Widely Used Drug Ineffective for Mild Alzheimer's

As reported in Health.com, a drug widely used to treat mild Alzheimer's disease appears to provide no benefit to this group of early stage patients, according to a new analysis of previously conducted research. 

Memantine, also known by its brand name, Namenda, is approved by the Food and Drug Administration for moderate-to-severe cases of Alzheimer's, although doctors often prescribe it for milder cases of the disease.  In 2003, the FDA approved memantine for moderate-to-severe Alzheimer's disease, but two years later the agency rejected an application from the manufacturer, Forest Laboratories, to expand the approval to mild Alzheimer's. The drug has remained popular for that purpose.

Says the lead researcher, Lon Schneider, M.D., a professor of psychiatry, neurology, and gerontology at the University of Southern California, in Los Angeles. "We think physicians, patients, and caregivers should simply know this."

Schneider and his colleagues reanalyzed data from three clinical trials that included 431 patients with mild Alzheimer's disease and 697 with moderate Alzheimer's. Patients with mild Alzheimer's who took memantine showed no improvement in mental function and their ability to handle everyday tasks compared with those who took placebo.

Gary Kennedy, M.D., the director of geriatric psychiatry at Montefiore Medical Center, in New York City, says that while the new study will "make people more appropriately cautious," it isn't likely to change doctors' prescribing practices.

VideoCaregiving an Exclusive All-Video Caregiving Site

A website from Terra Nova Films, Video Caregiving, is dedicated to "streaming" visual educational material to family caregivers. It has launched a Spanish edition too. Both sites are unique is the almost exclusive use of video in focusing on the challenges faced by the caregiver. 

The videos are designed to be short, simple and direct, and are able to be accessed easily by the user at any hour of the day or night. Many of the videos follow a documentary format that uses real people and follows real situations.

Studies indicate that roughly one-third of Hispanic households have at least one caregiver, many of those dealing with somebody who has Alzheimer’s.  Over 40% of these caregivers said they’d been forced into making major changes in their lives, from cutting back on their working hours, to changing jobs to taking a leave of absence or stopping work altogether.

While Alzheimer’s presents its own set of problems in the general population, it seems to be even more acute in the Latino culture.  Studies suggest that many Hispanics may have more risk factors for developing dementia than other groups. And surveys indicate that Latinos, less likely to see doctors because of financial and language barriers, more often mistake dementia symptoms for normal aging, delaying diagnosis. 

Among the goals of the sites are not only to help the caregivers better understand and deal with their situation, but also to remind—and actually SHOW—them they are neither isolated or alone in their struggle. The videos on the website are original footage, documentary in style, focusing on real stories of real people in real circumstances. 

An advisory team of representatives from the leading caregiving organizations and a production team of experts on caregiving and Alzheimer’s disease came together to create this resource, which offers specific videos on Alzheimer’s disease and general caregiving.

Seniors Who Engage in Shopping Every Day Stay Healthier Longer

My father-in-law will not be happy with this report.

In a study recently published in the Journal of Epidemiology and Community Health, it was found that seniors who engage in shopping every day, or almost every day, stay healthier longer than those who don't get out of their homes as frequently. 

As reported in Health Day News, Taiwanese researchers found that frequent shopping among seniors is associated with low-impact physical activity and helps them feel involved in their communities. Researchers equated this to “active aging" — staying active via physical, social and economic activity results in healthier aging. 

Of 1,850 participants 22% said they shopped two to four times per week. While the shoppers tended to be younger, the once-a-day shoppers were 27% less likely to die than those who never shopped, even after adjusting for physical and mental impairment. 

“I would not conclude that shopping itself increases longevity. The characteristics of individuals that enable them to shop are associated with greater longevity," S. Jay Olshansky, professor of public health at the University of Illinois, told HealthDay.

Gentlemen, hide those pocketbooks!

Caregiver Webinar Tomorrow

CareGiving.com has scheduled a family caregiver webinar for tomorrow called Planting Seeds for Your Future.

It is at noon eastern. 

Here is the description: The intensity of caregiving can mean days that never end. When the days of caregiving seem endless, how can you plan for your future? A future beyond caregiving? In this 45-minute webinar, Denise Brown will help you create a vision of your future—a vision full of possibilities without any guilt.

