Residents Rights Month October

Each year, the Consumer Voice develops a packet to help plan Residents' Rights events during October. This year's packet's include tips on building community involvement in long-term care facilities, tips for visiting residents and information about residents' rights to visitation and access.

Get the packet!

1/3 Women Living with Chronic Health Conditions

According to the Kaiser Family Foundation, more than one-third of women report that they live with a chronic health condition that requires ongoing medical attention. One fourth (29 percent) of women ages 50 to 64 report fair or poor health.

What is scary is that even among younger women, chronic conditions are prevalent. And that certainly has an impact on later life.

• One in 10 women (18 to 44 years) say they have been diagnosed with arthritis (9 percent), hypertension (11 percent), or high cholesterol (9 percent).
   
• By the time women reach their middle years (45 to 64 years), those rates tripled to 39 percent, 36 percent, and 34 percent respectively.
   
• Most women (83 percent) report that they have at least one healthcare provider that they see on a regular basis.
   
• This increases with age--from 77 percent of women ages 18 to 44 to 90 percent of women 45 to 64.

Two things:

1. It is never too late to start taking care of yourself.
   
2. You must set a good example for your daughters and granddaughters so they develop healthy habits early in life.

Having Purpose Adds Years to Your Life

Rush University studied 950 people with a mean age of 80 and found that people with a sense of purpose in life are 57% less likely to die over a five-year period than those who lack it. They also have a better chance of being mobile and able to accomplish daily tasks. 

This study is part of a field called happiness research or “positive psychology,” which is exploring the connection between living with a sense of purpose and aging well.

In my keynote, The Meaning of Life I cite purpose as a contributor to a quality life and further note that purposeful people are also more disciplined and research also suggests that self-disciplined, highly organized people are less susceptible to Alzheimer's Disease.

 

Extra Pounds at Midlife May Boost Dementia Risk Later

According to Health Day News, being overweight during middle age may increase your risk of developing dementia. Swedish researchers suggest that being overweight at midlife increases the risk of dementia in late life by more than 70 percent.

Why the link? A higher BMI is linked with diabetes and vascular disease, which is in turn related to the risk of dementia. Higher weight at midlife may reflect a long period of exposure to higher inflammation throughout the body, which has been linked with lower cognitive function. There is also evidence that fatty tissue secretes inflammatory cytokines and other chemicals inflicting damage to the neurons.

Decreased Ability to Anticipate Distances Increases Fall Risk Among Elderly

Texas A&M Research reveals that injuries from falls and other accidents among the aging can often be attributed to a decline in ability to mentally estimate and anticipate stepping and reaching distances.

Professor Carl Gabbard, director of the Texas A&M Motor Development Laboratory, focused on “estimation of reachability” — whether an object is within or out of reach.

Gabbard explains that before actions are performed the mind simulates the action ahead of time and gives an estimate of the possible outcomes or consequences. You can easily relate that to visualizing a golf shot for example.

In older people, the ability to estimate their capabilities declines. Mostly they overestimate. Activities such as imagery interventions and training specifically targeted at improving cognitive ability can be designed to help train elderly people to cope with this decline in their motor imagery ability, he concluded.

Depression and Diabetes Linked

Depressed diabetics are more likely to see improvement in their physical symptoms if they pursue treatment for their depression, that according to researchers at the University of Michigan.

Depression causes those with diabetes to be less compliant monitoring their blood sugar levels or following a diabetic diet. They are also less likely to exercise. 

Researchers followed 291 patients with diabetes and significant depressive symptoms. Of those, 145 received 12 weeks of cognitive behavior therapy over the phone, followed by nine “booster” sessions once a month. These patients began a phased-in walking program, using a pedometer to gauge their success. The group undergoing the phone counseling and walking therapy successfully lowered their blood pressure, increased their physical activity and saw an improvement with their depressive symptoms.

What is not addressed is whether the diabetes is the primary cause of their depression and ironically, the fitness program introduced for this study probably would have benefited these people and perhaps kept them from having diabetes in the first place. 

Lesson - take care of yourself physically to ward off disease and to keep a great attitude about life.

Cognitive Risk Declines with Activity

According to research conducted at Rush University Medical Center, frequent social activity may help to prevent or delay cognitive decline in old age.

In a continuing study, 1,138 older adults with a mean age of 80 underwent yearly evaluations that included a medical history and neuropsychological tests. Social activity was measured based on a questionnaire that asked participants whether, and how often, in the previous year they had engaged in activities that involved social interaction. 

