More Information on Fall Protection - Hey Put Some Shoes On!

From McKnights -

Researchers from the Hebrew SeniorLife Institute for Aging Research have found that seniors who go barefoot or wear only socks around the home are at greater risk for falls. Up to 52% of the seniors studied who reported a fall were barefoot, wearing socks without shoes, or wearing slippers at the time of the fall, according to the report. These shoeless fallers were more likely to experience serious injuries, including fractures. Falls prevention programs should include discussions about footwear, researchers said. The report will publish in the summer issue of Footwear Science.

Meanwhile, researchers at Queensland University of Technology, Brisbane, Australia, have developed a method to help predict which Parkinson's patients are likely to fall. Researchers were best able to predict falls by testing patients' overall Parkinson's symptoms, asking patients how often they “freeze” while walking, and testing patients' balance. The combination of these tests had a sensitivity of 78% and a specificity of 84% for predicting falls, according to the study, which appears in the June 23 online issue of Neurology.

Study Debunks Association of Brain Games and Cognitive Improvement

A new study debunks the theory that brain-training games help to boost people's cognitive abilities.

Participants in the BBC study got better at the games, but their general reasoning, memory, and planning abilities did not improve, the investigation found. The study followed 11,430 people—the largest ever investigation, according to BBC News. Results appeared in the journal Nature.

Still, experts said there needs to be more research to find out if cognitive games can help maintain people's brains as they age. The market for electronic brain games for seniors has mushroomed in recent years. Scientists from the Medical Research Council and the Alzheimer's Society designed the games that were tested.

This study has caused a lot of debate. After all we have been told that if we keep our minds stimulated it will help ward off dementia and Alzheimer's. What do you think? More importantly what have you observed in an elder client, friend or relative.

Apple Juice and Alzheimer's

From McKnight's - A new study reports that Apple juice could help soften the anxiety, agitation and delusions common to patients with moderate-to-advanced Alzheimer's.

Institutionalized Alzheimer's patients were given 4 oz. of apple juice twice a day for the one-month duration of the study. After 30 days, caregivers reported no noticeable improvement in the patients' dementia symptoms. But they did notice improved behavioral and psychotic symptoms—there was a 27% improvement, mostly in the areas of agitation, anxiety and delusion.

Twenty-one patients at two nursing homes in Massachusetts participated in the study. Researchers say the results support the use of nutritional-based approaches to delaying the onset of Alzheimer's and other dementias. The full study is available online for free for a limited time.

Reduced agitation, anxiety and delusion - heck, all of us need to be hitting this juice!

Older Adults Who Purposefully Lose Weight Live Longer

New research suggests that older adults who purposefully lose weight have a lower mortality rate. Wake Forest University researchers looked at data on 318 elderly adults enrolled in weight-loss-related trials in the 1990s. Half of those individuals actively lost weight through exercise programs, losing an average of 10.5 pounds over 18 months. The other half lost 3.1 pounds during that time naturally. After eight years, researchers noted that there was half the number of deaths in the active weight-loss group than in the natural weight-loss group. That suggests that intentional weight-loss does not increase the risk of mortality among the elderly. There was even a reduction in mortality for the oldest of the participants. The research appears online in the Journal of Gerontology: Medical Sciences.

I am not sure how the study defined “natural” weight loss. I would assume it was a test group that was not really actively engaged in trying to lose weight, say through a dedicated diet or workout plan. They just happened to lose weight during the study.

My takeaway – we already know that diet and exercise can help us lose weight and that has medical implications. Would seem a no-brainer that it helps us to live longer too. Perhaps this study was trying to determine if there was actual harm to deliberate weight loss. Not sure. So make a plan and be rigorous in your fitness regimen.

Anthony Cirillo Charlotte Today June 21, 2010

More Middle-aged Americans Reporting Mobility Disabilities

More older, middle-aged Americans are reporting serious mobility-related disabilities and difficulties performing activities of daily living than ever before.

