CMS Depression Screening

A new Centers for Medicare and Medicaid Services (CMS) proposal would screen more Medicare beneficiaries for depression, according to a recent memo. 

The U.S. Preventive Services Task Force determined that that such screening for depression in adults is “reasonable and necessary for the prevention or early detection of illness or disability, and is appropriate for individuals entitled to benefits under Part A or enrolled under Part B." 

Under the proposal, the screenings would take place in primary care settings, with staff that could help the physician screen results and coordinate referrals to mental health providers.

The task force reports that one in six seniors over the age of 65 suffers from depression. And it is highest in those with comorbidities including cancer, arthritis, stroke, chronic lung disease and cardiovascular disease. No surprise there.

So here's a thought. Would you willingly go to your physician and actually request a depression screening? I don't think so. So will they make it mandatory or will they find a way to couch it as something different in name so that the true purpose of the screening is not totally revealed?

Stay tuned.

Alzheimer's Preventable with Lifestyle Changes

New research suggests that nearly half of worldwide Alzheimer's disease cases can be prevented by making healthy lifestyle changes that are often associated with preventing other chronic health conditions.


Researchers at the San Francisco VA Medical Center concluded that the following contributed to the disease: physical inactivity, depression, smoking, mid-life hypertension, mid-life obesity, low education and diabetes. And that changing these could prevent Alzheimer's.


In analyzing data from other Alzheimer's studies with thousands of participants, lead researcher Deborah Barnes, Ph.D., found that together these risk factors are linked with 54% of Alzheimer's cases in the United States (2.9 million cases) and 51% of cases worldwide (17.2 million cases).


That is pretty compelling evidence. And totally in sync with what we write about here at WMD. These issues overlap but it comes down to one thing - how we take care of ourselves now will affect whether we age with a great quality of life or a low quality of life.


When researchers say that simple lifestyle changes, such as increasing physical activity and quitting smoking could have a tremendous impact on preventing Alzheimer's and other dementias that is worth paying attention. And it is nothing more than what we have advocated here. Educated Aging - Financial, Emotional and Physical Health.

Give Forward - a Social Solution for Out of Pocket Medical Care

Here's a new way to cover out-of-pocket medical expenses with crowdfunding that is worth checking out.

GiveForward is a Chicago startup that provides personalized fundraising web pages to help Americans cover out-of-pocket medical expenses like travel to treatment, medical equipment and co-pays.  

Recent studies show that Americans are struggling to cover even $2,000 in unexpected health care expenses. 

GiveForward gives people personal fundraising pages to raise money for loved one's medical expenses.  They have helped thousands of people raise millions of dollars for things like chemotherapy, organ transplants, travel, and living expenses while undergoing treatment. 

One user raised $24,000 in one day to pay for his friend's cancer treatments.

Since August of 2008 it has helped people raise over $5 million for out-of-pocket medical expenses.

GiveForward was co-founded by two young entrepreneurs, Ethan and Desiree, with the philosophy that too often, people are comfortable with giving gifts of money during times of celebration such as a graduation or wedding but during times of real need, like a critical illness, people are afraid to give financial help. GiveForward’s focus is to turn this perceived negative situation into an opportunity for the community to come together in support of a loved one. The simple fundraising page makes it easy for friends and family, no matter how far away, to contribute in a meaningful way by sending love and financial support.

Boomers - The Fattest Generation

According to an Associated Press-LifeGoesStrong.com poll, boomers are more obese than other generations and even those who aren't obese need to do more to stay fit.

Most adults are supposed to get 2½ hours a week of moderate-intensity aerobic activity. Only about a quarter of boomers polled report working up a sweat four or five times a week. And 37 percent never do any strength training.

Based on calculation of body mass index from self-reported height and weight, roughly a third of the baby boomers polled are obese, compared with about a quarter of both older and younger responders. Only half of the obese boomers say they are regularly exercising. An additional 36 percent of boomers are overweight, though not obese.

