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  • Omega-3s May Raise Prostate Cancer Risk

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    Omega-3 fatty acids have been shown to have many health benefits. But they may have risks as well, including an increased risk for prostate cancer.

    In a nine-year prospective study, scientists at the Fred Hutchinson Cancer Research Center in Seattle took annual blood samples from 834 men diagnosed with prostate cancer and 1,393 men who were cancer free. The study, published online in The Journal of the National Cancer Institute, controlled for more than a dozen cancer risk factors.

    Compared with men in the lowest one-quarter for omega-3 levels, those in the highest one-quarter had a 44 percent increased risk for low-grade prostate cancer and a 71 percent increased risk for high-grade cancer. They found the association with three different omega-3’s — eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA) and docosapentaenoic acid (DPA), which are all found in fish and fish oil supplements — but not with alpha-linolenic acid, which comes from flax seed.

    The findings are an association and do not imply causation. But according to the lead author, Theodore M. Brasky, now at The Ohio State University, omega-3’s can affect gene expression and, in high doses, be pro-oxidative or suppress immunity, all of which could promote cancer.

    Still, he added, the possible “increase in prostate cancer risk doesn’t preclude a beneficial effect for other diseases.”

    Apr 15 Tags: cancer, Omega-3
  • At Too Many Hospitals, a Revolving Door

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    Jessie Gruman can’t remember the number of times she’s been hospitalized for cancer. The list of the conditions she’s had over almost 40 years is daunting: from Hodgkin’s lymphoma to cancers of the cervix and lung.

    But Ms. Gruman, 59, can’t forget her experience three years ago, when it was time to leave the hospital after having her stomach removed, a consequence of gastric cancer.

    Ms. Gruman was alone; her husband was on his way to this hospital but hadn’t yet arrived. This is all she remembers a nurse saying before she was shown the door.

    Here is a prescription for pain medication. Don’t drive if you take it. Call your surgeon if you have a temperature or are worried about anything. Go see your doctor in two weeks. Do you want a flu shot? I can give you one before you leave. If you need a wheel chair to take you to the door, I’ll call for one. If not, you can go home. Take care of yourself. You are going to do great!

    What wasn’t communicated to Ms. Gruman: Here’s a number to call if you have any questions. Here’s the medical expert who’s in charge of your follow-up care and how to reach him or her. Here’s the plan for your care over the next month, and here’s the plan for the next six months.

    Or this: You’re going to experience a lot of challenges when you get home. Here are the three or four concerns that should be your priorities. Here’s what your caregiver needs to know to help you most effectively. Here are resources in the community that might be of assistance.

    Given the inadequacies in care for discharged patients — a well-documented and common problem — is it any wonder that so many bounce back to hospitals after they’re sent home?

    Medicare, the government’s health care program for seniors, has trained its sights on the issue and is focused on trying to reduce the number of seniors readmitted to hospitals shortly after being sent home. Nearly one in five older adults discharged from a hospital returns within 30 days, at an annual cost of $17.4 billion, according to a recent study in The New England Journal of Medicine.

    Not all readmissions are avoidable — sometimes a patient’s condition will worsen no matter what anyone does. But experts are convinced a substantial proportion of readmissions could be prevented if hospitals did more to educate patients, ensure they’re able to care for themselves, and coordinate their care with other medical providers.

    The Obama administration hopes to trim Medicare readmissions by 20 percent and, under the Affordable Care Act, has started penalizing more than 2,200 hospitals that have higher-than-expected readmissions rates for seniors with heart failure, heart attacks and pneumonia. Medical centers risk losing up 1 percent of their annual Medicare reimbursement; that financial penalty will rise to 3 percent by October 2015. More medical conditions will be added to the list over time.

    What does this mean to older adults and their caregivers? What can they expect as hospitals put into place programs to address readmissions and what can they do to prevent return trips to the hospital?

    Ms. Gruman’s problems began in the hospital, when a day after surgery a nutritionist came to visit and tell her how to manage life without a stomach. “It was misguided to see me so soon after surgery, when I was loopy and could barely remember my name,” said Ms. Gruman, now a patient advocate and president of the Center for Advancing Health in Washington.

    “When you’re in the hospital, you’re not operating on all cylinders,” she added. “You don’t really know until you’re home for a while and reality sets in what questions are going to be important, anyway.”

    Here’s what she learned from the experience.

    Lesson No. 1: If a patient isn’t ready to hear what a medical provider wants to say, meaningful communication becomes impossible. Ms. Gruman said she probably should have told the nutritionist, “I can’t possibly concentrate on what you’re telling me right now; it’s not a good time.” Speak up when you find yourself in a similar situation, feeling muddled or unable to concentrate.

    The morning of her discharge from the hospital, the nurse responsible for her discharge didn’t help Ms. Gruman see the big picture: “No one said this is going to be a really big deal, adjusting to this change in your body, and you’ll have a lot of adjustment to go through.” What was missing, she said, was “any recognition of the magnitude of the time and attention my husband and I would have to spend attending to my recovery.”

    Lesson No. 2: Handing someone a sheaf of papers and going over a set of instructions won’t guarantee a successful transition from the hospital to home. People need more. They need a human touch, emotional recognition, and a sense that they’re not going to be left on their own as they try to recover from the setback that brought them to the hospital.

    Feel free to stop the person handling your discharge and say, “Wait, slow down, I don’t really understand how I’m going to get along day to day and how all this is going to work.” Don’t leave until you feel more comfortable.

    At home, Ms. Gruman wasn’t sure about her health priorities. “I had a whole new digestive system, and I wasn’t sure how it functioned,” she said. “I wish I’d known more about eating, what to expect in terms of my energy level, how much I should try to exercise, if there was anything I needed to be monitoring.”

    Lesson No. 3: Some people may be able to assimilate information in the hospital or upon discharge, but many cannot. It may take several days or even longer at home for people to understand what challenges in their recovery are most important.

    Staffers also need to teach caregivers the skills they will need while the patient is still in the hospital. That’s the time to learn how to turn someone in bed, help with mobility, assist them in taking a bath, or assess their breathing or level of pain. Be willing to ask a nurse “show me how you do that” several times if necessary so you are not left in the lurch when you get home, Ms. Gruman said.

    Many of you have undoubtedly had experiences with this issue; we’d be glad to hear about those in the comments. Later this week we’ll post some advice from experts.

    Apr 15 Tags: cancer, Hospitals
  • A Novel Way to Document End-of-Life Preferences

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    Maybe we’ve been going about this all wrong.

    In the continuing campaign to get people, particularly the old and sick, to discuss their preferences for end-of-life care, we’ve been pushing for them to have intimate conversations with family members.

    Web sites like The Conversation Project and PREPARE, campaigns like National Healthcare Decisions Day in April, my own posts here — all reflect the idea that Americans can overcome their apparent aversion to acknowledging mortality if their children will just talk to them.

    Progress on this front has been slow, however. Pew Research surveys found in 1990 that 12 percent of Americans had a “living will,” a figure that rose to just 29 percent by 2005. So on a nearly daily basis, the palliative care specialist Dr. Joshua Lakin told me in an interview, “I’d see someone who’d had lung cancer for several years, who’d been in and out of the hospital, had seen 20 doctors, and still hadn’t thought about the future and his priorities. It kind of blindsided me.”

    So Dr. Lakin, who just completed a fellowship at the University of California, San Francisco, and some colleagues took an entirely different approach to what is called advance care planning. They experimented with brib . . . er, incentivizing doctors. And whaddya know, it worked.