Researchers at the RAND Corporation and the University of Michigan looked at responses to the “1997 to 2007 National Health Interview Survey,” and found a significant increase in the number of 50 to 64-year-olds with mobility issues. Roughly 40% reported having difficulties in at least one of nine physical functions measured by the survey. They also noted a rise in the proportion of older middle-aged adults needing personal care assistance for back or neck problems, diabetes, and depression, anxiety or emotional problems.

The reasons for the trend are unknown, but the findings run counter to a decline in similar mobility issues among seniors aged 65 and older. While overall, only 2% of people in the 50 to 64-year-old age group do require personal care help, the significant increase “does not bode well for future trends for the 65 and older population,” according to lead author Linda Martin. The report appears in Health Affairs.

I surmise that people 65+ at some point were confronted with a problem that begged taking care of and which may have scared them into healthier behaviors. My fear for the people my age, the 45-65 set, is that they tend to not want to take care of themselves because they believe if they get sick there will be a pill for fit, a procedure for it or a device for it. This tendency to ignore our own self-responsibility for our health is a scary one. That is why health reform is being fought. It does after all mean more out of our pockets most likely especially if we do not start taking better care of ourselves.

30% of Seniors Will Need Support for Making Healthcare Decisions

From McKnight's - Researchers at the University of Michigan reviewed the records of 3,746 people aged 60 and older (the average age was 80) who died between 2000 and 2006. Nearly 30% of those individuals at some point prior to death became unable to make health care decisions for themselves, researchers found. Of that 30%, roughly two-thirds had a living will of advance directive.

Most individuals with an advance directive wanted non-aggressive palliative care; only 2% wanted aggressive life-prolonging care, according to the report. The research appears in a recent edition of the New England Journal of Medicine.

It is encouraging that two-thirds of those who became incapacitated had living wills. But that is not enough. If you want a good example of a living will / advance directive, check out Five Wishes.

New Consumer Checklist Available for Choosing Nursing Homes

The Advancing Excellence in America’s Nursing Homes Campaign’s Consumer Tip Sheet provides nursing home residents and family members basic information and 10 questions they should be asking to better understand resident care planning, staffing, important care issues and the significance of measuring resident and family satisfaction.

In a typical year, 3.2 million Americans will spend some time in a nursing home. Although there are many guides for choosing a nursing home already available, the Campaign is trying to help residents and their families ensure the best care and quality of life while in a nursing home.

Read more.

Having Caregiver Support Not Always Comforting to Elders

From McKnight's - Some groups of elderly people actually report being more afraid of death if they have a strong family network of caregivers.

Researchers at the University College London interviewed roughly 1,000 people from a wide variety of ethnic backgrounds—including Indian, Pakistani, black Caribbean, Chinese and white—for their study of attitudes toward death. They discovered that nearly one-third of ethnic minorities interviewed lived in a household with four or more adults and two-thirds had a large family network that could help with caregiving. Only 1% of whites lived in such a household while roughly one-third had a family caregiving network, according to the study.

Ethnic minority groups were much more likely to report extreme fears of death in the four sampled categories: fear of the mode of death, fear of not being able to control their death, fear of dying itself, and fear of being in pain. In three out of the four categories, having a large family network was associated with higher reports of fear of death among the ethnic groups.

“Practitioners should not assume that fears about dying are the same in different social groups, or that extensive family support is protective against such anxiety,” researchers concluded. Their report was published online in the Postgraduate Medical Journal.

40% of Women Still Unaware of Dangers of Heart Disease

This from Health Day - Almost half of all American women still don't know that heart disease is the leading cause of death in women. Only slightly more than half would call for emergency help if they were having heart attack symptoms, according to the latest survey for the American Heart Association.

In 1997, 30 percent of women realized that heart disease was the leading cause of death in women. In 2009, that number was 54 percent down slightly from 57 percent in 2006.

Young women were more likely to believe that breast cancer was their biggest potential health threat.

Women are taking important preventive steps such as seeing their doctors and having their blood pressure checked. However, many women are relying on unproven strategies to prevent heart disease, as well. For example, 82 percent said they believed that fish oil would help them prevent heart disease, and 29 percent said aromatherapy could be helpful, according to the survey.

