More Young in Nursing Homes

The Associated Press recently published an article about the number of younger people in nursing homes. The numbers are small but it does point to the fact that not all aging services are provided to the aging. The article profiled a 26 year old, further citing that one in seven people now living in nursing homes is under 65. An NPR article in December confirms that.

When a younger resident is in a nursing home, his or her schedule and activities revolves around the interests of the majority in most cases. They get up later. They don't like bingo. Heck, they wouldn't like me coming in and singing Sinatra! They eat at different times and prefer different food. Young people have unique and sometimes acute psychological and social needs. And there are generational differences and tensions to boot.

Some homes such as Bayshore Health Center in Duluth, Minn., cited in the article, are adapting. Young people live in private rooms in their own wing. Instead of bingo night, there is poker night. Pizza is served instead of lasagna. And meals are accommodated at preferential times. But let's face it, these are not the appropriate conditions for young people.

This is a very important issue. Fourteen percent of residents in nursing homes is a large percentage of young people. We can debate two things. Should they be there at all? And when they are, shouldn't their care be different and how?

Adapted and edited from my about.com blog.

Consider Your Lifestyle as New Year Approaches

This guest post is contributed by Bobbie Walker. She welcomes your comments at bobbiew862@gmail.com.

At this year’s World Medical Tourism and Global Health Congress, keynote speaker Dr. Jeanette Takamura, Dean of the School of Social Work at Columbia University identified the following as the top issues that affect baby boomers:

·      Chronic disease

·      Prevention

·      Education

·      Mental health

·      Physical activity

If we look closer at the above factors, we see that different demographics are affected in different ways by each of them.

·      Chronic disease is determined not just by lifestyle choices but also by genes. So some sections of the population are prone to diseases like cancer, asthma, osteoporosis and diabetes because of their genetic makeup while others become victims because of unhealthy and irresponsible habits accrued over a lifetime.

·      Prevention of disease is more common in sections of the population that are more aware of the dangers of unhealthy habits and anticipate the problems that aging and physical and mental degradation can cause.

·      Education plays a large role in determining the amount of awareness baby boomers have about disease, aging and preventive measures. While it’s not always the rule, in general, the more educated the person, the higher their level of awareness.

·      Mental health is prone to degeneration as the years go by; however, research has shown that the onset of diseases like Alzheimer’s and dementia can be slowed and delayed by being aware that they exist and working on ways to keep brain cells active and healthy. Mental health is also determined by genetic factors and lifestyle choices.

·      Physical activity plays a key role in good health; baby boomers who are aware of this tend to be in better physical and mental condition than those who eschew any kind of activity because of laziness or ignorance.

A combined look at all the issues that affect baby boomers tells us that those who are blessed with good genes and those who are aware of the preventive measures that need to be adopted to keep mental and physical disease at bay are the ones who are relatively in good health for their age. Some are just plain lucky, others get this way due to hard work and a healthy lifestyle.   

While it may be too late for some plagued by ill health, it’s time for the rest of us to realize that if we don’t wise up and accept responsibility for our health today, we’re going to be facing poor health, exorbitant insurance and medical costs, and a very poor quality of life as we take the curve and turn onto the road called old age.  

Editor's Note - Don't make your better health an idle New Year's resolution. Take real action.

Alzheimer's Test Clears Hurdle

From McKnight's - An advisory committee to the U.S. Food and Drug Administration voted unanimously last week that the FDA should approve a brain scan that can identify the beta amyloid plaques that characterize Alzheimer's in living persons. The FDA typically follows the advice of the advisory committee.

Prior to the development of this new scan, the only way Alzheimer's researchers could identify such plaques was by conducting an autopsy. The advisory committee said that approval is contingent upon physicians being trained how to read and interpret the scans. Researchers say that if the FDA votes to approve the scan, it could be in widespread use quickly.

Over 90 and Loving It - More Beautiful Aging Stories

Filmmaker Susan Polis Schutz has put together a documentary featuring people in their 90s and 100s living extraordinary and passionate lives.

Here's a sampling.

Nola Ochs receives her Master’s Degree just three months shy of her 99th birthday.
Folk singer Pete Seeger, 90, uses his music to change the world through the power of words.
Fan Benno-Caris runs for Addison City Council at the age of 91.
Katie Brown, 91, reports to Cinnabon five days a week.
Marlow Cowan, age 91, and his wife Fran have over 7 million views on youtube.com playing the piano in the lobby of Mayo Clinic.
Annell and Dr. Ernest Rogers, 95 years of age, recently got married in a formal church wedding.