     

    As the team reported in JAMA Internal Medicine last week, the UCSF Medical Center has an incentive program to improve quality; each year its doctors-in-training pick one area to focus on. For the 2011-2012 academic year, the internal medicine department decided to concentrate on documenting patients’ advance care decisions.

    The researchers came up with a standard form, which was inserted in patients’ electronic health records. It asked just a few questions: Does the patient have any “expressed wishes” about how much care he wants or doesn’t? Where are those preferences recorded — in a living will, a durable power of attorney, a P.O.L.S.T. form (which would be scanned into the record). Or are they expressed orally?

    The researchers’ form requests a brief summary: He doesn’t want to be resuscitated or intubated? She wants a feeding tube but not a ventilator? Or she wants “all available care?” Does he have a designated decision maker? What is that person’s name and phone number, and what language does he or she speak?

    If residents recorded this information for at least 75 percent of discharged patients, for three of the four quarters in the academic year, they each got a $400 bonus. If not, they didn’t.

    The hospital, not the researchers, established that sum, but “it was enough to get people motivated,” Dr. Lakin noted. Residents around the country earn between $40,000 and $50,000 a year, plus housing stipends. An additional 400 dollars isn’t life-changing, but it’s not pin money, either. And the researchers sent out bar graphs via e-mail to point out if teams were hitting the goal or endangering everyone’s bonus. (“Marketing 101,” Dr. Lakin called it.)

    The experiment followed nearly 1,500 patients, more than half the adults (of all ages) seen by the hospital’s medical department that year.

    In July, the first month, only about 22 percent had their preferences documented, roughly the same proportion as before the incentives began. So “the template itself wasn’t enough,” Dr. Lakin said.

    But by October, following Marketing 101, the proportion of patients with documented preferences hit 90 percent and stayed there. By contrast, a separate team of attending physicians who didn’t participate in the incentive program averaged less than 12 percent for the year.

    So maybe we don’t have to keep nudzhing our parents, bracing for uncomfortable discussions. Maybe a doctor, at a hospital or not, can do this in 10 minutes without angst.

    Of course, the study doesn’t answer some major questions. We don’t know how much of an incentive, if any, would motivate practicing physicians, who are paid more than residents. We also don’t know whether simply having a standard form in your medical records means that you will actually have your wishes respected — that you’ll be put on a ventilator if you said you’d want that, but not if you said you didn’t.

    But we do have some idea of the scenario that ensues when people have never discussed their wishes. The medical conveyor belt cranks up. “There’s a set of default choices in the hospital system, which does things unless told not to,” Dr. Lakin said.

    I’d still rather have the family conversation. But so often, it never takes place. Stricken families, sometimes bitterly at odds, wonder what Mom would want if she could speak. Maybe nobody really knows. Maybe, for a paltry sum compared with the cost of a single day in intensive care, her doctor could have found out.

  • Scientists Seek to Rein In Diagnoses of Cancer

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    The panel said that some premalignant conditions found in mammograms should not be identified as “carcinoma.”

     

    A group of experts advising the nation’s premier cancer research institution has recommended changing the definition of cancer and eliminating the word from some common diagnoses as part of sweeping changes in the nation’s approach to cancer detection and treatment.

    The recommendations, from a working group of the National Cancer Institute, were published on Monday in The Journal of the American Medical Association. They say, for instance, that some premalignant conditions, like one that affects the breast called ductal carcinoma in situ, which many doctors agree is not cancer, should be renamed to exclude the word carcinoma so that patients are less frightened and less likely to seek what may be unneeded and potentially harmful treatments that can include the surgical removal of the breast.

    The group, which includes some of the top scientists in cancer research, also suggested that many lesions detected during breast, prostate, thyroid, lung and other cancer screenings should not be called cancer at all but should instead be reclassified as IDLE conditions, which stands for “indolent lesions of epithelial origin.”

    While it is clear that some or all of the changes may not happen for years, if it all, and that some cancer experts will profoundly disagree with the group’s views, the report from such a prominent group of scientists who have the backing of the National Cancer Institute brings the discussion to a higher level and will most likely change the national conversation about cancer, its definition, its treatment and future research.

    “We need a 21st-century definition of cancer instead of a 19th-century definition of cancer, which is what we’ve been using,” said Dr. Otis W. Brawley, the chief medical officer for the American Cancer Society, who was not directly involved in the report.

    The impetus behind the call for change is a growing concern among doctors, scientists and patient advocates that hundreds of thousands of men and women are undergoing needless and sometimes disfiguring and harmful treatments for premalignant and cancerous lesions that are so slow growing they are unlikely to ever cause harm.

    The advent of highly sensitive screening technology in recent years has increased the likelihood of finding these so-called incidentalomas — the name given to incidental findings detected during medical scans that most likely would never cause a problem. However, once doctors and patients are aware a lesion exists, they typically feel compelled to biopsy, treat and remove it, often at great physical and psychological pain and risk to the patient. The issue is often referred to as overdiagnosis, and the resulting unnecessary procedures to which patients are subjected are called overtreatment.

    Cancer researchers warned about the risk of overdiagnosis and overtreatment as a result of new recommendations from a government panel that heavy smokers be given an annual CT scan. While the policy change, announced on Monday but not yet made final, has the potential to save 20,000 lives a year, some doctors warned about the cumulative radiation risk of repeat scans as well as worries that broader use of the scans will lead to more risky and invasive medical procedures.

    Officials at the National Cancer Institute say overdiagnosis is a major public health concern and a priority of the agency. “We’re still having trouble convincing people that the things that get found as a consequence of mammography and P.S.A. testing and other screening devices are not always malignancies in the classical sense that will kill you,” said Dr. Harold E. Varmus, the Nobel Prize-winning director of the National Cancer Institute. “Just as the general public is catching up to this idea, there are scientists who are catching up, too.”

    An expert panel says lesions found in some cancer screenings should not be called cancer but should instead be reclassified.
    Joe Raedle/Getty ImagesAn expert panel says lesions found in some cancer screenings should not be called cancer but should instead be reclassified.

    One way to address the issue is to change the language used to describe lesions found through screening, said Dr. Laura J. Esserman, the lead author of the report in The Journal of the American Medical Association and the director of the Carol Franc Buck Breast Care Center at the University of California, San Francisco. In the report, Dr. Esserman and her colleagues said they would like to see a multidisciplinary panel convened to address the issue, led by pathologists, with input from surgeons, oncologists and radiologists, among others.

    “Ductal carcinoma in situ is not cancer, so why are we calling it cancer?” said Dr. Esserman, who is a professor of surgery and radiology at the University of California, San Francisco.

    Such proposals will not be universally embraced. Dr. Larry Norton, the medical director of the Evelyn H. Lauder Breast Center at Memorial Sloan-Kettering Cancer Center, said the larger problem is that doctors cannot tell patients with certainty which cancers will not progress and which cancers will kill them, and changing terminology does not solve that problem.

    “Which cases of D.C.I.S. will turn into an aggressive cancer and which ones won’t?” he said, referring to ductal carcinoma in situ. “I wish we knew that. We don’t have very accurate ways of looking at tissue and looking at tumors under the microscope and knowing with great certainty that it is a slow-growing cancer.”