At the start all participants were free of any signs of cognitive impairment. Over an average of five years, however, those who were more socially active showed reduced rates of cognitive decline. On average, those who had the highest levels of social activity (the 90th percentile) experienced only one quarter of the rate of cognitive decline experienced by the least socially active individuals. 

Researchers said it is unclear why social activity plays a role in the development of cognitive problems. One possibility is that “social activity challenges older adults to participate in complex interpersonal exchanges. They said that future research is needed to determine whether interventions aimed at increasing late-life social activity can play a part in delaying or preventing cognitive decline.

Of course I am not a scientist but in my work with elders, I have observed is that people who remain socially active have a better quality of life. This is not the first Rush study on the subject.

• Rush University and Duke University conducted a study that showed people with broad social networks did not manifest Alzheimer's even though after death autopsy revealed they had the tangles and plaques associated with the disease.
   
• The American Journal of Psychiatric Health conducted a study that showed that social support helps protect against dementia.
   
• The Journal of Pain conducted a study that showed social support reduces pain and depression.   

The ironic part is that we are spending less time with each other because of the Internet. Lesson learned.

Homebound Seniors More Likely To Get Alzheimer's

@Joanne Green, Getty Images

Housebound seniors are twice as likely to develop Alzheimer's disease as more active individuals.

Investigators at Rush University Medical Center in Chicago followed 1,294 seniors from two separate studies. None of the study subjects exhibited dementia symptoms at the beginning of either study. 

During an average of 4.4 years, 180 participants developed Alzheimer's. Of this group, patients who self-reported that they never left their home environments during an average week were two times as likely to develop Alzheimer's than those who periodically traveled out of town.

Those homebound that are physically and perhaps mentally not able to go outside are in a bind. Home care is not a substitute for what I think researchers are hinting at - socialization. I think in these cases it is about how the community rallies around home-bound elderly. 

For those that can but choose not to go out, I would think that adult day care, medical or otherwise, would be an ideal solution. But many are reluctant to try. And that is where families need to become educated about choices for mom and dad and reduce their own fear and anxiety about having a loved one try them out.

2011 Cost of Long-Term Care Study Releases Findings

John Hancock Financial (John Hancock) recently announced the results of its 2011 cost of care study, which found that long-term care (LTC) costs have continued to increase, but not as much as other goods and services.

@Paul Burns, Getty Images

The study surveyed more than 11,000 providers, including nursing homes, assisted living facilities, and home health care agencies, in key cities across the country. 

Its findings revealed that:

• the national average annual cost of care in the U.S. is $85,775 for a private room in a nursing home
  
• $75,555 for a semi-private room in a nursing home
  
• $39,240 for an assisted living facility
  
• The average cost of care received at home was approximately $20 per hour.

• The 2011 average cost of a private nursing home room ($235 a day/ $85,775 annually) has risen an average 3.5 percent per year.

• The 2011 average cost of a semi-private nursing home room ($207 a day/ $75,555 annually) has risen an average 3.2 percent per year.
  
• The 2011 average cost for a month in an assisted living facility ($3,270 a month/ $39,240 annually) has risen an average 3.4 percent per year.
  
• The 2011 average cost for a home health aide ($20 hourly/$37,440 annually) has risen an average 1.3 percent per year.

Hey folks. It ain't cheap and as I have been harping on you, paying for it will ultimately be your responsibility. Start researching long-term care insurance options as well as a little know Assurance Benefit that can convert your life insurance into a long-term benefit. Look for a detailed blog on that in the future.

7 Fold > in 100+ Projected

Turning 100 isn't such a big deal anymore. That according to a recent Associated Press article. America's population of centenarians has roughly doubled in the past 20 years to around 72,000 and is projected to at least double again by 2020, perhaps even increase seven-fold, according to the Census Bureau.

The Census Bureau estimates there were 71,991 centenarians as of Dec. 1, up from 37,306 two decades earlier. Experts attribute the rise in 100-year-olds to better medical care and the dramatic drop in childhood-mortality rates since the early 1900s. They also have good genes on their side and have made common-sense health decisions, such as not smoking and keeping their weight down. Get the lesson? 

Irregular Activity / Sex Can Be Dangerous - Consistency is Key

Being a couch potato six days of the week and deciding to ride a bike, work in the yard, go hiking, and/or have sex on day seven - well it could kill you. A recent USA Today article looked at how bouts of exercise and sex may be riskier to your heart if you're inactive.