Somehow they forgot to grow old and are always curious to see what’s going to happen next.

More here.

Ninety-Two Percent of Female Retirees Not Planning Long-Term for Retirement

A new report from the Society of Actuaries (SOA) shows that while half of women will likely live beyond age 85, 92 percent do not plan far enough in the future to cover the 20 some years between retirement and life expectancy.

Actuaries say that an understanding of post-retirement risks women face is particularly important. For example, they cite that the expected average value of the cost of lifetime long-term care services is $29,000 for males and $82,000 for females. And while I admit to not knowing that, it makes perfect sense. Women tend to live longer.

The report highlights five key risks affecting women in retirement, including:

1. Outliving Assets - Four out of 10 women over 65 living alone depend on Social Security for virtually all of their income. Simply put they do not have enough assets to pay for their needs.
   
2. Loss of Spouse - If anyone would know the following it is actuaries. A widow on average lives 15 years more after a spouse has died. While not as common for future generations, for today's widow the death of a spouse is usually  accompanied by a decline in standard of living. Eighty-five percent of women over age 85 are widows, compared to 45 percent of men.
   
3. Decline in Functional Status - Women are likely to have a longer period of chronic disability and are more likely to need care in a long-term facility or from a paid caregiver. Forty-six percent of retired women are more likely to expect to pay for assistance than retired men (34 percent), during the less active, somewhat limited stage of retirement. Additionally, 70 percent of retired women are more likely to rely on family or community services for help than retired men, during the least active stage of retirement.
   
4. Healthcare and Medical Expenses - Health benefit costs may affect women more than men because they often have lower incomes, but not lower health care costs, and are less likely to have employer provided early retiree health benefits. Health care costs for a retired couple both at age 65 in 2010 can amount, on average, to $250,000 over their retirement years, not including the cost of long-term care.
   
5. Inflation and the Economy - Inflation has a greater impact on women due to their longer life expectancy.

"This report underscores the need for women to understand the full-blown drama of retirement," said Cindy Hounsell, President of the Women's Institute for a Secure Retirement (WISER), who co-sponsored the report with the SOA. "For most women, there is little room for error and being unprepared for nearly a third of their lives will have consequences. Women need to know what their future risks are and make mitigating those risks a priority throughout their lives."

Here's the full report.

People Who Snore at Increased Risk for Heart Disease

People who snore loudly, have difficulty falling asleep, or often wake up feeling tired may also be at increased risk of developing heart disease and other health problems say researchers at the University of Pittsburgh.

They asked more than 800 people between the ages of 45 and 74 about the quality of their sleep. Three years later, the people who reported snoring loudly were more than twice as likely to have metabolic syndrome -- a cluster of risk factors for heart disease, diabetes, and stroke that includes high blood pressure, high blood sugar, low "good" cholesterol, high triglycerides, and excess belly fat.

Overall, 14 percent of the study participants developed metabolic syndrome. African Americans were more susceptible than whites, as were sedentary people.

The findings, which appear in the journal Sleep is said to be the first study to follow people with sleep problems over time to see if they develop metabolic syndrome.

Virend Somers, M.D., a professor of medicine at the Mayo Clinic, in Rochester, Minnesota, says that sleep deprivation is an "epidemic" that is "almost in parallel" with the obesity epidemic and the widespread rise of risk factors for heart disease and diabetes. 

Hormoz Ashtyani, M.D., medical director of the Institute for Sleep-Wake Disorders at Hackensack University Medical Center, in New Jersey, says that doctors should begin asking patients about their sleep quality in order to gauge their risk for heart disease and diabetes.

South Korea's War on Dementia is Something U.S. Should Emulate

The New York Times has reported that South Korea is training thousands of adults and children to become “dementia supporters” as part of the country's recently launched “War on Dementia.”

These supporters are taught to recognize the symptoms of dementia and techniques for comforting those who are afflicted. Even kids between the ages of 11 and 13 can participate in the government's dementia simulation exercises and attend classes to learn more about the disease. Then, they are taught to visit nursing homes and give residents therapeutic hand massages.

Hundreds of neighborhood dementia diagnostic centers have been created as well.  Nursing homes have nearly tripled since 2008. Other dementia programs, providing day care and home care, have increased fivefold since 2008, to nearly 20,000.

A government dementia database allows families to register relatives and receive iron-on identification numbers. Citizens encountering wanderers with dementia report their numbers to officials, who contact families.