    Dr. Norton, who was not part of the report, agreed that doctors do need to focus on better communication with patients about precancerous and cancerous conditions. He said he often tells patients that even though ductal carcinoma in situ may look like cancer, it will not necessarily act like cancer — just as someone who is “dressed like a criminal” is not actually a criminal until that person breaks the law.

    “The terminology is just a descriptive term, and there’s no question that has to be explained,” Dr. Norton said. “But you can’t go back and change hundreds of years of literature by suddenly changing terminology.”

    But proponents of downgrading cancerous conditions with a simple name change say there is precedent for doing so. The report’s authors note that in 1998, the World Health Organization changed the name of an early-stage urinary tract tumor, removing the word “carcinoma” and calling it “papillary urothelial neoplasia of low malignant potential.” When a common Pap smear finding called “cervical intraepithelial neoplasia” was reclassified as a low-grade lesion rather than a malignancy, women were more willing to submit to observation rather than demanding treatment, Dr. Esserman said.

    “Changing the language we use to diagnose various lesions is essential to give patients confidence that they don’t have to aggressively treat every finding in a scan,” she said. “The problem for the public is you hear the word cancer, and you think you will die unless you get treated. We should reserve this term, ‘cancer,’ for those things that are highly likely to cause a problem.”

    The concern, however, is that since doctors do not yet have a clear way to tell the difference between benign or slow-growing tumors and aggressive diseases with many of these conditions, they treat everything as if it might become aggressive. As a result, doctors are finding and treating scores of seemingly precancerous lesions and early-stage cancers — like ductal carcinoma in situ, a condition called Barrett’s esophagus, small thyroid tumors and early prostate cancer.

    But even after years of aggressively treating those conditions, there has not been a commensurate reduction in invasive cancer, suggesting that overdiagnosis and overtreatment are occurring on a large scale.

    The National Cancer Institute working group also called for a greater focus on research to identify both benign and slow-growing tumors and aggressive diseases, including the creation of patient registries to learn more about lesions that appear unlikely to become cancer.

    Some of that research is already under way at the National Cancer Institute. Since becoming director of the institute three years ago, Dr. Varmus has set up a list of “provocative questions” aimed at encouraging scientists to focus on critical areas, including the issue of overdiagnosis and molecular tests to distinguish between slow-growing and aggressive tumors.

    Another National Cancer Institute program, the Barrett’s Esophagus Translational Research Network, or Betrnet, is focused on changes in the esophageal lining that for years have been viewed as a precursor to esophageal cancer. Although patients with Barrett’s are regularly screened and sometimes treated by burning off the esophageal lining, data now increasingly suggest that most of the time, Barrett’s is benign and probably does not need to be treated at all. Researchers from various academic centers are now working together and pooling tissue samples to spur research that will determine when Barrett’s is most likely to become cancerous.

    “Our investigators are not just looking for ways to detect cancer early, they are thinking about this question of when you find a cancer, what are the factors that might determine how aggressively it will behave,” Dr. Varmus said. “This is a long way from the thinking 20 years ago, when you found a cancer cell and felt you had a tremendous risk of dying.”

  • Concerns About Dementia Screening

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    Marie Theriault, with husband, Paul, started dropping things three years ago, and was given a diagnosis of a rare form of Alzheimer’s.

    Marie Theriault started having trouble with her hands more than three years ago. She was the director of a day care center, but suddenly she couldn’t change diapers or tie shoelaces. She started dropping things.

    “People would say to me, ‘Look, you dropped your folder,’ ” Mrs. Theriault, 59, said. “I wasn’t aware I had dropped it.”

    Though she did not have any problems with memory, Mrs. Theriault eventually found out that she has a rare form of Alzheimer’s disease. The diagnosis enabled her family to plan ahead: Her husband took early retirement and found a clinical trial for her to enroll in, and the two went on a safari that had been a dream for years.

    “We’re front-loading a bit, enjoying life as much as we can, now that the disease is manageable,” said Paul Theriault, 57. “It can get pretty ugly.”

    For the Theriaults, getting an accurate diagnosis of Alzheimer’s disease brought a measure of relief, even though the future might be grim. Indeed, there is a growing interest in the early detection of dementia, not only in patients like Mrs. Theriault but also in people with normal age-related memory changes or even no symptoms at all.

    The idea is that treatments for Alzheimer’s disease and other dementias have been largely ineffective because the conditions aren’t caught early enough. Now researchers are starting clinical trials that focus on people in the “pre-symptomatic phase” of Alzheimer’s disease. Medicare is paying for wellness visits that include cognitive assessments and screening.

    But the push for ever-earlier dementia screening raises troubling questions for patients and their families. When the diagnosis is early Alzheimer’s disease, the medical profession has little treatment to offer. This month, researchers at an Alzheimer’s Association conference in Boston urged policy makers to think hard before recommending wider dementia screening, saying studies have found no evidence that early detection improves outcomes.

    And the experts said that little, if anything, is known about the potential risks of early detection. The diagnosis may cause stress, anxiety, depression and even suicide in patients, and can have implications for employment, purchasing life and long-term care insurance, and one’s overall quality of life, sense of autonomy and self-image.

    “It colors how people see you and how you see yourself,” said Dr. Daniel J. Brauner, a geriatrician and ethicist at the University of Chicago. “Everyone forgets things, but if you have the diagnosis, whenever you forget something you’ll think, ‘It’s because I’m sick.’ It pathologizes everything.”

    The amyloid plaque that is characteristic of Alzheimer’s disease starts to accumulate years, even decades, before symptoms become apparent, and some researchers are convinced that in order to prevent or postpone cognitive impairment, these plaques must be attacked earlier.

    Laurie Ryan, director of the Alzheimer’s Disease Clinical Trials Office at the National Institute on Aging, said new trials of a monoclonal antibody that binds to amyloid will specifically recruit subjects who do not show any symptoms of Alzheimer’s disease but already have evidence of amyloid plaque buildup.

    Healthy subjects will have to volunteer to undergo PET scans that detect amyloid plaque in the brain. They may be recruited from among the many “worried well” who are seeking reassurance and clear answers about the future.

    “This trial will require participants to have an amyloid burden that is consistent with risk for Alzheimer’s disease, so you essentially will know your status, which is uncharted territory,” Dr. Ryan said. “This type of trial has not been done before.”

    There are already 450 medical centers that have PET scanners that use an imaging agent called amyvid approved by the Food and Drug Administration to detect amyloid plaque in the brain. Yet this month the federal Centers for Medicare and Medicaid Services, in a draft proposal, indicated that the agency would not pay for these brains scans as diagnostic tools because they just don’t help much.

    Even when a brain scan helps confirm the diagnosis of early Alzheimer’s disease, available treatments only delay symptoms for a relatively short period of time. And there is the potential for misdiagnosis, since plenty of people have amyloid plaque in their brains without developing symptoms of Alzheimer’s disease or other dementias.

    The rush to find early Alzheimer’s disease worries some physicians and ethicists.

    “You are telling someone they have a disease that they’re not experiencing in any way that they can see, and you’re telling them it’s an incurable disease. That’s kind of tough,” said Nancy Berlinger, the lead author of “The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life.”

    “We don’t know yet what it’s like to live with the experience of asymptomatic Alzheimer’s,” she added. “It’s hard to even conceive of.”

    Still, many scientists use heart disease as an example in describing how Alzheimer’s disease may develop. It takes decades for the underlying biological changes, including plaque accumulation, to damage the brain, just as high cholesterol and hypertension, left uncontrolled, may ultimately lead to a heart attack.