"Although there may be some benefit to alternative and complementary therapies, they pale in comparison to turning off the TV and going out for a walk," said Dr. Pamela Marcovitz, medical director of the Ministrelli Women's Heart Center at Beaumont Hospital in Royal Oak, Mich. "When people exercise even moderately most days of the week, they're incredibly more likely to be healthier and live longer."

Two comments - first this again shows why the "Let's Move" campaign of Mrs. Obama needs to be heeded by adults not just children. Second, the breast cancer initiative has simply drawn more publicity so it is no wonder women think that is there biggest threat. Thank the Komen Foundation for that. The Heart Association needs to put faces and stories to the disease and they need one big catalyst that can boost concern about this disease to the forefront.

The sad part is that there are steps you can take to minimize your risk of heart disease. I think the breast cancer movement has benefited by showing the steps people can take around early detection. And sadly because many women die much too young from breast cancer, there are more compelling stories to tell. Don't let heart disease creep up on you. Educate yourself.

Consumer Reports Assesses Central Line Infections in Hospitals

Some of you may know that Consumer Reports (CR) is also in the health care rating business. I know them best from their work involving nursing homes. Their latest data release has to do with central line infections in hospitals, of which 1.7 million occur each year in U.S. hospitals.

They are bloodstream infections introduced through the large intravenous catheters that deliver medication, nutrition, and fluids to patients in intensive care. These infections account for 15 percent of all hospital infections but are responsible for at least 30 percent of the 99,000 annual hospital–infection–related deaths, according to CR.

So take a look at the findings.

I am always nervous about publications like CR being in the health care rating business. There are certainly enough players. And all this data confuses the public at best. And I am not sure what the end game is - is it to shame hospitals into getting better? Is it to make them more transparent in their reporting? (many states do not require reporting central-line infections and the CR list is incomplete for sure); Is it to sway the public on where to go for their hospital care?

But you can't ignore the ratings once published. It has to be out there. And this is a particularly vexing issue because infections can be greatly curtailed just through simple hygiene. As CR states "the steps require equipment no more complex than hand soap, an antiseptic solution, and sterile drapes and garb. Other key components: giving nurses the authority to make doctors follow all the steps, and measuring and reporting infection rates."

So consumers facing surgery may want to pay attention to these ratings and question your physician about them. If your physician has multiple admitting privileges and one hospital's infection rates are lower than another's it may be worth considering where you have surgery.

And remember the skill of your physician, specialist, surgeon is just one thing to consider. The hospital where they practice needs to be considered as well. Hospitals report out many metrics that can give the consumer an idea of what is taking place inside an institution. Health care is not about one particular procedure. It is about the entire experience.

Long-Term Acute Care Hospitals Mortality Rates High

From Fierce Health - New approaches to patient care at long-term acute care hospitals throughout the U.S. are needed considering that the survival rate of elderly patients transferred to such facilities after a critical illness is low, a new study published in today's Journal of the American Medical Association finds.

From 1997 to 2006, the use of long-term acute care hospitals increased by an average of nearly 9 percent annually. The number of such hospitals more than doubled over that time period, with the number of patients nearly tripling. The one-year mortality rate was high throughout for such patients: between 1997 and 2000, the mortality rate stood at 50.7 percent. From 2004 to 2006, it mortality rate was 52.2 percent.

"The clinical and economic burden of patients with chronic critical illness is significant and likely to expand with the aging of the population and advances in critical care that increase patient survival," said lead author Jeremy Kahn, MD, of the University of Pennsylvania. "Long-term outcomes of the chronically critically ill are poor, with substantial need for new approaches to their care."

Kahn reported that costs over the study period increased from $484 million to over $1.3 billion annually. While in 1997 fewer than 40 people per 100,000 (.7 percent of the Medicare patient base) were admitted to the facilities, by 2006, that number was close to 100 people per 100,000 (2.5 percent of the patient population).

Here's the study's abstract.

So caregivers be careful in looking out for a loved who might have to be transferred to such a facility. Talk to your physician about best options.