The Journal of the American Medical Association examined 14 previous heart studies that suggested irregular physical activity can be a trigger for a heart attack or unexpected death, and infrequent episodes of sexual activity increases risk for just heart attacks.  

About 1 million heart attacks and 300,000 cardiac arrests occur in the USA a year.

Researchers found a 3.5 times increased risk of heart attack from episodic physical activity, and sex was associated with a 2.7 times greater risk. They compared the results akin to an older person who does very little exercise, then snow falls and they're out shoveling.  

Cardiologists say that inactive people tend to also have other risk factors for heart disease, such as smoking and obesity. The message isn't to stop exercising or having sex. It is really about getting physical activity on a routine basis so you don't shock your body when you decide to be active out of the blue.

National Health and Aging Trends Study Will Offer Holistic Ongoing Monitoring of Senior Trends

The National Health and Aging Trends Study (NHATS) is a new resource for the scientific study of functioning in later life. The NHATS is being conducted by the Johns Hopkins University Bloomberg School of Public Health, with data collection by Westat, and support from the National Institute on Aging. 

NHATS is intended to foster research that will guide efforts to reduce disability, maximize health and independent functioning, and enhance quality of life at older ages.

The NHATS will gather information on a nationally representative sample of Medicare beneficiaries ages 65 and older. In-person interviews will be used to collect detailed information on activities of daily life, living arrangements, economic status and well-being, aspects of early life, and quality of life. 

Among the specific content areas included are: 

• the general and technological environment of the home
• health conditions
• work status and participation in valued activities
• mobility and use of assistive devices
• cognitive functioning
• help provided with daily activities (self-care, household, and medical).  

Study participants will be re-interviewed every year in order to compile a record of change over time. As the population ages, NHATS will provide the basis for understanding trends in late-life functioning, how these differ for various population subgroups, and the economic and social consequences of aging and disability for individuals, families, and society.

What impresses me about this study is that it is really holistic in its approach. It is about health in its broadest sense with the overarching goal of tracking quality of life. 

More here.

Healthy Older Drivers Make Mistakes Too

According to an article in MSNBC from My Health News Daily, a new study suggests that aging is associated with an increase in crucial driving mistakes, even among healthy people with safe driving records.

The oldest people, between ages 85 and 89, made four times as many critical errors in a driving test than the youngest people ages 70 and 74.

Those mistakes included:

• veering
• failing to check blind spots
• speeding
• tailgating
• sudden braking without cause

None of the volunteers had any signs of dementia, all lived independently and drove at least once a week. They were taken out for a 12-mile drive. A professional driving instructor and an occupational therapist rode along.

Men and women made the same number of mistakes in the study. The most common mistake were:

• failing to check blind spots
• veering across lanes of traffic
• failing to use turn signals

Older drivers made up 7.5 percent of fatal car crashes and 3.1 percent of all car accidents in the United States in 2008. The CDC has some tips for older drivers:

• Review medications with your doctor or pharmacist to make sure there are no side effects that can impair your driving ability.
• Get your eyes checked at least once a year, and always wear glasses or contacts while driving, if needed.
• Plan your driving route before you start driving.
• Don't tailgate; leave a large distance between you and the car in front of you.
• Avoid distractions such as cellphones, loud radios and eating.
• Consider public transportation if you don't feel safe driving.

COPD Drugs Could Cause Urinary Problems

A specific class of drugs used to treat chronic obstructive pulmonary disease (COPD) may result in urinary problems for patients.

The medications are in a drug class called inhaled anticholinergics. That includes:

• Spiriva (tiotropium)
• Atrovent (ipratropium bromide)
• Combivent (ipratropium combined with albuterol).

Canadian researchers analyzed the medical records of 565,000 COPD patients aged 66 and older. Of these patients, 9,432 men and 1,806 women developed an inability to pass urine. The odds of developing the urinary condition were about 40% higher in men for those who'd been using the drugs for four weeks or less. They were 80% higher among those with enlarged prostate glands.

Researchers concluded that "Physicians should highlight for patients the possible connection between urinary symptoms and inhaled respiratory medication use to ensure that changes in urinary flow are reported to the physician," the authors wrote.

Check with your doctor.

Source: McKnights

Vitamin D May Prevent Macular Degeneration

Women might be able to prevent macular degeneration by consuming a diet with high levels of Vitamin D.

Macular degeneration, a progressive eye disease that can take away one's vision, affects one in 10 Americans over the age of 40. Research from investigators at New York University's Lagone Medical Center found Vitamin D can delay onset of the disease, perhaps because of the vitamin's anti-inflammatory effect. Women have higher rates of developing macular degeneration, which some scientists believe is tied to estrogen loss.