    “The plaque is kind of like cholesterol,” Dr. Ryan said. “Not everyone who has high cholesterol goes on to have a heart attack, but it puts you at higher risk.”

    It makes sense, she said, to treat this risk factor as early as possible, even if not everyone with plaques will develop Alzheimer’s. Still, that is just a hypothesis, said Dr. Malaz Boustani, an associate director of the Indiana University Center for Aging Research and the medical director of the Healthy Aging Brain Center at Wishard Health Services.

    “It’s a beautiful hypothesis and it’s what I do my research on, but it’s still a hypothesis, and we need data,” Dr. Boustani said.

    Both he and Dr. Brauner urge patients who notice cognition or memory problems — or whose family members notice changes — to get a complete evaluation. The physician should take a history, do a thorough exam, and rule out a number of potential causes of mental impairment: depression; thyroid, kidney and liver function; vitamin B12 levels; infections; and dehydration and electrolyte disturbances.

    Sometimes an M.R.I. or CT brain scan may also be done to assist in diagnosis. These are different from the PET scans that detect amyloid plaque, and proponents argue that they can help clarify a diagnosis under certain circumstances.

    The physician should also do a careful review of medications, since many drugs can have adverse effects on cognition. “You cannot believe the number of people who come to our clinic with memory symptoms and we find it was driven by their exposure to medications, like taking Benadryl to sleep or bladder medications,” Dr. Boustani said.

    Reassuringly, many people who experience mild cognitive impairment do not progress to dementia, and many even return to normal, some studies suggest. A study of primary care patients seen at Wishard Health Services identified 130 patients with mild cognitive impairment. A year later, most were stable, and nearly one-third had reverted to normal.

    Mar 11 Tags: dementia
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  • Advice About Assisted Living for Aging Relatives

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    Readers have sent more than 100 questions and suggestions to Debra Drelich, a specialist in geriatric care, about assisted living and other special living arrangements for aging relatives.

    Debra Drelich, an expert on elder care.

     

    Ms. Drelich, a social worker licensed in New York State with more than 25 years of experience in the field, is the founder of New York Elder Care Consultants. She is an active member of the National Association of Professional Geriatric Care Managers and is a former president of the Greater New York Chapter of Professional Geriatric Care Managers, where she is currently chairwoman of education. She has worked for the Hebrew Home at Riverdale and Dorot, a volunteer agency, and has been in private practice as a geriatric care manager for many years. Ms. Drelich received her master’s degree from Hunter College. Some questions below have been edited for length.

    More answers from Ms. Drelich will be posted next week.

    A Range of Arrangements

    Q. There are different types of assisted living facilities. The one my wife, who had Alzheimer’s, resided in for four and a half years provided full care, dispensed medication I provided, fed her when needed, changed and bathed her when she was incontinent, and loved and hugged her every day. Not many are like this, but they’re there, just keep looking and asking. — Jim Makris, Chuckey, Tenn.

    A. You have all brought up excellent points in this discussion of living arrangements for aging family members. Let’s start with Jim from Tennessee, who points out that there are all different types of assisted living facilities. Services provided in assisted living facilities and senior housing communities can range from independent to enhanced listing. Enhanced assisted living is a newer license type that permits residents to fully age in place, even if they require complete assistance — even while using a wheelchair, something that is not permitted (at least in New York) in a regular A.L.F.

    It is heartwarming to hear that his wife’s facility went beyond the regulations and even provided hugs and love. It does NOT get better than that. Thank you for sharing.

    For more about assisted living arrangements, here are several good resources:

    ¶The Assisted Living Federation of America offers policy information as well as a community locator

    ¶The American Association of Homes and Services for the Aging provides lists of non profit residences by state.

    ¶The United States Administration on Aging has an Eldercare Locator to find the closest Area Agency on Aging (AAA) office.

    ¶The National Institute on Aging has a broad range of information on aging.

    No One-Size Plan

    Q. A good assisted living facility can give a person much more freedom than they would have in their own home because many of their responsibilities are taken care of by the facility. Just having meals provided can be a tremendous relief. I’ve seen elderly folks who were trapped in their homes with only a hired aide or caretaker blossom when they moved into assisted living and could interact regularly with other folks their own age. —ceilidth, Boulder, Colo.

    A. There is no one “right” plan for all elders. Many elders prefer not being “trapped” in their homes with a stranger or hired caregiver, yet they need services. Having the services they need throughout the day provided by the overall facility staff helps to enhance their privacy as well. Yet others will do anything to remain at home, and might come to cherish their caregivers. I once had a resident in a subsidized independent living senior housing building who lived to be 104 years old. She was known as “the cookie lady” because of the homemade cookies she baked and distributed to the staff and other tenants. When she finally accepted care in her late 90s, she and her beloved aide initially made the cookies together, and eventually the aide made the cookies (with her recipe) and distributed them in her name. Needless to say they had become dear companions, and the dignity this provided at the her very end of life was fantastic. Again, there is no one size fits all plan.

    Q. Our 74-year-old relative currently has two broken ankles (both broke as she was standing still). She’s accepted that she can’t return to her large house (on the market). Her son wants her to move into assisted living. Instead, she wants to return to her hometown and find a first-floor condo near us, her relatives. However, she’s been limited for 40 years by a bad back, has arthritis (osteo and rhumatoid), diabetes, high cholesterol, zapped thyroid (synthroid). Of course she can feed herself, but she can’t get herself to the bathroom. We don’t know how to help. Suggestions? — Sal, New Orleans

    A. Sal, you may want to consider touring several independent living facilities — housing designed for the elderly that provides more hospitality based service, such as meals, housekeeping and recreational programs. Hands-on services such as medication management and bathing assistance are not provided. Before committing to one place, I suggest visiting a number of facilities to see the actual apartments, sample a meal and speak with other residents about their experiences living there. Unfortunately, many large metropolitan area facilities offer tiny spaces, which might be challenging for someone who is relocating from an especially large private home. Larger spaces can be available; however, they will significantly increase the cost.

    Group Home Care

    Q. One parent is frail, has frequent infections and can’t transfer on his own. The other parent has a diagnosis of moderate dementia. They’ve been married to each other for more than 55 years and we, the children in the family, believe their quality of life depends on their being able to stay together. How do we find a facility that will allow them to stay together when they need different levels and skills of care-taking? — aef, Troy, N.Y.

    A. Some local facilities may have strict guidelines on how their different level of needs are going to be met. It is very sad, but it is possible that the only way for them to remain together is to supplement with additional home care.

    Q. Be cautious in looking at facilities that offer Memory Care. Often it is just a nursing home that can be locked down to prevent residents from wandering off. Be sure to ask a lot of questions about what the patient’s day will be like. Stimulation through mental and physical activities can help even severe cases of dementia. Ask if your husband will be able to interact with other residents and attend planned and supervised activities. Often, if the facility also has an assisted living wing the memory care patients can be included in their activities. — Indyanna, Westfield

    A. Indyanna offers some good insight here. Some memory care units are no different than nursing home units; however, their staffing ratio may differ greatly from that of a nursing home. Definitely go in with a list of questions — you are a consumer, and just as you would carefully shop around for a material item, so, too, be thorough in your research. Another factor to keep in mind is what provisions can they make to have two spouses interact, even if not living together in the same apartment.

    Q. See if your state has licensed group homes. Then visit as many as you can, check references and talk to other family members and residents.