New Long Term Care Insurance Survey Suggests Premiums Not as High as Public Perceives

Over a third (35.4%) of individuals who recently-purchased long-term care insurance protection pay less than $1,499-per-year according to a new report issued by the American Association for Long-Term Care Insurance. Among buyers under age 61, 43.5 percent pay less than $1,499 annually, whereas 73.6 percent of buyers between ages 61 and 75 pay $1,500 or more.

The organization analyzed data on some 93,500 new long-term care insurance buyers. Among buyers under age 61, over one-fourth (28.1%) paid less than $999-per-year. Fewer than one in 10 (9.3%) pay $3,500 or more annually the report notes.

Age at the time of application plays an important role in determining the cost for long-term care insurance the Association study reports. While 41.5 percent of buyers under age 61 pay between $500 and $1,499-per-year, only 20.8 percent of buyers who are ages 61-to-75 pay within this range.

The Association fsuggests the following tips that can help you significantly reduce the cost of insurance coverage.

1. Leverage Your Good Health: Insurers will require you meet certain health qualifications to obtain coverage. Discounts are provided to those in good health and 62 percent of applicants between ages 40-49 qualified in 2009. The percentage drops to 46% for ages 50-59 and only 38% for ages 60-69. Once obtained, the preferred health discount is not lost when your health changes.

2. Right-Size Your Coverage: Some long-term care insurance is always better than none. Factor in other sources of income such as Social Security, pension and 401k plans that can pay costs and allow you to add money-saving options such as a 90-day deductible (Elimination Period) or consider a limited-pay plan with a Shared Care option that allows two spouses to share a common benefit pool.

3. Compare Coverage: Each insurer establishes it's own rates, health standards and available discounts. As a result, virtually equal protection from two highly-rated insurers can vary by between 30 and 80 percent. Ask your insurance professional if they have access to policies from just one or from multiple insurers.

I have to say that I was surprised by this report as my own research into buying coverage for myself suggests that I would pay well more and I am someone who is in good health.

So as always do your homework. Remember that this report is issued by an association that wants to promote the sale of this insurance. That said I am in favor of it because at the end of the day we are each going to be responsible for many of these costs in the future. The current financing of long term care is unsustainable.

Geriatricians in Short Supply and More Will Be Needed

The country's fastest growing age group is 85 and older, with the leading of edge of the baby boom already well into their 60s. Yet the number of geriatricians in the nation has dropped by a quarter since 2000, down to 7,000, according to the American Geriatrics Society, which estimates that 36,000 will be needed by 2030.

Young medical school graduates are not inclined to go into primary care let alone geriatric primary care. They prefer the higher paying specialist fields. Yet as medical homes become more prevalent I would foresee a geriatric medical home as a highly sought after and higher reimbursed model that needs to take hold.

We need to educate the public and the health care field about the great shortage of geriatric physicians and why their knowledge is so vital for the continued health of our aging population.

Read more here and here.

Driving Risk for Elderly with Dementia Greater than Previously Thought

From Health Day - A study published in the a recent issue of American Journal of Occupational Health says that elderly people with failing memories often keep driving and the risk of getting lost may be greater than once thought.

Even with early dementia, there may be no safe period behind the wheel because the disease is unpredictable, said Linda Hunt, an associate professor in the School of Occupational Therapy at Pacific University, Oregon, and author of a new study.

It is estimated that 30 to 45 percent of Alzheimer's patients continue to drive after diagnosis.

Of 207 drivers with Alzheimer's who went missing while driving, 32 died and 35 were found injured, the research showed. Another 70 were not found at the time the data was analyzed. Some had driven for almost two days and covered more than 1,700 miles while lost. Most had set off on routine trips to the post office, store or a relative's house.

Hunt, who thinks the problem is "bigger than we realize," called her study "the tip of the iceberg." The public needs to become more aware of this problem because it has been previously thought that Alzheimer's patients' driving ability need only be monitored.

Only six states -- Oregon, California, Nevada, Delaware, Pennsylvania and New Jersey -- have mandatory reporting laws when a doctor finds a patient is mentally impaired. Advocates for Alzheimer's patients believe that driving privileges should not be terminated upon a diagnosis.