Go here to participate.

Multi-Tasking and Aging

According to the National Academy of Sciences older adults have more trouble with multitasking than younger people. CNN, citing Health Day News, reports that researchers, through functional magnetic resonance imaging (fMRI), compared brain activity in 20 healthy adults, with an average age of 69, to 22 healthy younger people aged 18 to 32. 

Participants were given a memory task, which was interrupted with another task, and then asked to return to the original activity.

Older and younger people direct about the same amount of attention to the interrupting task, but older adults run into more trouble when they need to let go of the interruption and reestablish the original task.

Researchers think that brain changes involved in multitasking may begin as early as the 20s and 30s and note that some mental abilities do improve with age, such as vocabulary and wisdom.

It’s turning out to be much more difficult than researchers thought to identify cognitive exercises that would help the aging brain stay sharp, researchers said. 

Conclusions:

• Avoid interruption if you need to get something done.
   
• Do one task at a time rather than trying to juggle them.

Older Adults Not Getting Preventive Screenings

A new report from agencies of the U.S. Department of Health and Human Services say that critical gaps exist between older Americans who receive preventive services and those who do not.

Clinical prevention services examined in the report include:

• vaccinations that protect against influenza and pneumococcal disease
• screenings for the early detection of 
• breast cancer
• colorectal cancer
• diabetes
• lipid disorders
• osteoporosis
• smoking cessation counseling

Challenges underlying these disparities are complex and reach beyond the traditional healthcare arena of patient-provider interactions. Older adults may not be aware of the services recommended for their age group or may not know that the services are covered by Medicare, the report said.

Some of the recommendations offered include: 

• Reducing out-of-pocket costs.
  
• Promoting annual wellness visits.
  
• Issuing client reminders in the form of letters, postcards, or phone calls to alert adults that it is time for their cancer screening or vaccination.
  
• Using “small media” to increase awareness of available services and convey messages about their benefits.
  
• Tailoring messages, information, and services to meet the needs of each adult.
  
• Issuing “standing orders” as a way to reduce missed opportunities at the point of care or in the physician’s office.
  
• Reducing structural barriers that make it difficult for adults to make or keep their appointments – distance from a service location, limited hours of operation, caregiver responsibilities, or work commitments.
  
• Expanding access beyond traditional health care settings to community sites and locations.
  
• Offering multiple services in one location and at the same time for expedient “one- stop shopping.

Clearly the health care sector is being pushed to prevention and wellness and creating accountable care organizations and medical homes is good. But self-responsibility and education around the screening you need are important. Providers can help with timely reminders but you need to take charge as well.

Find the report here.

“Enhancing Use of Clinical Preventive Services Among Older Adults"

Alzheimer Caregiver Toll

A USA Today article recently looked at the toll on Alzheimer's caregivers citing recent reports from the Alzheimer's Association.

Among the highlights:

• 15 million unpaid caregivers help someone with Alzheimer's and other forms of dementia in the USA — 37% more than last year.
  
• an estimated 5.4 million people are living with Alzheimer's; every 69 seconds, someone develops it.
  
• Alzheimer's is the sixth-leading cause of death in the USA.
  
• Family members provide 17 billion hours of unpaid care, valued at $202.6 billion.
  
• Alzheimer’s and dementia caregivers had $7.9 billion in additional health care costs in 2010.
   
• More than 60 percent of family caregivers report high levels of stress because of the prolonged duration of caregiving and 33 percent report symptoms of depression.

Clearly the toll is sometimes worse on the caregiver than the patient. That is why resources we have blogged about are so crucial such as Losing Our Parents, The Caregiver Relief Fund and Lotsa Helping Hands. Check them out.

Senior Fitness, Obesity and Medicaid - Weighty Issues!

Obesity carries with it inherent health problems. Combine obesity and old age and you exacerbate age-related decline. 

A new study published in the New England Journal of Medicine shows those over 65 should continue with diet and exercise, dispelling the belief that weight loss can cause the elderly to lose muscle and bone mass.