    My 91-year-old mother with mild dementia has lived in a wonderful group home (a regular house in a regular neighborhood) in the Phoenix metropolitan area for three-plus years. My mother receives 24-hour care, a private room (with a bathroom across the hall, but a potty chair tucked discreetly in a corner behind her armchair), three home-cooked meals a day, supervision of her medications, help with bathing, laundry, cable, housekeeping and thrice-weekly activities. She is content and feels very well taken care of. I can visit any time I want and have fun with her now instead of being exhausted, as I was when I took care of her in my home for eight months. Her monthly bill is $2,200, compared to the $7,500 that another relative paid several years ago for a private room at a large local nursing home. He had far less attentive care.

     

    Oct 22 Tags: Untagged
  • Values Conflict at the End of Life

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    In theory, or in a more perfect universe, our family members wouldn’t have a hard time deciding what to do when we were near death. However painful the task, the decisions would be clear: We would have prepared a written document, an advance directive, stating what we wanted doctors to do or not do, and our about-to-be survivors would follow our instructions. Simple.

    But most people haven’t taken that step, or, if they have, their family members don’t know where the advance directives are, or their doctors don’t know that they exist or what’s in them. “It turns out they’re only part of the puzzle, for all kinds of reasons,” said Dr. Alexia Torke, an assistant professor of medicine at Indiana University and a bioethics researcher at the Regenstrief Institute, a nonprofit organization specializing in health care research.

    How do surrogates actually make decisions for relatives who can no longer direct their own care? It’s hardly a hypothetical question: a British study published in The Lancet in 2004 found that about 40 percent of hospitalized patients lacked the mental capacity to make decisions because they were unconscious, delirious, demented or otherwise cognitively impaired.

    Dr. Torke and her colleagues talked to 35 surrogates who had made major decisions — about life-sustaining treatments, surgery or other procedures, or about where the patient would go when discharged — on behalf of incapacitated seniors admitted to two Indianapolis hospitals. These were not legally designated health care proxies, for the most part, because most patients had no advance directive and hadn’t chosen a decision maker. The surrogates were simply the family members — mostly daughters — to whom the doctors turned for guidance.

     

    What these relatives disclosed, in face-to face interviews lasting an average of 40 minutes, mirrored what several other studies have found: Surrogates often base their judgments on considerations other than what the patients want.

    The researchers, who published their findings recently in The Journal of Clinical Ethics, analyzed these surrogates’ decision making and identified two basic approaches, which they labeled “patient-centered” or “surrogate-centered.”

    Patient-centered decisions focused on the sick person’s wishes and interests. If they couldn’t rely on documents, the relatives might recall past conversations to infer what the person wanted. “More often, it was based on a general knowledge of the person,” Dr. Torke said. “They knew Mom was ‘a fighter,’ or they knew she ‘wouldn’t want to suffer.’ ” They also tried to reach decisions based on what they deemed the patient’s best interests, sometimes seeking the advice of a physician or other professional.

    This is how ethicists say we should proceed. If you don’t have instructions from the patient, you go with what’s called substituted judgment: If the patient were sitting in the room with you, what would she want? And if you don’t know that, you opt for “beneficence” — that is, for what appears to be in her best interests.

    Those tactics can still be problematic. The surrogates often found it stressful to make such big decisions without more information, they said, and, of course, they could have interpreted a patient’s interests differently than the patient would have, or guessed the patient’s preferences incorrectly.

    But at least they were trying to do what they thought their loved one would want.

    Decision making that is surrogate-centered involved a different set of factors, the researchers found. For instance, family members might proceed based on what they would want in a similar situation, “consistent with the concept of the golden rule,” Dr. Torke said.

    They might also be guided by their own spiritual or religious beliefs. Several surrogates explained that they had followed God’s plan, though they had differing views on what that might be. The majority of study participants were Protestant, but “we found rationales that were both accepting of death or fighting against it,” Dr. Torke said.

    Surrogates also drew other family members into the decision, seeking consensus. “Regardless of what happens to the patient, families have to live with each other,” Dr. Torke said. “It’s a way to share the responsibility,” and, perhaps, to avoid guilt.

    All of which is understandable, and maybe this is what some people have in mind when they select (or don’t select) a family member to make decisions if they are incapacitated. They want someone who cares about them to weigh all the issues and then do whatever she and other family members think best.

    But many readers here have made known their insistence on personal autonomy, their desire to have their lives end in just the way they have determined. If that’s you, then this small study points to potential pitfalls.

    It underscores the importance of having an advance directive and distributing copies to anyone who might be involved, including your doctors. (A P.O.L.S.T. form may work better for people who are chronically ill and near the end of their lives.) Beyond that, “it’s a call for having conversations with your family members about what you want,” Dr. Torke said — that’s conversations, plural. Your ideas and your health can change over time, and your surrogate needs to understand your current thinking.

    And, crucially, you will want to choose a surrogate whose values and beliefs are close to yours, if you want him to follow your plan rather than try to divine the Almighty’s. “You can’t write down all the possibilities,” Dr. Torke said. “Find someone you trust.”


    Sep 11 Tags: Ethics
  • 4 Ways To Help Seniors Stay Active During The Winter

    Posted by Sign of the Dove
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    One of the biggest challenges that seniors all over face is not so much health, but loneliness and inactivity. I should know, my mom just barely became one a few years ago and one of her biggest complaints is just that. She basically wants more of my time. A lot more. But how do we as caregivers find a balance between what our senior parents need or want and what we can properly provide.

    This article covers a few good ideas on ways that seniors whether living independently at home or in an assisted facility, can stay active and fight off the dreaded lonesome blues.

    1. Fun Local Clubs/Groups/Organizations -

     

    It’s truly amazing to me that plethora of groups, clubs and organizations right in our backyards that we all have access to. All we need to do is look, seek and ask around about them. Everything from fitness centers for seniors to local clubs that provide activities for those aged 50 and over to simply the local mental health center that usually have loads of programming and workshops or groups for inactive seniors. Just keep in mind that one thing you will want make sure of is that whatever activity, club or group you look into is one that involves interaction of some kind, as this is what is most sought after by seniors. And while you’re at it, why not seek out an activity that is not only healthy and functional, but also fun. Maybe an art class, photography, computer instruction, jewelry making, scrapbooking, collage making, etc.

    2. Outdoor Time -

     

    They say that a leisurely paced walk can work wonders for anyone regarding most issues. Why not apply this same ideal to your senior relative or friend and make sure they get plenty of outdoor time. This could be in the form of a neighborhood walk, a picnic in the park, a minor bike stroll, kite flying or even a mild outdoor game of some sort such as Bocce. Again the key is to provide plenty of company to go along with the activity.

    3. Family Play -

     

    This idea is quite simple really and it involves regular family time. Be it a weekly dinner or lunch, play time with grandchildren, a monthly or weekly visit, etc. The bigger your family, the more members can take turns doing the socializing. From a cousin to uncle to nieces and nephews anyone with a bit of time on their hands and the kind disposition to simply “be there” will work wonders for granny or grandpappy.

    4. Online Friendships and Stimulation -

     

    Did you know that the Senior population is one of the fastest growing segments of online interaction. Those aged 65 and older have embraced the web like no other group and in droves according to this article by the Pew Internet Research firm. And according to Mashable, they’re also embracing social media to connect and share with others. Everything from email to hopping on Facebook and sharing photos, news and or jokes with friends and family members. But another great use of the web by Seniors is simply for online friendships and stimulation. Sites like (ThirdAge.com) post huge traffic and member numbers for a reason, because there is big demand. However your friend or relative might need some help jumping on this online social bandwagon. Help them along by introducing them to one or two sites, maybe Facebook to start with and then showing him or her how best to use it along with sharing a few safety tips.