• Nearly half of boomers polled worry most about cancer.
• Heart disease is third in line on the boomers' worry list. 
• Memory loss is a bigger concern.

You may want to read our recent post, Living In Denial. We talk about a White Paper by Catalyst Healthcare Research - LIVING IN DENIAL - that is absolutely eye-opening in its revelations. There has been a huge push on wellness programs, particularly in the workplace. Yet often times the people who use them are the same health-conscious people who really don't need them as much as others.

What this research reveals is that most overweight Americans avoid the truth about their health. The majority agree that obesity is the number one threat to public health. Yet most adults who are overweight or obese – even the well-educated – say their health is excellent or good.

We need more than a wake-up call. We need a good slap in the face.

More on Caregiving Costs and Toll

The AARP Public Policy Institute has released a new paper updating the national and state estimates of the economic value of family caregiving.  

• In 2009, about 42.1 million family caregivers in the U.S. provided care at any given point in time.
• 61.6 million provided care at some time during the year.
• The estimated economic value of their unpaid contributions was approximately $450 billion in 2009, up from an estimated $375 billion in 2007. 

The report also explains the contributions  of family caregivers, details the costs and consequences of providing family care, and provides policy recommendations to better support caregiving families.

In related news, a new Gallup poll shines light on the vast amount of time family caregivers spend each month caring for a loved one.

• Researchers surveyed 2,805 adults, aged 18 and older, who self-identified as caregivers and were working at least 15 hours per week. 
• Most respondents reported caring for someone 75 or older, and 72 percent of these caregivers were providing care for a parent. 
• A majority of these caregivers did not live with the person to whom they provided care, but 66% of individuals not living with the person they cared for lived within 10 miles.
• Caregiving is generally a long-term commitment and is often a major time commitment, with more than 19 days per month devoted to providing care. 
• Thirteen of these days were spent with tasks such as shopping, food preparation, housekeeping, laundry, transportation, and taking medicine.
• Six of these days were spent assisting with personal tasks such as toilet visits, eating, dressing, grooming, and bathing. 
• Caregivers also spent 13 hours per month coordinating physician visits, managing financial matters, and researching care services for their loved one and an average of 5 hours per day in which they provide care devoted to companionship.

Living in Denial

A White Paper by Catalyst Healthcare Research - LIVING IN DENIAL - is absolutely eye-opening in its revelations. There has been a huge push on wellness programs, particularly in the workplace. Yet often times the people who use them are the same health-conscious people who really don't need them as much as others.

What this research reveals is that most overweight Americans avoid the truth about their health. The majority agree that obesity is the number one threat to public health. Yet most adults who are overweight or obese – even the well-educated – say their health is excellent or good.

A recent McKinsey Quarterly report estimated the annual cost of obesity in the United States at $450 billion. That includes $160 billion in medical costs plus such items as absenteeism and decreased productivity on the job and the cost to individuals of extra food.

“Some epidemiologists believe that excess weight will soon rival tobacco as the world’s leading cause of preventable premature deaths,” McKinsey said. “The obesity pandemic’s health effects may wipe out the gains in life expectancy achieved through decreasing smoking rates.”

Sixty percent (60%) of those questioned in the Catalyst Healthcare Research study were overweight or obese as measured by their Body Mass Index. That percentage is similar to the U.S. adult population at large. 

Of those considered to be obese or overweight, 11 percent of those who responded to the survey considered themselves to be in “excellent health,” and an additional 61 percent said they were in “good health.” It is perhaps not surprising that the overall prevalence of exercise in this group is relatively low.

Obese or overweight people don’t fully appreciate that their own health is in danger.

As the study concludes - It's Time to Look in the Mirror."

Blood Pressure Drugs Safe in Older Adults

@Dale Wilson, Getty Images

Because hpertension in older adults is more difficult to treat, physicians often are hesitant to prescribe blood pressure-lowering medications in adults over 80.