Study participants were randomly assigned to a control group, a weight-management (diet) group, an exercise group, or a weight-management-plus-exercise (diet-exercise) group. Exercise consisted of a 90-minute routine three times a week. A modified Physical Performance Test scored their progress.

Scores in the diet-exercise group were better across categories - peak oxygen consumption improved; body weight decreased by 9%; lean body mass and bone mineral density at the hip decreased less; strength, balance, and gait improved consistently.

Researchers suggest that a combination of weight loss and exercise provides greater improvement in physical function than either intervention alone.

So then...

Arizona Gov. Jan Brewer (R) has proposed enacting an annual $50 surcharge for obese Medicaid enrollees, a move she says would help Arizona’s financially troubled Medicaid program. If approved, the fee would be the first time a state or federally funded healthcare program for the poor fined individuals for unhealthy habits or behaviors, The Wall Street Journal reported.

So it gets back to basics - diet and exercise not one or the other. And as you will continue to find in Medicaid and other health plans, there will be rewards for healthy behavior and in some cases disincentives for unhealthy behavior. 

Life Expectancy > But Hold the Parade

According to the National Vital Statistics Report from the Centers for Disease Control and Prevention, the average life expectancy of a baby born in the U.S. climbed to 78.2 years. At the same time, the death rate fell to an all-time low.

The age-adjusted death rate fell from 758.7 deaths per 100,000 people to just 741 deaths per 100,000 people. Life expectancy for men rose from 75.5 years in 2008 to 75.7 years in 2009 and for women from 80.5 years to 80.6 years during that same time.

The average age of a nursing home resident is 79, with slightly more than half of all nursing home residents over the age of 85, according to statistics from the American Health Care Association. View the CDC report online here.

Hold off on any parades. Yes we are living longer in the U.S. but...

Life expectancy is not rising as fast as it once was. And, compared with other developed nations, the National Research Council reports the U.S. lags the average life-expectancy gains of 21 other countries for men and women.

Heart-disease rates in the United States are to blame according to researchers and surpriningly in women, smoking appears to account for lower life expectancy relative to other countries. Obesity may account for one-fifth to one-third of the shortfall in U.S. life expectancy as compared with other countries too.

We all know that the U.S. has the highest rate of medical spending in the world and most of it is devoted to treating disease and not preventing it. Couple that with our obesity epidemic and how poorly many Americans take care of themselves, it is a wonder that life expectancy actually didn't decrease. 

And there's the rub. Because there is bit of an entitlement attitude in this country. Many figure that what the heck if I let myself go, there will be a pill, procedure, or device that will take care of me. That may be true but that in of itself will not extend a quality life the way healthy living habits will and do.

1.1 Million 50+ Taken to ED for Adverse Medication Reactions

The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related emergency department (ED) visits in the United States. Their latest report in February focused on Emergency Department visits that involve adverse reactions to medications among older adults in 2008.

• In 2008, an estimated 1.1 million emergency department (ED) visits were made by adults aged 50 or older for adverse reactions to medications; more than half by those 65+.
• Central nervous system (CNS) drugs (e.g., pain relievers and drugs used to treat anxiety and insomnia) were involved in almost one fourth (24.3 percent) of ED visits.
• Nearly two thirds of older adults were treated and released (64.2 percent), and nearly one third were admitted to the hospital (32.9 percent).

You can help prevent drug-drug interactions by:

• informing physicians, nurses, and mental health care providers of all medications, supplements, and vitamins you take. 
• Make sure that any medical records are shared with all physicians, including specialists. 
• Use one pharmacy to handle all their prescriptions. 
• Advise your pharmacy of any adverse reactions to prescription or OTC medications.

Caregivers need to be knowledgeable about the potential side effects of both prescription and over-the-counter medications and be aware of any past history of adverse reactions to particular pharmaceuticals and medications.

Boomers Reluctant to Curtail Lifestyle in Retirement

According to U.S. News Money, workers who haven’t saved enough to retire have three choices: work longer, save more, or reduce their standard of living in retirement. 

When workers were given these three choices, most said they would delay retirement and continue to save rather than cut costs, according to a Center for Retirement Research at Boston College study. It covered those who had accumulated at least $50,000 in retirement savings before the downturn and had lost at least 10 percent of retirement assets at the time of the interview.