To finance this, South Korea created a long-term-care insurance system, paid for with 6.6 percent increases in people’s national health insurance premiums. The over-65 population has will jump from 7 percent in 2000 to 14 percent in 2018 to 20 percent in 2026.

Here I think is a country with their priorities straight. They have recognized a huge issue, funded it and involved youth. Kudos to Korea and the hope we can follow suit in some way.

More than Half of Americans Will Have Diabetes

More than half of Americans will have diabetes or be prediabetic by 2020 at a cost to the U.S. health care system of $3.35 trillion if current trends go unabated, according to a report released by UnitedHealth Group Inc.

Diabetes and prediabetes will account for an estimated 10 percent of total health care spending by the end of the decade, according to the report titled "The United States of Diabetes: Challenges and Opportunities in the Decade Ahead."

Diabetes is one of the fastest-growing diseases in the United States and currently affects about 26 million Americans. Another 67 million Americans are estimated to have prediabetes, of which 60 million are unaware that they have the condition. 

The report also focuses on the growing obesity epidemic as that condition is a leading cause of diabetes.
Researchers note that there are multiple opportunities to intervene early on and prevent this devastating disease before it's too late. So again, a lot of this comes down to our own lifestyle and taking care of ourselves.

Read more.

Sexier is Perceived Better When It Comes to Scientific Studies

There is always two sides to the story. And when it comes to medical studies, positive stories may sway physician practice methods more so than studies that conclude that there was no difference as a result of the research. Even in science, sexier stories sell.

"No-difference studies affect practice just as much as positive ones, but they aren't as sexy," said Dr. Seth Leopold of the University of Washington in Seattle, who led the research. "Something splashy, something new, is more exciting to everybody."

With journal articles focused on the next best thing it can make the new drugs and treatments seem better than they really are, while giving the proven standbys none of the respect they deserve.

To study the level of 'positive-outcome bias' among journal editors, researchers presented peer reviewers at two orthopedic journals with one of two fictitious studies that were identical in every way except one: One study showed that one treatment was superior to another, while the other indicated no difference between treatments. Reviewers not only overwhelmingly picked the positive study (97.3 percent recommended publishing the positive study vs. 80 percent for the negative study), but they also more harshly criticized the quality of the no-change study.

So despite the rigors of evidence and science, even researchers can get caught up in perception and brand considerations. Typically they do not get their hands dirty with that but they are influenced by it nonetheless, even if they are not aware that they are influenced at all!

And that should be a lesson to us all about perhaps questioning and being a bit more cynical of studies, products and services that promise to cure all of our ills.

Get the Rhythm - Music Therapy Improves Balance, Reduces Falls

According to Swiss researchers, taking part in classes that involve music and rhythmic exercise may improve the balance and walking skills and reduce the number of falls for older adults.

More than 130 seniors were tested in walking and balance skills after taking part in a music-education program called Dalcroze eurhythmics. Participants, all of whom had a history of problems with falls, fell fewer times over the test period.

Greater improvements occurred in the test group that took the class once a week for six months. The program involves free-form movement to improvised piano music and gradually adds other elements of movement and manipulation.

Study participants continued to show improvement in balance and walking ability six months after the study ended. The findings suggest that social dancing or other activities that challenge balance and require continuous adjustments to the environment could have a positive effect on older adults.

There is an Arthur Murray near you!

Depression in Nursing Home Residents - It's All Connected!

Researchers at the University of Missouri have discovered a series of indicators associated with the development of depression in nursing home residents, according to a study published in the Journal of Gerontological Nursing.

Increased verbal aggression, urinary incontinence, increased pain, weight loss, changes in care needs, reduced cognitive ability, and decline in performance of daily living activities, not surprisingly, contributed to depression.

Residents with increased verbal aggression were 69% more likely to be diagnosed with depression. Researchers analyzed 14,000 nursing home residents aged 65 and older who were not diagnosed with depression at the beginning of the study.

I'm not sure if you needed a scientific study to know that all of these things are connected. It's no different than if my 89-year-old mom was faced with not being able to drive any longer. I think that would be grounds for depression, don't you?

Am I missing something here? Does common sense have any role in how we practice medicine?

Limits on the Use of FSA's Take Effect This Month

Starting this month you'll no longer be able to use your flexible spending account (FSA) for over-the-counter drugs and medicines unless you have a doctor's prescription. So forget those routine drugstore purchases like aspirin and vitamins.