The American College of Cardiology and the American Heart Association have released new recommendations regarding which medications are safest and most effective for older adults, as well as guidance in identifying other non-drug treatments.

Research has found that blood pressure drugs are safer in this age group than previously thought.

According to the guidelines, appropriate blood pressure drugs in very elderly adults are ACE inhibitors, beta-blockers, angiotensin receptor blockers, diuretics and calcium channel blockers. Doctors prescribing antihypertensive drugs for this age group should be sure to start at the lowest dose possible, experts say.

Check with your physician.

New Guide For Male Caregivers Available

A new book, Who Says Men Don't Care? is written specifically for four generations of male caregivers. The premise of the Guide is that men care differently than women, and these differences present both opportunities and potential problems in all male caregiving situations. Knowing better who you are can make you a healthier and more balanced caregiver.

A step by step approach to strengthening areas that need attention while acknowledging, encouraging and celebrating those areas of successful care giving is enhanced with helpful checklists that assist with analysis of care management. While exposing and debunking myths and stereotypes about male caregivers, it gives an important examination of generational attributes that impact upon care giving.

A "typical" male caregiver

• Is between the ages of 30 and 80 years old
• Represents every race, culture, economic class, and sexual preference in the US
• Is married, living with a partner, or cares for a child or relative
• Provides care to someone fifty or older or 15 years and younger
• Feels unappreciated and isolated
• Manages a variety of medications
• Hasn't recently taken a vacation and spends little time on leisure activities
• Manages caregiving while working full or part time
• Doesn't or can't afford outside help
• Has an income between $20,000 and $50,000 a year
• Spends approximately $6,200 a year out of pocket for the person he is caring for
• Provides an average of 25 hours a week caregiving (many spend more time)
• Costs industry billions in lost productivity because of lost time
• Saves this country billions of dollars in government tax supported services

Smoke? Overweight? High BP? You Are More Likely to Have Cognitive Impairment Later in Life

@Nisian Hughe, Getty Images

Those who smoke, are overweight, or have high blood pressure are more likely to have cognitive challenges later in life say researchers from the University of California at Davis.

Examining MRI scans of approximately 1,352 people researchers found that:

• people with diabetes in mid-life lost brain volume faster in the hippocampus
• participants who smoked in mid-life lost their overall brain volume faster than non-smokers
• obese participants and those with hypertension were more likely to do badly on tests involving executive functioning or planning

Study author Charles DeCarli, M.D., said: “Our findings provide evidence that identifying these risk factors early in people of middle age could be useful in screening people for at-risk dementia and encouraging people to make changes to their lifestyle before it's too late.

A Catalyst Healthcare Research study, Living in Denial, would suggest that people may not or will not make the necessary changes in their lifestyle. In the white paper, survey responders admitted to being overweight and even obese yet described their health as good to excellent. That is alarming. They do not see themselves in the equation as needing help.

So typically those who have always been health conscious and in shape will respond to wellness programs and the like embracing it as an extension of what they already are doing. And the couch potatoes will just observe from the sidelines.

Which are you? 

Guide to Hospice Available to Caregivers

The National Hospice and Palliative Care Organization has created several new resources, including a worksheet that individuals and family caregivers can use to decide which hospice to use.   The worksheet encourages people to call hospices and ask questions regarding the type of services that are important to them as a means of selecting the hospice that meets their needs.

Here is an overview of what to ask. (We have deliberately left many questions out so that you can find more by downloading the worksheet yourself.)

• Is the Hospice Medicare Certified?
• Has the hospice been surveyed by a state or federal oversight agency in the last five years?Is the hospice accredited by a national organization?
• Does the hospice conduct a family evaluation survey?
• Are clinical staff (physicians, nurses, social workers) certified or credentialed in hospice and palliative care?
• What hospital is the hospice affiliated?
• What “extra” services does the hospice offer?
• How long has the hospice been operating in the community?
• What is the organization’s governance structure?

If you have any questions or would like a list of hospices serving your community call NHPCO’s HelpLine at 800-658-8898 or visit them here.