Over half said they would save more and work longer to recoup their losses. Just over a quarter said they will only work longer and 16 percent plan to exclusively ramp up their retirement savings. Only five percent of the survey respondents said they would learn to get by with less.

Previous research from Boston College found that many households actually increase their spending on the verge of retirement, especially after their children leave home. Per-person spending increases by an average of 51 percent in the years after the children move out.

Most baby boomers aren’t planning to cut costs in retirement. Only 15 percent of baby boomers turning 65 in 2011 plan to downsize to a smaller home in retirement, according to a recent AARP survey.

Where do you see yourself? I think some of us boomers are delusional!

Mediation Growing as a Field as Siblings Argue Over Parents' Care

As aging parents live longer, there are more issues that require the involvement of other family members—and more opportunities for dissension. 

A new web site, www.mediate.com explains the growing field of elder mediation, offers articles on the subject, and has a directory to find mediators around the country. 

Elder mediators have special training to help stressed out families come to consensus on topics like a parent’s independence, safety, living arrangements, or medical decisions. There is also advice to help with sibling conflicts and communication skills.

Alzheimer's Often Misdiagnosed

Alzheimer's disease may not be as prevalent as commonly believed. New research indicates that Alzheimer's diagnoses often may be wrong.

In a research study, only about half of 211 study subjects diagnosed with Alzheimer's while alive were found during autopsies to have brain conditions commonly association with the disease. While they did not have amyloid plaques and neurofibrillary tangles, most of the unconfirmed Alzheimer's patients had other brain abnormalities, such as sclerosis and generalized brain atrophy.

“Larger studies are needed to confirm these findings and provide insight as to how we may more accurately diagnose and prevent Alzheimer's disease and other principal dementing disease processes in the elderly,” said researcher Lon White, MD, MPH, of the Kuakini Medical System in Honolulu. 

Given that the patients still had some sort of brain abnormality I wonder if the aggressive treatment for Alzheimer's actually helped them in the end anyway. Or did it harm their quality of life?

Plan for the Unexpected - Have a Flexible Retirement Plan

The Met Life Mature Market Institute and the Scripps Gerontology Center recently published a report, Best Case Strategies for a Flexible Retirement.

This study examined retirement-related thinking, experiences, and behaviors in the face of the unexpected, combining two methods: 50 in-depth interviews with individuals and couples (approximately half recently retired and half nearing retirement) and a national survey of 1,007 individuals ages 50 to 70 (both retired and pre-retired). 

Personal retirement expectations vary from individual to individual, and retirement planning is generally built on those individual expectations. However, it is not generally built on the unexpected. The study reveals that the capacity to withstand the unexpected is dependent upon the capacity of individuals to imagine, anticipate, and prepare for circumstances that are sometimes well beyond their control. 

Key Findings - quoting from the study....
 

Retirement timing is not a simple equation of the “lure” of retirement vs. the “pull” of work. There are multiple ways and complex influences through which retirement timing can be thrown “off schedule." 

Declining or stagnant income or loss of job. Loss or erosion of pension. Catastrophic illness or disability. Loss of health insurance, or escalation of health care costs. Death of a spouse. Caregiving demands.

Only two in ten individuals report that they are “very confident” that they will have enough money to live comfortably if they or their spouses/partners live to 85+ years of age, and another six in ten (58%) are only somewhat confident. 

Confidence in retirement security is most strongly related to the presence or sufficiency of a guaranteed stream of income (68%) and adequacy of savings (51%). Alarms about retirement risks do not inevitably or immediately prompt retirement planning. Several styles of thinking about the future suggest that people are not easily awakened to retirement risks. Paradoxically, alarms may produce inaction rather than action. The study characterized people as follows:

• Snoozers, who don’t think about future risks at all.
• Active Resisters, who “choose to snooze,” or choose to ignore information about future risks.
• Immobilized Worriers, who understand future risks but whose worry prevents them from acting.
• Oversleepers, who are late in their thinking and planning, and may regard their decision or action windows as “come and gone.”
• Wood Knockers, who think about the unexpected but rely on hope; they choose optimism. Somehow, things will “work out.”
• Plan B-ers, who hold on to a contingency plan, or the loose idea of one, as a protection against trouble ahead. A Plan B may be a “plan” in name only.
• Realists, who use the lessons of past experience to think about the future.
• Stewers and Brewers, who take a while to make decisions.
• Compromisers, who think about both today and tomorrow and balance their current needs against future risks.
• Preemptive Planners, who strive to preempt future risks, or at least their consequences.