Since employee contributions to FSAs are made on a pretax basis, they reduce taxable earnings and thus the amount workers pay in income tax. Financial experts say the feds were simply looking for ways to perhaps get consumers to contribute less to their FSA, allowing more taxable income to be left on the table. An estimated $5 billion in federal revenues through 2019 is predicted.

 

The new regs do not apply to insulin and medical equipment and supplies such as crutches and bandages or to diagnostic devices such as blood sugar test kits. 

Some groups like the Asthma and Allergy Foundation of America are not happy noting that 50 million Americans have allergies, and many can control their symptoms with over-the-counter medications.

So use your FSA properly to avoid getting "dinged" by the feds.

The Secrets to Living Past 100

I subscribe to the magazine, The Week. In case you fall off the planet for a week, you can easily catch up on the world's goings on easily. Recently they published a feature about the world's oldest siblings and their secret to life.

Helen is 108 years old. Eats unhealthy. Drinks. And smokes. Helen is a certified psychologist, a fashion expert, a former TV presenter, and a professor emeritus at New York University.

Helen, her brothers Irving, 104, and Peter, 100 attract a lot of attention. Their sister, Lee, died in 2005 at the age of 102. Together they have provided blood samples and submitted to hours of interviews with age researchers. Ironically the conclusions are, ah, inconclusive.

One researcher noted that "the usual recommendations for a healthy life — not smoking, not drinking, plenty of exercise, a well-balanced diet, keeping your weight down — they apply to us average people, but not to them. Centenarians are in a class of their own." 

His centenarian subjects have been overweight; long-time smokers; exercised only moderately or not at all. Ouch, flies in the face of a lot of things I preach. Researchers were quick to note that a healthy lifestyle is still important to we other mere mortals.

You see in order to reach the age of 100 you need a special genetic makeup. "These people age differently. Slower. They end up dying of the same diseases that we do — but 30 years later and usually quicker, without languishing for long periods."
Irving, the younger brother, did tell the reporter that diet and abstaining from drinking and smoking were important to his health and was somewhat mystified at his sister's lifestyle and longevity. Researchers did agree with Irving's assessment that being an extroverted and having a stable social network were important. I certainly agree. The value of friendship is one of the points I make in my Meaning of Life keynote. Another point, optimism seems to surface with these siblings. I call it having a great attitude.

So there you have it. It's in the genes.

Medicare Competitive Bidding for DME Could Affect You

Medicare began its Competitive Bidding Program for Durable Medical Equipment at the start of the year.

This program puts forth new rules about obtaining durable medical equipment in North Carolina, South Carolina, Ohio, Kentucky, Indiana, Texas, Missouri, Kansas, Florida, Pennsylvania and California.

This Medicare web site can help you find suppliers, costs and equipment.
 
Check to make sure your current provider is still a Medicare provider. You may be able to continue renting your equipment from that provider if the provider chooses to be grandfathered in. However, the supplier may choose not to be grandfathered in and you will need to change suppliers.

There is a lot of controversy surrounding this program. On one side, the Centers for Medicare and Medicaid Services (CMS) is trying to push down costs. On the other side, critics argue that there will be:

• Difficulty finding an equipment providers.
• Delays in delivery of equipment or services.
• Fewer choices of equipment or providers.

And low ball suppliers, it is said will use inferior, lower cost supplies in order to make a profit.

Problems, concerns, and feedback about this bidding system can be lodged by calling a toll-free number, 1-888-990-0499, or by visiting this website.

Thanks to David Green for insight into this issue.

When Boomers Must Take the Wheel (from Mom or Dad)

The following is reprinted with permission from Frontline Geriatric Care Management

My company, Partners In Care, recently encountered a challenging situation. I received the following call from a client's daughter: "Dad's driving skills are getting worse. I'm afraid he's going to hurt
himself or someone else. I don't think he should be driving anymore, but he simply won't listen
to me.  Please help!"

Truth is, this is a very real issue that our clients and their families are dealing with all the time, and we try to help mediate whenever requested by the family. So, in these difficult situations, what's the rule of thumb? A major part of my business is helping seniors to remain independent, and we want them to
continue driving as long as they can do so safely. However, for many Baby Boomers,
the time may come when we must intervene with our parents' driving.