Vitamin D can be found in natural sunlight, leafy vegetables and fish, as well as vitamin supplements. Researchers found women under 75 who had high levels of Vitamin D in their blood were less likely to develop macular degeneration later in life. 

Source: McKnight's

New Alzheimer's Biomarkers Could Detect Alzheimer's Sooner and Lead to Therapies

New guidelines released by the Alzheimer's Association and the National Institutes of Health and the National Institute of Aging identify new diagnostic criteria and new biomarkers for Alzheimer's disease.

The guidelines identify previously unrecognized phases of the disease. The three new phases refer to the disease's progression, starting before well-known symptoms such as memory loss appear. 

• In “preclinical Alzheimer's disease,” scans of the brain and measurement of spinal fluid changes can provide clues to any physical deterioration.
   
• In “mild cognitive impairment due to Alzheimer's disease,” family members and physicians might recognize mild memory and cognitive problems, which are measurable but don't greatly impact day-to-day functioning.
   
• In the third phase, “dementia due to Alzheimer's disease,” memory, thinking and behavioral deficiencies become clear.

Focus Group Participants for Caregivers of those with Brain Disorders Needed

The Society for Neuroscience has recently announced it will build a new brain information website, BrainFacts.org. This public information initiative of The Kavli Foundation, The Gatsby Charitable Foundation, and the Society for Neuroscience (SfN) will launch in spring 2012.

This website will provide a wealth of information, including facts about brain diseases and disorders, brain research, and strategies to promote brain health and wellness. 

SfN is in the crucial research phase for the site and is reaching out to those affected by brain and nervous system diseases and disorders. Specifically they are looking for participants for in-person focus groups in Washington (June 16), Chicago (June 21), and Los Angeles (June 23). The focus groups will be 1.5 hours long and a stipend is paid.
 

Family members, friends, and caregivers are the target audiences not the patients or persons affected. 

If you are interested in participating please complete a short qualifying survey found here.

Medical Errors Hospitalizing Seniors Most

According to data from the Agency for Healthcare Research and Quality, the number of patients treated in a hospital after a bad reaction to medication grew 52% between 2004 and 2008. More than half of the errors involved seniors over the age of 65.

• Taking or being given the wrong medication or dosage was the main culprit.
  
• The top five categories of medicines causing injury or illness were:
  • corticosteroids (283,700 cases)
  • painkillers (269,400)
  • blood-thinners (218,800)
  • drugs to treat cancer and immune system disorders (234,300)
  • and heart and blood pressure medicines (191,300).

The AHRQ, a division of the U.S. Department of Health and Human Services, also provided data on patients treated in an emergency department. Out of the 838,000 people, the majority involve unspecified medicines (261,600), painkillers (118,100), antibiotics (95,100), tranquilizers and antidepressants (79,300), and corticosteroids and other hormones (71,400). 

Do yourself a favor. There are a myriad of resources to help you properly manage your medications. From simple pill boxes to iphone apps, you can help yourself or a loved one avoid being one of the above statistics. 

Botox May Dampen Emotions

@ballyscanlon, Getty Images

A recent article in Forbes cited a study in the journal Social Psychology and Personality Science that found that Botox may not only numb facial muscles, but also numb users perceptions of other people's emotions.

Researchers concluded that “if muscular signals from the face to the brain are dampened, you’re less able to read emotions." Researchers compared the effects of Botox with a gel that amplifies facial signals.  They found that when the facial muscles are dampened, you get worse in emotion perception, and when when facial muscles are amplified, you get better at emotion perception.

Logic to me would seem to indicate that if your face is numb and therefore somewhat emotionless it would be hard for others to read your emotions. Seems that research is indicating the opposite.

The real test would seem to be whether facial expressions and the sensory feedback from them can influence emotions.

And what do you think of the San Francisco mother who injected her beauty pageant daughter with Botox? Seems Botox or not the mother has no emotions whatsoever.

For my money anything you have to inject yourself with to promote so called beauty runs the risk of side effects, whether losing emotional potential or looking like Burt Reynolds.

Caregiver Depression Two Times National Average

@Digital Vision, Getty Images

Caring.com recently released the results of a new study, in which 86 percent of caregivers said that caregiving impacted their work situation because they had to take time away from their jobs, quit, retire early, reduce hours, or take a leave of absence.