     

    There you have it. Four good ways to help the senior or seniors in your life stay active this and any Winter. They’ll be healthier for it, you’ll be happier for helping them and basically you’ll have a win win situation for everyone involved. Keep in mind there are many other things you can do, but the ideas above are a good start.

     

    Missy Diaz a senior lifestyle blogger for Lakewood Manor contributed this piece. Feel free to follow her on Twitter for additional tips, to ask her a question or simply to connect with her.

    Sep 05 Tags: Untagged
  • When the Grandchildren Grow Older, and Closer

    Posted by Sign of the Dove
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    Growing up, Melanie Cortese always felt close to her maternal grandmother, who lived eight blocks away in South Plainfield, N.J. What really cemented their relationship, though, was adulthood.

    Melanie Cortese, left, and her grandmother, Ann Ciampa.
    Lara Collado/Lara Elizabeth Photography Melanie Cortese, left, and her grandmother, Ann Ciampa.

    Once she’d graduated from college, landed a job and married her boyfriend, Ms. Cortese found herself turning to her grandmother for counsel on everything from dealing with in-laws and buying a house to throwing dinner together when she came home from work. “She gave me the feeling that whatever I did was O.K.: ‘You’ll get through it. Not everything has to be perfect,’ ” said Ms. Cortese, now 38. “She had the wisdom just from having lived so long. It was always comforting.”

    Her grandmother, Ann Ciampa, occasionally needs her help, too. Though still healthy and independent at 90, Mrs. Ciampa asks her granddaughter to buy her health food supplies online. She stayed with Ms. Cortese, who now lives in nearby Linden, when hurricanes caused extended power failures in the area, and she relied on her granddaughter for a ride home after cataract surgery. (She gives “gas money,” too, which Ms. Cortese accepts with a certain amount of private eye-rolling.)

    The cycle continues. Ms. Cortese hosted her grandmother’s 90th birthday celebration last month. And now that she has two children, she still seeks Mrs. Ciampa’s advice. “Raising kids, when you never know what you’re doing, it’s nice to sit back and hear her say: ‘It’s fine. Don’t worry so much,’ ” she told me.

    Much of the research on grandparents and grandchildren has focused on young children and on the safety-net function that grandparents can provide in troubled families. But lengthening lifespans mean that more people will have adult relationships with their grandparents, too, sometimes for many years.

     

    “We know relatively little about what grandparents and grandchildren do for each other on a daily basis during the grandchildren’s adulthood,” said Sara Moorman, a Boston College sociologist who set out to learn more. She presented the results of her research at the American Sociological Association’s annual meeting in New York this week.

    Using the Longitudinal Study of Generations, which surveys families in Southern California about every three years, Dr. Moorman and her co-investigator, Jeffrey Stokes, looked at data from 1985 through 2004. Their sample included 376 grandparents and 340 grandchildren (selected randomly if a grandparent had more than one grandchild) who were over the age of 16. In 1994, halfway through the period in question, the grandparents’ mean age was 77; the grandchildren’s was 31.

    These relationships had impact, the results showed. When the pairs described themselves as fairly close emotionally (“affectual solidarity,” the sociologists called it), both generations showed fewer symptoms of depression on a standard psychological scale than those with more detached relationships. Those with close relationships were less likely to report feeling lonely or sad, and were not as prone to symptoms like insomnia, lack of energy or sleeplessness.

    More practical assistance — for example, “helping each other with chores, with transportation, with advice, with money,” Dr. Moorman said — had no significant connection to grandchildren’s depression scores, but it did affect the grandparents’ scores. They reported fewer depressive symptoms if they provided help (“functional solidarity”) or if the assistance was reciprocal.

    If they were only the recipients of aid, though, the grandparents’ depression scores were higher. “Older adults want to continue to be independent and productive,” Dr. Moorman said. “When they can’t give back, that’s depressing.”

    It’s worth noting that, over all, these grandparents and grandchildren — some of whom may have moved away from each other over the years of the study — did not describe particularly high levels of involvement. Based on six questions and a scale in which 1 meant “not at all” close and 6 meant “extremely” close, the grandparents rated their emotional closeness at 3.96 on average; the grandchildren rated their relationships at 3.54. “Pretty centrist responses,” Dr. Moorman said.

    Over the full study period, the grandparents estimated that they gave practical support to adult grandchildren about 14 percent of the time, received it about 3.4 percent of the time, and both gave and received it about 8 percent of the time. The grandchildren saw the relationship differently. “Grandparents say they’re giving more,” Dr. Moorman said. “The grandkids perceive more of an exchange.” Most of the time, though, both generations said they neither received nor provided practical support.

    Still, the connections between these relationships and depression scores were statistically significant. “A close relationship that induces exchange is good for both parties,” Dr. Moorman said. “Grandchildren and grandparents are a resource for each other, or at least they can be.”

    She knows whereof she speaks. “My grandma and I were really close,” she said. They lived in State College, Pa., where as a teenager, Dr. Moorman worked in the public library. Her grandmother, Mary Moorman, whose house was right next door, often made her lunch. And with her brand-new driver’s license, Dr. Moorman drove her to hairdressers’ appointments and restaurants, thrilled to be trusted.

    Her grandmother died last summer at 94. The new study, Dr. Moorman said, was a tribute to her.

    Aug 19 Tags: Untagged
  • Understanding and Combating Age-Related Eyesight Problems

    Posted by Sign of the Dove
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    As we age, it’s not uncommon for our eyesight to become impaired. A significant portion of seniors rely on glasses in order to see, but glasses alone shouldn’t be relied on to care for and maintain the health of your eyes. No one appreciates eyesight problems, of course, but for seniors looking to keep their independence, eye problems pose an especially difficult challenge.

    By understanding common age-related eyesight afflictions, we can be better prepared to take proactive measures to minimize impairment.

    Cataracts

    Of vision-impairing diseases, the most common is the cataract. This disease occurs when the lens of the eye, which is typically transparent, becomes opaque or cloudy. Cataracts can be a challenge to detect because they generally develop slowly. Symptoms can include:

    Blurry, cloudy, yellow or dimmed vision Heightened sensitivity to light Faded colors Frequent changes to glasses prescription Double vision

    While age is the most common risk factor associated with cataracts, there are other notable risks – including smoking, eye injuries, tanning, diabetes and steroid use. It is crucial to visit an ophthalmologist once a year to monitor eye health and take proactive steps to avoid vision degradation. To minimize your risk of developing cataracts, it is also recommended to avoid tanning booths and quit smoking. Certain glasses can help with cataracts, but the only true treatment is surgery, in which an artificial lens replaces the cloudy lens.

    Age-Related Macular Degeneration

    Among adults over the age of 70, age-related macular degeneration (ARMD) is the leading cause of vision impairment. A degenerative disease, ARMD affects the macula, which is the small spot in the center of the eye that provides sharpness and clarity in the center of the field of vision. Accordingly, those with ARMD are likely to experience blurred vision or blind spots. People with heightened risk of ARMD include adults over 75, smokers, women, people with high cholesterol and people with a family history of the disease. There is no definitive treatment for ARMD yet, but some cases can be treated or slowed with laser eye surgery.