Thinkers about the unexpected may not necessarily fall neatly into one of the above types or another, and if they do, they may not stay there. Each individual may have pieces of one type or another, or change from one time to another. 

Tenuous health care coverage, long-term care costs, eroding defined-benefit pensions, the vagaries of the stock market - these are on the minds of potential retirees.

So where do you fit?

According to the researchers, there is no single road to retirement security. There are too many variables to suggest a universal package, yet even a simple contingency plan framework can be very helpful.

Eat Drink and Be Merry - Scientists Said So!

Leave it to German researchers to conduct a study where they found that elderly adults who consume about two alcoholic beverages per day are at a significantly lower risk of developing Alzheimer's disease and dementia than non-drinkers.


Researchers said that study subjects were 30% less likely to develop dementia, and 40% less likely to develop Alzheimer's disease. 

The study sampled 3,200 German seniors aged 75 and older. At the start of the study, none of the participants had dementia. Over the course of three years, participants were occasionally interviewed about their drinking habits and evaluated for signs of dementia. During that time, 217 participants were diagnosed with some form of dementia.

Researchers surmised that older men and women who drink alcohol sensibly in old age also have a healthier lifestyle in terms of physical, dietary, and mental perspectives. The study was published in the journal Age and Aging. 

So is it really the drinking or the fact that responsible adults take better care of themselves.

I'm going with the drinking!!!!

Alzheimers Onset Less in Bilingual

Bilingual individuals who have been able to speak more than one language for several years are able to delay the onset of Alzheimer's symptoms four or five years longer than those who speak just one language, Canadian researchers have found.

Scientists studied 450 Alzheimer's patients. Half of the participants had been able to speak two languages for most of their lives, while the other half were strictly monolingual. The investigators found that the bilingual group reported symptoms and were diagnosed four or five years later than the monolingual participants.

Although more studies are needed researchers concluded that exercising the brain, whether it be through crossword puzzles or learning new languages, helps to keep the brain nimble.

And normally I would agree with that because it makes sense with everything I have read over time. Yet creeping into the literature are studies that suggest brain stimulation does not delay or prevent the onset of Alzheimer's. Whether or not any of this works remains to be seen. It would seem to me that stimulating your brain, whatever the means, can only be a good thing.

Third of Home Care Staff Make Medication Errors - What You Can Do

A Northwestern University study has shown that more than one-third of paid home care staff had difficulty reading and understanding health-related information and directions. Sixty percent made errors when sorting medications into pillboxes.

Nearly 100 paid, non-family caregivers were recruited in the Chicago area and their health literacy levels and the health-related responsibilities were assessed, said Lee Lindquist, MD, assistant professor of geriatrics at Northwestern University Feinberg School of Medicine and physician at Northwestern Memorial Hospital.

Nearly 86 percent of the caregivers performed health-related tasks. Most were women, about 50 years old, foreign born or with limited education. Many made under minimum wage.

Despite pay, country of birth, or education level, 60 percent of all the caregivers made errors when doling medication into a pillbox.

Lindquist said. "If you really want to know if the caregiver is doing a good job and is taking care of the health needs of your senior, start by going into the home, observing them doing the tasks, and asking more questions."

When evaluating a care provider ask if:

• they provide training for staff at orientation on medication management.
• they provide ongoing training to staff as medications change, come and go.
• use a licensed pharmacist on a consulting basis.
• they equip staff with smart-phone apps that staff can download that can help with medication identification and management.

“Most physicians and family members do not realize that while the caregiver is nodding and saying ‘yes,' she might not really understand what is being said," he said.

Women Caregivers and Savings

The Women's Institute for a Secure Retirement has some good tips about saving throughout the stages of your life. Here's a snapshot but do check out their site for more. And consultant with your tax and accounting professional before making any moves.