• Twenty-five percent of respondents stated that they suffer from depression, well above the national figure of 9 percent cited in a 2010 study by the U.S. Centers for Disease Control and Prevention.
  
• Caregivers are turning to their churches, synagogues, mosques, or other religious organizations (31 percent) for support.
  
• Family caregivers are also seeking support online (25 percent) via discussion forums, chat rooms, and through social networks such as Facebook.
  
• A third (32 percent) of family caregivers spend more than 30 hours per week on caregiving tasks.
   
• Seventy-seven percent of caregivers are concerned about the impact of their caregiving on their savings.
   
• The majority of family caregivers suffer from their own health issues, including high blood pressure (35 percent), arthritis (30 percent), and high cholesterol (28 percent).
   
• Over half (53 percent) of respondents report having trouble falling or staying asleep due to stress.

We have blogged about this often. Caregivers need help. And caregivers also have to recognize that they need help. 

Patients with DNR Orders May Face Poorer Outcomes

In a new study appearing in the Archives of Surgery, those with do not resuscitate orders (DNR) were at least two times more likely to die soon after surgery. Researchers compared clinical information for 4,128 adults with DNR orders with a group of 4,128 individuals without DNR orders. They were all all age-matched and procedure-matched and had surgery at one of 120 U.S. hospitals between 2005 to 2008.

Nearly one-fourth of the DNR patients died within the month following their surgery. The outcome depended on the type of surgery. For example, about half patients with DNRs having exploratory laparotomies died within a month of the surgery--compared with one in five of the patients without DNRs. However, for surgeries such as thighbone fracture repair or appendectomies, no differences were reported between the two patient groups.

I was grappling with the implications here. What were the researchers trying to say? Do not have a DNR? Do not have surgery? 

Then I read some of the comments to the original article at Reuters. Here are two perspectives.

"DNR is code for “Do Not Bother.” There are plenty of doctors who feel that some patients, especially terminal ones are not worth the bother. Which is why they die more often."

"By signing a DNR may have put the patients in a mindset that “I’m going to die”. Perhaps the ‘fight’ was taken out of them."

What do you think?

Those Hospitalized with an Alcohol Related Condition at Risk

Hospital patients who have alcohol use disorders are more likely to develop healthcare-associated infections (HAIs) during their hospitalizations and face much greater odds of death.

@Digital Vision, Getty Images

Researchers analyzed 2007 data from U.S.inpatients. They performed a retrospective study of all patients who developed healthcare-associated pneumonia or sepsis--excluding those patients transferred from another healthcare facility.

Patients with alcohol disorders were 71 percent more likely to die and stayed at the hospital an average of two days longer, said Marjolein de Wit, associate professor of medicine at Virginia Commonwealth University and first author of the study. 

Patients with healthcare-associated pneumonia or sepsis were younger, had a lower income, had frequent emergencies, and experienced less surgery. Researchers were concerned to see more young people coming to the hospital too late to be treated adequately. Young patients do not typically see a physician unless they have been injured.

To state the obvious, conclusion = stop drinking. Or seek counseling and treatment now before serious medical conditions develop. Most of us know you often come out of a hospital sicker than you went in. So son't increase your chances of a bad outcome because of an alcohol disorder.

Increase in Mentally Ill Seniors Likely

@Thinstock, Getty Images

Researchers at Queen's Medical Center in Honolulu found that mental illnesses will affect 20% of the U.S. population by 2030. Americans are living longer with dementia and psychiatric illnesses that can lead to problematic behavior, such as aggression, delusions and wandering.

The researchers studied emergency room records and noticed an overall increase in visits by elderly people with mental illnesses in recent years. They saw a 30% jump between 2008 and 2009. Elders were often brought to the ED by exhausted family caregivers or nursing home workers who weren't equipped to handle violence and other severe symptoms. Investigators also observed an increase in 911 calls from caregivers.

Experts say more geriatric psychiatrists will be needed in the future to handle these problems.

"We need to have the resources to help this population and help the caregivers of this population who are stuck in the middle," said Dr. Jeffrey Borenstein, M.D., chairman of Council of Communications for the APA, told the Los Angeles Times. 

That is true and we also need more young people wanting to go into medical school and specialize in geriatric medicine. I can tell you firsthand that it benefits our elders. My mom happens to be in a rehab facility currently. It is her second. The first place she went the medical director was a general practitioner. The second place she went the medical director was a geriatric physician. 

He has single handily saved her life through his interventions. Seek out a geriatric physician for your loved one.