    Glaucoma

    Glaucoma is signified by pressure buildup in the eye which causes damage to the optic nerve. Glaucoma is considered one of the hardest eyesight diseases to diagnose because most people do not display any symptoms, but if it is detected in its early stages, excessive vision loss can be prevented through surgery. To be safe, it is advised to have your eyes checked regularly – especially if you are 60 or older, have diabetes or have a family history of glaucoma.

    Diabetic Eye Disease

    Approximately 80% of people who have had diabetes for at least 15 years develop diabetic eye disease. This affliction causes diabetic retinopathy, or damage to the eye’s blood vessels. Annual eye exams are critical in detecting this disease early and preserving eyesight. Diabetics who are successful in keeping their blood sugar levels under control are also less likely to experience diabetic eye disease.
    Eye health is closely tied to other areas of physical well-being, so annual medical check-ups are an important way to detect and treat other problems that can lead to eyesight issues. Additionally, you can help preserve your sight in your senior years by maintaining a healthy diet that includes dark greens, wearing UV protective sunglasses when outdoors and of course by getting your eyes checked regularly.


    Author Bio:

    Charlie Nadler is a community education writer for Chicagoland Methodist Senior Services. CMSS is the most extensive senior services network on Chicago’s north side, providing services such as senior home care, assisted living, and more.

     

    Jul 26 Tags: Untagged
  • Show all entries from Assisted Living

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  • Quality Matters: Which Plans Provide Highest-Quality Health Care?

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    Five words or less

    (NewsUSA) - Choosing the right health care plan can have a big impact on your quality of life, especially if you're a senior or otherwise Medicare eligible. With the 5-star Special Enrollment Period underway through November, now is the time to consider whether your current plan provides the high-quality care and value of a 5-star Medicare health plan. To help Medicare beneficiaries understand why quality matters and what it means to their health, Kaiser Permanente, which has the most 5-star plans nationwide for 2013, is sharing information about a key area to consider when evaluating a Medicare plan -- preventive care. "Medicare members should select a plan that is proactive in helping them stay healthy and active as they age. They need to know if their plan does a good job preventing them from getting sick through screenings, vaccines and tests," said Jed Weissberg, M.D., medical director, Kaiser Permanente Medicare plans. "They also need to know how well their plan manages chronic conditions such as high blood pressure, high cholesterol and diabetes." Kaiser Permanente scores well above the national average in preventive screenings. For example, only one in six traditional Medicare members -- 16 percent -- used a free preventive service in 2011, according to the Centers for Medicare & Medicaid Services. By contrast, nearly 90 percent of eligible Kaiser Permanente Medicare members received breast cancer screenings, and nearly 88 percent received colorectal cancer screenings, as reported by the 2012 Healthcare Effectiveness Data and Information Set, commonly known as HEDIS. Ratings matter, because if CMS rates a Medicare health plan 5 out of 5 stars, beneficiaries can feel confident about choosing the highest-quality plan available and join that plan almost any time of year. Learn more about the Medicare Star Quality Ratings and Kaiser Permanente's Medicare plans by visiting kp.org/medicare or by calling 1-855-817-5831. Plan performance summary star ratings are assessed by the Centers for Medicare & Medicaid Services each year and may change from one year to the next.

    Aug 14 Tags: Untagged
  • Safeguard the Golden-Years Through Vascular Screenings

    Posted by Sign of the Dove
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    Five words or less(NewsUSA) - Vascular disease is among the leading causes of death in the U.S. Symptoms, however, often are not present until a catastrophic event occurs, like a stroke or aneurysm rupture. Millions of Americans at risk for stroke or death from vascular disorders remain unaware of the danger. "Vascular screenings are the best way to locate blockages in arteries and help you avoid serious disease," said Anil Hingorani, M.D., a vascular surgeon at Lutheran Medical Center in Brooklyn, N.Y., and member of the Society for Vascular Surgery (SVS). "These are painless, noninvasive tests (like an ultrasound examination or Doppler pressure studies)." Dr. Hingorani said that if your cartoid artery is not clear, vascular disease can lead to stroke, leg artery blockages and limb loss, and even travel to the brain and cause paralyzing strokes. Vascular disease can cause potentially lethal aneurysms of the aorta (AAA), the main artery of the body. The probability of AAA in the general population is low but increases with the following risk factors: increasing age, male gender, white race, smoking, family history of aneurysms, history of other vascular aneurysms, hypertension, atherosclerotic diseases, cerebrovascular disease and high cholesterol. According to the SVS, a one-time ultrasound screening for AAA is recommended for all men 65 years or older, and for all women 65 years or older with a family history of AAA or who have smoked. Re-screening patients for AAA is not recommended if an initial ultrasound scan performed on patients 65 years of age or older demonstrates an aortic diameter of less than 2.6 cm. However, because of their risk factor, men who have a family history of AAA may be screened as early as 55 years of age. Vascular disease also can impair circulation or cause peripheral arterial disease in the legs, leading to reduced ability to walk and in some cases, leg amputation. Early screening can slow or stop the progression of the disease process and identify individuals who may be at risk for heart attack and stroke due to blockages. To learn more about your vascular health, visit the SVS website at www.VascularWeb.org.
    Aug 07 Tags: Untagged
  • New Research Emerges For Parkinson's

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    Five words or less(NewsUSA) - People often believe the myth that Parkinson's disease only afflicts the elderly, but research indicates that a growing number of middle-aged adults are developing the neurodegenerative disorder. The National Parkinson Foundation reports that 10 percent of people with Parkinson's are diagnosed before age 40. Although there are effective ways to deal with the symptoms of Parkinson's -- exercise, brain stimulation, dopamine replacement drugs -- diagnostic tests and curative treatments still have a long way to go. "Existing approved therapies only treat the symptoms of Parkinson's," explains Gerald E. Commissiong, president and CEO of Amarantus BioScience Holdings, Inc. (OTCQB:AMBS) -- a biotechnology company that focuses developing new treatments for neurodegenerative conditions. "A therapeutic protein called MANF (Mesencephalic Astrocyte-derived Neurotrophic Factor) has shown the potential to rejuvenate dying cells and protect the neurons that produce dopamine in rodents." Parkinson's belongs to a group of conditions known as motor system disorders, in which the brain cells that generate dopamine start to die. Symptoms typically get progressively worse, including trembling in the limbs and face, stiffness in the torso, slowness of movement, depression, trouble speaking and chewing and poor balance and coordination. According to Commissiong, the therapeutic MANF program from Amarantus may eventually prevent Parkinson's from getting worse and possibly restore some normal cell function. The ability to prevent cell death -- otherwise known as apoptosis -- is vital. It could be used to treat Alzheimer's, stroke and traumatic brain injuries (TBIs). Amarantus, a publicly traded company, also develops a diagnostic platform for Alzheimer's, Lou Gehrig's disease, breast cancer and Parkinson's. To learn more about the therapeutic MANF program at Amarantus, visit www.amarantus.com.
    Jun 18 Tags: Untagged
  • What Every Woman Should Know About Long-Term Care