Consider the following warning signs, which may suggest that it's time for your loved one to limit (or stop) driving and hand over the keys:

* feeling less comfortable and more nervous or fearful while driving
* difficulty staying in the lane of travel
* more frequent "close calls," or more frequent dents and scrapes on the car, fences and mailboxes
* trouble judging gaps in traffic at intersections
* other drivers honking at them more often
* more instances when they are angry at other drivers
* friends or relatives not wanting to drive with them
* getting lost more often
* difficulty seeing the sides of the road when looking straight
* violating signals, road signs and pavement markings
* slower response to unexpected situations
* confusing brake and gas pedals
* difficulty concentrating while driving
* difficulty checking over shoulder while backing up or changing lanes
* medical conditions or medications that may be affecting their safety while driving
* more traffic tickets or "warnings" by law enforcement recently

Often, people fail to recognize declining abilities, or they fear stopping driving will make them permanently dependent on others or reduce their social and leisure activities. Conditions such
as dementia or early Alzheimer's disease may make some drivers unable to evaluate
their driving properly.

I know from personal experience with my own Mom that this is a tricky situation, especially with aging parents. If you think that you may need to intervene with your loved one's driving, begin having conversations with the driver. As people age, they tend to look first to family members for candid advice concerning their well-being and health issues. Suggest various options, depending on the
degree of impairment. One size does not fit all, and while stopping driving may be the only
answer in some cases, stopping driving too early can cause a person's overall health to decline prematurely. Options may include:

* taking a refresher course (such as the AARP Driver Safety Program)
* limiting driving to certain times of day or familiar areas
* encouraging the driver to gradually begin using other methods of transportation such as rides from family and friends, caregivers, public transportation,
or other options available.

Americans Less "Nuts" As They Grow Older

As Americans grow older, they tend to become more emotionally stable—translating into longer, more productive lives, according to a new Stanford study published online in the journal Psychology and Aging.

Between 1993 and 2005, researchers tracked about 180 Americans between the ages of 18 and 94. For one week every five years, the study participants carried pagers and were required to immediately respond to a series of questions whenever the devices buzzed. The periodic quizzes were intended to chart how happy, satisfied, and comfortable they were at any given time.

“As people get older, they're more aware of mortality,” researchers said of the findings. “So when they see or experience moments of wonderful things, that often comes with the realization that life is fragile and will come to an end. But that's a good thing. It's a signal of strong emotional health and balance.”

Over the years, the older subjects reported having fewer negative emotions and more positive ones compared with their younger days. But even with the good outweighing the bad, older people were inclined to report a mix of positive and negative emotions more often than younger test subjects.

Source: Long Term Living Magazine

Person Centered Care Program Gets People Back to Home from Nursing Home

As much as they'd like to think it's possible, elderly residents in long-term care facilities have come to accept that a nursing home might be the last place they will call home. But a new pilot project, called Project Home, helped 60% of project's participants transition from long-term care facilities to their homes, a news outlet reported.

Project Home, which is funded by the New York State Department of Health, uses a person-centered approach to help nursing home residents develop the skills they need to return to their own communities. A team of case workers were assigned to each participant and helped them tackle logistical barriers to moving home, such as finding affordable housing, setting up prescription refills and medical appointments, arranging transportation, helping with grocery shopping and other critical day-to-day obligations, Electronic Component News reported.

Those involved with the project emphasize that entry into a nursing home isn't necessarily a one-way street. Dedicating staff to patients' individual needs can cut through the red tape that keeps them in nursing homes, researchers found.

Secrets of Centenarians

Need some inspiration for a new year? Check out the New York Times Secrets of Centenarians.

You know Willard Scott used to celebrate 100th birthdays on the Today Show every once in a while. Now it is almost a daily occurence.

Are you prepared for a loved one living to 100?

Growth of Adult Day Care

The Met Life Mature Market Institute recently published a study showing the rise in use of adult day care centers.

Researchers from The Ohio State University College of Social Work collected and analyzed data from 557 Adult Day Services centers, which represented a 40% return from a randomly selected group of 1,518 Adult Day Services centers. Surveys were predominantly completed by center administrators.

Among the findings:

• Almost 80% of centers have professional nursing staff and about 50% have a social worker and physical, occupational, or speech therapy
• Direct care worker-to-participant ratio is 1:6
• Over 80% of participants attend full days and 46% attend five days per week
• Centers are serving populations with higher levels of physical disability and chronic disease
• ADS centers are leaders in providing care to individuals with Alzheimer’s disease and other dementias
• Approximately 90% provide cognitive stimulation programs
• Most centers provide caregiver support including educational programs (70%) and caregiver support groups (58%)

As the continuum of care continues to shift people are finding adult day centers as a solution for their elder's needs. Often times, unless someone does not have the ability to leave the home, these are a great place for not just care but much needed socialization. You may want to look at this type of setting for a loved one.