable to manage their own affairs. This system placed a strong emphasis on protecting property rights, which laid the groundwork for the development of modern guardianship law.

In early modern Europe, the Age of Enlightenment brought about a greater focus on individual rights and the protection of vulnerable populations. In response, guardianship law began to prioritize the well-being of the person under guardianship, rather than just property management.

Modernization and Reform in the 19th and 20th Centuries

The 19th and 20th centuries saw a wave of legal reform that led to the standardization of guardianship law in many countries. This period marked a shift from a property-centered approach to one that emphasized the personal rights and welfare of the individual under guardianship.

In the United States, for example, the Uniform Guardianship and Protective Proceedings Act was introduced to create a consistent legal framework for guardianship across state lines. This act provided guidelines for the appointment of guardians, their duties, and the rights of the person under guardianship.

The 21st Century: Balancing Rights and Protection

In recent years, the focus on individual rights and autonomy has prompted a re-evaluation of guardianship law. The United Nations Convention on the Rights of Persons with Disabilities (CRPD) has played a significant role in promoting the rights of individuals with disabilities, urging nations to adopt legal frameworks that prioritize supported decision-making and the least restrictive alternatives to guardianship.

As a result, many countries have reformed their guardianship laws to promote a more person-centered approach. Such reforms have introduced alternatives to guardianship, such as limited guardianships and supported decision-making, that empower individuals to retain greater control over their lives while still receiving the necessary support and protection.

Conclusion

The history of guardianship law reflects the evolution of societal values and the growing understanding of the importance of protecting the rights and interests of vulnerable individuals. As our world becomes increasingly interconnected and diverse, it is vital that guardianship law continues to adapt to the changing needs of society, striking a balance between the protection of vulnerable individuals and their right to autonomy and self-determination.

The Crucial Role of Geriatricians in Guardianship Matters

As a guardianship lawyer in Western Australia, I have the privilege of working alongside various healthcare professionals, including geriatricians, who play a crucial role in guardianship applications and hearings at the State Administrative Tribunal.

I wanted to take a moment to shed some light on the role of geriatricians and how they contribute to these processes.

👩‍⚕️ What is a geriatrician?
A geriatrician is a medical doctor specializing in the care, diagnosis, treatment, and prevention of diseases and health issues affecting older adults, typically aged 65 and above. They focus on promoting healthy aging, managing chronic conditions, preventing disease, and maintaining independence and quality of life for their patients.

📋 Geriatricians in Guardianship Matters:
In guardianship applications and hearings, geriatricians often provide invaluable medical reports and expert evidence. They help the Tribunal determine an individual's capacity to make decisions and assess their ability to manage personal, medical, and financial matters. Their expert opinions can guide the Tribunal in making decisions about appointing a guardian or an administrator.

📞 Providing Evidence at Hearings:
Geriatricians often participate in hearings, typically via telephone, to present their findings and answer questions from Tribunal Members, legal representatives, and other parties involved. Their expertise ensures that accurate and relevant information is considered when making critical decisions about the welfare and best interests of vulnerable adults.

Geriatricians play a vital role in guardianship matters, providing essential medical expertise to help safeguard the rights and interests of older adults.

If you have any questions about guardianship matters or the role of geriatricians in these cases, feel welcome to contact me.

#Geriatricians #GuardianshipLaw #ElderLaw #alzheimers #dementia #StateAdministrativeTribunal

When Less is More: Importance of Considering Less Restrictive Means in Guardianship and Administration

I am pleased to share a decision published by the State Administrative Tribunal of Western Australia in which I acted for the Subject of the application, "DJJ", who is 94 years of age.

The decision highlights the importance of finding the most suitable and least restrictive means of decision-making for individuals in guardianship and administration matters.

📄 Key takeaways from the decision:

1️⃣ Administration: The Tribunal found that although DJJ was in need of an administrator, a less restrictive means was available for managing her estate. Consequently, the Tribunal chose not to appoint an administrator and instead reinstated the enduring power of attorney (EPA) that had previously been revoked.

2️⃣ Guardianship: The Tribunal determined that DJJ required a guardian and found no less restrictive means available for making decisions on her behalf. CTJ (the Daughter) was deemed suitable and was appointed as DJJ's guardian.

This decision serves as a reminder that each case is unique and requires careful consideration of the Subject's individual needs and circumstances. It also emphasizes the importance of exploring less restrictive options when determining the best course of action for the Subject's well-being.