Saving in your 60’s, 70’s and beyond:

• continue to invest your retirement assets, living off a small percentage each year, and consider annuitizing all or a portion of your retirement assets, or a little bit of both.

Saving in your 40’s and 50’s:

• use a retirement calculator to see how much you should be saving at this point in order to meet your future retirement goals. 
• don’t be afraid to ask for help from a financial planning professional if you feel you have fallen off course or need help getting more organized.
• caregiving can have serious financial consequences. It is important, especially for women who tend to take the majority of caregiving responsibilities, to understand the consequences and to take steps to protect their retirement security. 

Saving in your 20’s and 30’s: 

• the savings habits you develop in your 20’s and 30’s can set a precedent for how you will save throughout your life. Get into the habit of saving now.
• start by depositing about five percent of your salary into a savings account each pay period. 
• start an emergency savings fund in your 20’s and 30’s. You should have about three to six months’ pay saved up in case you run into financial surprises – a job loss or expensive car repairs, for example.
• sign up for your company’s 401(k) plan if they have one, and contribute at least enough to get the full match if offered.

Alzheimer's Plaques Might Begin in the Liver

The brain “plaques” commonly associated with Alzheimer's disease might actually originate in the liver, according to scientists at Scripps Research Institute in a study published in The Journal of Neuroscience Research.

Researchers evaluated the effect of three different genes on the presence of amyloid-beta plaques in the brain. Lower gene activity in the liver coincided with lower prevalence of that gene in the brain and therefore with greater protection of the brain. One of those genes, called Presenilin2, is similar in both mice and humans. It is associated with increased production of amyloid-beta plaques in the liver, as well as early-onset Alzheimer's disease in humans.

Using a drug that prevents amyloid plaques created in the liver from entering the brain through the bloodstream, researchers were able to dramatically reduce the levels of amyloid-beta plaques in the brains of healthy mice. Scientists speculate that humans may have a similar response to this method of treatment.

I am certainly not a scientist but I would imagine that the mice had pristine livers to start. In other words the mice were not on any other medications from researchers and were clean and sober! Obviously I am referring to the effects of drinking on the liver. So I wonder whether those factors affect the suppression or production of those plaques.

Emeritus Senior Living has partnered with Life Care Funding Group LLC

Emeritus Senior Living has partnered with Life Care Funding Group LLC to educate seniors about the financing options available for covering long-term care, including assisted living.

Emeritus, one of the largest assisted living chains, entered the alliance to raise awareness of the Assurance Benefit offered by Life Care Funding, Portland, Me. The Assurance Benefit converts the death benefit of an active life insurance policy into a long-term care benefit to help pay for long-term care services. 

Said Jayne Sallerson, executive vice president of sales and marketing at Emeritus: "Many seniors and families are unaware that their life insurance policies are valuable assets and can be used in this way. And as a result some let active policies lapse.

Frankly this is a policy I was unaware of and we will look to blog further about this in the future. Do your homework as well. Ask your insurance, tax and legal professionals about this.

Cost of Assisted Living May Be Tax Deductible

The cost of assisted living may be deductible on Federal income tax returns. The IRS has certain guidelines to determine eligibility. The cost of housing and meals and certain personal care services may be deductible; the determining factor is generally the inability to perform at least two activities of daily living without assistance. These daily functions include such activities as eating, toileting, transferring, medication assistance, dressing, and bathing. A physician must certify in writing that the patient has been unable to perform these activities for at least 90 days.

If you are paying for a resident to be in an assisted living care facility for the reasons above, you may be eligible for a deduction on your itemized tax return. The resident must qualify by criteria and must be related to the payer or have lived as a member of their household for an entire year. A parent must also be a citizen or resident of the United States, Mexico or Canada, and the child must have paid over 50% of their support for the year.

The deduction may also be taken in the case of certain cognitive diseases such as Alzheimer's disease or Dementia related diagnosis. Although many residents may not qualify under the "inability to perform to basic life activities" rule, they often require a substantial amount of care, oversight and guidance in order to insure their safety.

Tax deductions for this care help to offset the cost and the financial burden on both the residents and family members responsible for their care.

Consult with your tax professional to determine your eligibility for this deduction.