New Caregiver Guide to Urgent Care Released

The United Hospital Fund has created a new family caregiver guide online.

This Guide covers urgent care centers, specifically looking at:

• About Urgent Care Centers 
• When There Is a Medical Emergency 
• Types of Urgent Care Centers 
• How to Find an Urgent Care Center 
• Questions to Ask Before Going to an Urgent Care Center 
• What to Do After Going to an Urgent Care Center

 

Supplements May Improve Memory

@Tooga, Getty Images

Adults who take vitamin and mineral supplements such as vitamins C and E, selenium, zinc, and beta-carotene exhibited better long-term memory skills than those who took placebos over the course of ten years,according to French researchers.

Researchers followed 4,500 French men and women between the ages of 45 and 60 for eight years, with half the group taking a daily supplement and half taking placebo pills. After that period, all were given the option of taking vitamin supplements for six more years.

At the end of the six-year period, both groups were given a series of memory tests. The groups performed similarly on most of the tests, but the nutrient-taking group did better on long-term memory exercises than the placebo group.

The study was published online in The American Journal of Clinical Nutrition.

A couple of years ago my wife and I went and had a complete metabolic study and were prescribed a regiment of supplements. While initially believing that this was just nothing more than a way to drive supplement sales, the combination of the supplements actually improved our health and led to some incredible weight loss over six months. People who know what they are doing in this arena are invaluable. Beware of the hucksters however.

Time to Buy That Pet

The Journal of Personality and Social Psychology^® published a study recently that showed that pets can serve as important sources of social and emotional support for “everyday people,” not just individuals facing significant health challenges.

In a press release they reported that:

• pet owners were just as close to key people in their lives as to their animals, indicating no evidence that relationships with pets came at the expense of relationships with other people, or that people relied more on pets when their human social support was poorer.

“We observed evidence that pet owners fared better, both in terms of well-being outcomes and individual differences, than non-owners on several dimensions,” said lead researcher Allen R. McConnell, PhD, of Miami University in Ohio. “Specifically, pet owners had greater self-esteem, were more physically fit, tended to be less lonely, were more conscientious, were more extraverted, tended to be less fearful and tended to be less preoccupied than non-owners.”

Three studies were conducted around this.

• In one, 217 people answered surveys aimed at determining whether pet owners in the group differed from people who didn’t have pets in the areas of well-being, personality type and attachment style. In all cases, pet owners were happier, healthier and better adjusted than were non-owners.
   
• A second experiment, involving 56 dog owners examined whether pet owners benefit more when their pet is perceived to fulfill their social needs better. This study found greater well-being among owners whose dogs increased their feelings of belonging, self-esteem and meaningful existence.
   
• The last study found that pets can make people feel better after experiencing rejection. Subjects were asked to write about a time when they felt excluded. Then they were asked to write about their favorite pet, or to write about their favorite friend, or to draw a map of their campus. The researchers found that writing about pets was just as effective as writing about a friend when it came to staving off feelings of rejection.

And so what are you going to do? How much is that doggie in the window, the one with the (sing along kids!)

Another Case for Caregiver Support Groups

On July 20, we wrote about the need for employer caregiver affinity groups. Fran Melmed writing for TLNT reported on the need for more caregiver affinity groups in the workplace. Citing the Pew Internet Project’s latest study on the social life of health information, Pew found that caregivers use social network sites for updates and gathering information support more than other online social network participants.

On the heels of that is this article from the Herald Tribune that show support groups as lifesavers for caregivers.

Here are some highlights:

• there are two rules in most support groups: personal information is confidential and one person talks at a time.
   
• you learn that you're not the only one having trouble coping.
   
• when people say "how are you?" they genuinely want to know how you are, instead of focusing only on your loved one," as one participant said.
   
• As trust grows, people in the group become accountable to each other and often encourage one another to move forward to find solutions.
   
• Support groups specific to the disease your loved one has been diagnosed with are especially beneficial. 