#Guardianship #dementia #alzheimers #EnduringPowerOfAttorney #LeastRestrictiveMeans #administration

The Montreal Cognitive Assessment Test: An Essential Tool for Guardianship Applications

The decision to seek a guardianship for a loved one is a challenging and emotional process.

As a guardianship lawyer, I understand the importance of ensuring that the best interests of your loved one are protected.

One of the essential tools in evaluating mental capacity for the purpose of guardianship applications is the Montreal Cognitive Assessment (MoCA) test.

In this blog post, I will provide a detailed explanation of the MoCA test and how it can be an invaluable tool in the guardianship process.

What is the Montreal Cognitive Assessment (MoCA)?

The MoCA is a widely recognized and respected cognitive screening tool designed to quickly assess cognitive functioning in adults. Developed by Dr. Ziad Nasreddine in 1996, the MoCA test evaluates various cognitive domains, including memory, attention, language, visuospatial abilities, and executive functions.

The MoCA test consists of 30 questions that are scored on a maximum of 30 points. It is relatively quick to administer, taking approximately 10 to 15 minutes. A score of 26 or above is considered normal, while a score below 26 may indicate mild cognitive impairment (MCI) or dementia.

Why is the MoCA test important in guardianship applications?

In guardianship applications, it is crucial to determine whether the individual in question has the mental capacity to make informed decisions and manage their daily affairs.

The MoCA test provides an objective evaluation of cognitive abilities, offering valuable insights into the individual's cognitive strengths and weaknesses.

Here are a few reasons why the MoCA test is essential in guardianship applications:

1. Objective assessment: The MoCA test provides an unbiased evaluation of cognitive abilities, minimizing the risk of subjectivity and personal bias.

2. Comprehensive evaluation: The MoCA test covers various cognitive domains, allowing for a well-rounded understanding of the individual's cognitive functioning.

3. Quick and efficient: The test is relatively brief, making it an efficient tool for initial cognitive assessment in the guardianship process.

4. Widely recognized: The MoCA test is respected by healthcare professionals and the legal community, making it a reliable indicator of mental capacity in guardianship proceedings.

How is the MoCA test used in guardianship applications?

The results of the MoCA test can be used to support the determination of whether an individual requires a guardian. It is important to note that the MoCA test is just one part of a comprehensive evaluation. Additional information, such as medical records, input from healthcare professionals, and a thorough understanding of the individual's daily functioning, is also essential in making an informed decision about guardianship.

The MoCA test may also play a role in determining the scope of the guardianship. If the test results reveal specific cognitive impairments, the guardian's powers may be tailored accordingly to ensure that the individual's rights and autonomy are respected to the greatest extent possible.

Key takeaways

• The Montreal Cognitive Assessment test is an invaluable tool in the guardianship application process.

• It offers a comprehensive, objective assessment of an individual's cognitive functioning, providing crucial information to make the difficult decision of seeking guardianship.

• By using the MoCA test and other relevant information, we can ensure the well-being and protection of our loved ones.

If you have any questions about the MoCA test or the guardianship process, please do not hesitate to reach out to my team or myself. We are here to support you and your loved ones, offering guidance and expertise in navigating this complex legal landscape.

7 Simple Ways to Reduce Fall Risk for People with Dementia

7 ways to prevent falls for people with dementia

A hospitalisation from a fall is a common theme in my guardianship cases where the Subject of the SAT application has dementia.

Did you know that falls are one of the leading causes of hospitalisations for people with dementia?

A study showed that 26% of individuals with Alzheimer's were hospitalised due to falls, and people with dementia experience 8 times as many falls as those without dementia.

To help prevent falls in your loved one with dementia, here are 7 simple ways you can reduce fall risk:

1️⃣ Review their medications with a healthcare provider, as some medications can increase the risk of falls
2️⃣ Consider their medical conditions and diagnoses, such as Parkinson's disease or changes in blood pressure
3️⃣ Talk to their doctor about the best time of day to take medications to decrease falls risk
4️⃣ Be extra alert and vigilant during concerning times for falls
5️⃣ Do tests to assess their fall risk, such as closing their eyes while standing
6️⃣ Implement safety measures in the bathroom, such as using a shower chair or bench
7️⃣ Reduce fall risk by being mindful of when blood pressure changes can occur

When I speak to clients, concerns about falls risks come up time and again, and are a top-of-mind risk for Public Advocate Investigators when doing reports in advance of a hearing. Something to be mindful about when caring for people with dementia.