Family members should begin a conversation upon diagnosis. The person will have more insight into the problem. If it is decided the patient can no longer drive, the doctor can be the bad guy.

The Alzheimer's Association offers a web-based program called "Comfort Zone" that families of Alzheimer's patients can use if the person can still drive safely in familiar places. The driver agrees to limit driving to a "comfort zone," and a global positioning system (GPS) monitors driving. If the driver leaves the area, the family is notified in real time.

Knee Replacements Beneficial for Balance Improvement as Well as Pain Reduction

A study presented at the annual meeting of the American Academy of Orthopaedic Surgeons showed that a knee replacement can help improve an elderly person's balance.

Balance problems and increased risk for falls are common among seniors and falls are the leading cause of injury for seniors in the United States, and hip fractures caused by falls can prove deadly.

So essentially while knee replacements are typically done to reduce the severe pain that people are in, this study has shown that the replacements are not only good for reducing pain but improving balance, which could ultimately be a better benefit.

So should you run out and get a knee replacement? No. But if you are on that borderline where you think you might need one and have have already spoken to your physician, the balance issue is just one more thing to consider. I am sure my orthopedic surgeons friends can hear the cash register ringing.

Tips for Those Concerned About Older Loved One's Driving

Driving demands good judgment, quick reaction times and split-second decision making. A diagnosis of Alzheimer's disease alone is not a reason to take away driving privileges. But due to the progressive nature of Alzheimer's, a person with the disease will eventually be unable to drive.

It's often difficult to decide when to stop or limit driving. To help make this decision, get a driving evaluation from a certified professional. Contact the Alzheimer's Association (800.272.3900) for referrals to organizations in your community that can perform these evaluations.

Ideally, families should talk openly about driving soon after a diagnosis. They should make plans for how the person will get around when he or she can no longer drive.

Here are some additional tips from the Alzheimer's Association.

Good Health is as Simple as Washing Your Hands

Hospital-acquired infections is a big issue these days where you end up coming out of a hospital sicker than when you went in. One of my local hospitals does a phenomenal job with staff, visitors and patients on hand hygiene so as to prevent the spread of infections.

Truth is that the problem, while acute in the hospital setting, is not isolated to hospitals. We can acquire infections anywhere. That is why you see so many stores starting to have hand wipes available as you exit or enter, particularly supermarkets.

As much as we think we may know how to wash our hands chances are we are not doing it properly. So take a look at this informative piece to learn more.

Alzheimer's Study Needs Volunteers

The Alzheimer’s Disease Cooperative Study (ADCS) is sponsoring a study to raise awareness about Alzheimer’s disease (AD) and to encourage otherwise healthy adults with early complaints of memory problems to participate in the Alzheimer’s Disease Neuroimaging Initiative Grand Opportunity (ADNI GO).

ADNI GO will build on the Alzheimer’s Disease Neuroimaging Initiative (ADNI), a study to find more sensitive and accurate methods to detect AD at earlier stages and track its progress through biomarkers.

By being able to recognize changes in the brain, scientists hope to treat memory loss and other symptoms of AD before they appear, but the only way to recognize what these changes are and learn more about who is at risk is through the participation of volunteers.

If you, a friend, or a family member is experiencing early signs of memory loss, you may be eligible to participate in this study. Please visit this site or call the Alzheimer’s Disease Education and Referral Center at 1-800-438-4380 for more information on study sites in your area.

Blacks and Hispanics Highest Risk for Alzheimer's

This Business Week article reports on an Alzheimer's Association study that shows that over 5 million Americans are living with Alzheimer's disease, and blacks and Hispanics are at highest risk of developing the disease.

The report, 2010 Alzheimer's Disease Facts and Figures finds that black Americans are about two times more likely to develop Alzheimer's disease than whites, and Hispanics face about 1.5 times the risk.

Much of the increase in Alzheimer's is because of increasing high blood pressure and diabetes, which increase the odds of developing Alzheimer's in all populations but is particularly acute in minority populations. These are preventable conditions and we all need to educate the public about them because they are systemic to future health conditions, Alzheimers not to mention what they are costing the health care system.