Check out the article.

Coaching Into Care Can Help Vets

Coaching Into Care works with family members or friends who become aware of their Veteran’s post-deployment difficulties—and supports their efforts to find help for the Veteran.

This is a national clinical service providing information and help to Veterans and the loved ones who are concerned about them.

The program was formerly operated under the name Families at Ease. Coaching Into Care focuses on our primary mission: helping those who care about Veterans encourage them to seek help.

A veteran may need help if they are experiencing and you are noticing:

• Sleep problems
• Restlessness
• Overly watchful
• Easily angered
• Social withdrawal
• Depression
• Reckless driving
• Risk behaviors (alcohol abuse, smoking)

Call 1-888-823-7458 for confidential help.

Antipsychotic Drugs Called Hazardous for the Elderly

A government audit has revealed that nearly one in seven elderly nursing home residents, nearly all suffering dementia are given antipsychotic drugs even though the medicines increase the risks of death and are not approved for such treatments.

More than half of the antipsychotics paid for by Medicare in the first half of 2007 were “erroneous,” costing the program $116 million for those six months. 

Daniel R. Levinson, inspector general of the Department of Health and Human Services, noted that such drugs — which include Risperdal, Zyprexa, Seroquel, Abilify and Geodon — are “potentially lethal” to many of the patients and that some drug manufacturers illegally marketed their medicines for these uses “putting profits before safety.” 

In response to some backlash from the audit, the Centers for Medicare and Medicaid Services said that some of the inappropriate use of antipsychotics in elderly nursing home patients is a result of drug makers’ paying kickbacks to nursing homes to increase prescriptions for the medicines.

Omnicare Inc., a pharmacy chain for nursing homes, paid $98 million in November 2009 to settle accusations that it received kickbacks from Johnson & Johnson and other drug makers for antipsychotic prescriptions.

The government auditors found that of the 2.1 million elderly patients in nursing homes during the first six months of 2007, 304,983 had at least one Medicare claim for an antipsychotic medicine. Nursing home residents received 20 percent of the 8.5 million claims for antipsychotic medicines for all Medicare beneficiaries at a cost of $309 million during those six months.

The auditors found that 83 percent of antipsychotic prescriptions for elderly nursing home residents were for uses not approved by federal drug regulators, and 88 percent were to treat patients with dementia — for whom the drugs can be lethal.

Drug interactions, over-prescribing, under-prescribing - these are huge issues. In fact my mom's recent surgery rehabilitation has been prolonged because of this confusion. You need a good patient advocate in your corner to track these issues. Thank goodness my sister has been doing it for my mom. But if you don't have the time with all of your other caregiving duties consider reaching out for help. That could be to a registered nurse, patient advocate, or geriatric care manager.

Many Lost When It Comes to Financial Planning for Retirement

Nearly 60% of Americans over the age of 50 are worried about the costs of long-term care, while only 16% feel prepared financially, according to a recent study by Sun Life Financial and conducted by Kelton Research. 

Bob Klein, Sun Life's vice president of Strategic Planning and Linked Benefits says that “the younger and healthier a policy owner is, the more leverage he or she will have for multiplying the original single premium into a long-term care benefit.

He recommends that adult children should start talking about LTC insurance with their parents when the parents believe they are five to 10 years away from retirement.

Meanwhile J.P. Morgan's white paper  “Searching for Certainty” details the findings from more than 1,000 people with 401(k) plans wrestling with how to make their savings last through retirement. J.P. Morgan research shows that a minimum guideline for successful retirement income is a replacement ratio of at least 70% or more. Overall, only 40% of respondents even feel comfortable that they will be able to reach their financial goals in retirement.

Americans have pushed aside retirement savings priorities, which rank a distant second to paying monthly bills, according to J.P. Morgan. This is despite the fact that 401(k)s are the only or the primary source of retirement savings for two thirds of Americans.

I'll let this stand. See our other posts on financial planning. It is not easy but if you do not do it, no one will do it for you.