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    Five words or less(NewsUSA) - With women generally outliving men, planning for long-term care becomes more urgent for them in their pre-retirement years. After all, while longevity definitely has its upside -- including more time to enjoy travel and family -- there's no denying its biggest potential downside: the increased risk of health problems that can make caring for oneself difficult. Today, seven in 10 nursing home residents are women. They also represent a whopping 76 percent of assisted living residents, according to the latest statistics, and two-thirds of all home-care recipients. And that care isn't necessarily what many would consider "affordable" -- unless you're perhaps lucky enough to have the opportunity to enroll in the likes of the Federal Long Term Care Insurance Program (FLTCIP). "Like other forms of health care, long-term care is expensive, and costs continually increase," says Paul Forte, CEO of Long Term Care Partners, which administers the FLTCIP. The program is specifically designed to help current and retired federal employees safeguard their retirement income and savings while maintaining their independence and avoiding reliance on their children. How Will You Pay for Care? The most recent John Hancock Cost of Care Study puts the national average cost of a licensed home health aide at $20 per hour, with private and semiprivate nursing home rooms going for $235 and $207, respectively, a day. Those costs aren't generally covered by health plans such as Medicare, the Defense Department's TRICARE, TRICARE for Life, or even the regular Federal Employees Health Benefits Program. And as for Medicaid, as Forte notes, "it covers long-term care only for those with very low income and assets, so the responsibility for paying may fall on you." Now suppose you're a woman who's eligible for the FLTCIP, but you haven't yet applied. Ask yourself these four questions: * Considering your health and family history, might you live a long life with health conditions that could hinder caring for yourself? * Do you live alone? * If you don't live alone, how might tending to you disrupt the professional and personal lives of others, and do you wish to be dependent on them? * If you do live alone, will you have the resources not just to pay for care, but to also maintain a comfortable lifestyle? The Advantages of the FLTCIP Established by an act of Congress in 2000 and overseen by the U.S. Office of Personnel Management, the program is tailored exclusively to meet the budgetary and lifestyle needs of what's referred to as "the federal family." And as so often is the case with the federal workforce, the cost to enrollees is surprisingly affordable. How affordable? Well, there's a choice of four prepackaged plans that combine the most popular program features, with customized plans also available. So, say you're a 45-year-old woman who chooses the FLTCIP's most popular prepackaged plan (Plan B, with the 4 percent inflation rider). You'd pay a biweekly premium of $33.90 -- less than $68 per month, or slightly more than $2 a day -- for protection that can save you thousands of dollars in future care costs. The program's consumer-friendly website lets you calculate the premium rate for your age and choice of plans (www.LTCFEDS.com/rate), and view current and past informational webinars (www.LTCFEDS.com/webinar). Personal consultants can also walk you through the entire process, including plan design and applications, by calling 1-800-582-3337 or 1-800-843-3557. Again, not everyone is eligible for FLTCIP, and certain medical conditions, or combinations of conditions, will prevent some from being approved for coverage. Premiums are set with the expectation that they'll suffice, but aren't guaranteed. While the group policy is in effect, OPM must approve an increase in premium.
    May 10 Tags: Untagged
  • Improving Brain Research for Better Alzheimer's Diagnoses

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    Five words or less(NewsUSA) - More than 5 million Americans live with Alzheimer's disease -- a number that's only going to rise as more adults age into their mid to late 60s. So, making strides to better understand the disease is a must. The Alzheimer's Association estimates that an adult in the U.S. develops Alzheimer's every 68 seconds. Yet, differentiating Alzheimer's from other types of dementia can't fully be determined until after death. President Obama's brain-mapping initiative is arguably overdue, but regardless, it's vital to giving Alzheimer's and brain research the boost needed to see real results. Promising diagnostic tests are already on the horizon. "The key next step in the fight to cure Alzheimer's is proper diagnosis," says Gerald E. Commissiong, president and CEO of Amarantus BioScience Holdings, Inc. (OTCQB: AMBS), a biotech company that specializes in treatment and diagnostic work for neurodegenerative diseases like Alzheimer's. "LymPro was developed to diagnose the disorder before the disease shows any symptoms," says Commissiong. "It identifies specific biomarkers in the blood, which gives doctors the ability to definitively discern Alzheimer's from other causes of memory loss or dementia." Using a diagnostic blood test will help scientists and physicians get a better understanding of what it takes to treat Alzheimer's. Existing technologies allow experts to monitor brain activity in a large group of cells, but the new BRAIN Initiative calls for an unparalleled degree of neurological detail. If Congress approves the funding -- which amounts to less than a fifth of NASA's annual budget on sun research alone -- scientists will explore minute cell interactions by mapping the activity of individual brain cells. That kind of knowledge, combined with a greater chance of early diagnosis via LymPro blood tests, could lead to more effective treatment programs and better care. But, like the potential for brain mapping, the medical possibilities of Amarantus technology aren't restricted to Alzheimer's. The publicly traded "brain company" develops treatment options for other neurological disorders like Parkinson's, traumatic brain injury and stroke. LymPro has currently been funded by two rounds of NIH funding. To learn about Amarantus BioScience Holdings' therapeutic MANF program, visit www.Amarantus.com.
    May 10 Tags: Untagged
  • Show all entries from Seniors for Living

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  • Unafraid of Aging

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    The signal public health achievement of the 20th century was the increase of the average human life span. Now, as that achievement helps raise the proportion of the aged around the world, what once seemed an unalloyed blessing is too often regarded as a burden — a financial burden, a health care burden, even a social burden.

    This is the tenth in an occasional series of articles and videos about leaders in science.

    “It’s nuts,” said Dr. Linda P. Fried, an epidemiologist and geriatrician who is dean of the Mailman School of Public Health at Columbia University. “To assume defeat from what every one of us as individuals wants suggests we’re not asking the right questions.”

    Findings from the science of aging, Dr. Fried said, should “reframe our understanding of the benefits and costs of aging.”

    From her perch at Mailman, a position she has held for four years, Dr. Fried is pushing students, professors and a wider audience to ask the right questions and ponder the right policies for coping with an aging world population.

    Dr. Fried’s mandate is to lead a school that will give a new generation the tools to deal with global challenges to public health, including environmental degradation, climbing health care costs and the pressure of rapid urbanization. But she believes that research on aging and health changes “across the life course” are central to designing solutions to public health problems in the 21st century.

    The Mailman School is newly energized, with enrollment in the master’s and doctoral programs up 26 percent over the last four years, and grants from the National Institutes of Health up 12 percent in 2011 — a year in which the overall N.I.H. budget declined slightly. Mailman’s curriculum has undergone a major redesign to reflect a new emphasis on health preservation and prevention for every stage of life. Interdisciplinary study will be required of all students. The curriculum, Dr. Fried boasts, is “absolutely unique” among schools of public health, and has generated a great deal of interest. Applications for 2012 admission to the master’s program were up more than 20 percent from the year before.

    It would be too soon to call the dean’s job the capstone of Dr. Fried’s career. Petite, energetic and seemingly indefatigable, Dr. Fried, 63, travels extensively, serves on numerous nonprofit initiatives on aging, maintains a house in Baltimore and an apartment in New York, and on occasion dons in-line skates for a spin in Central Park.

    She gives the impression of having only just begun a campaign to change people’s thinking, and frequently answers a question by saying that she’d like to take several hours to do it justice.

    Dr. Fried has spearheaded a large body of scientific research on aging. She spent more than two decades at Johns Hopkins University studying data collected on the health of more than 5,000 men and women 65 years and older as part of the Cardiovascular Health Study, and later mined data on 1,000 women over 65 for the university’s Women’s Health and Aging Study.

    She broke new ground in defining frailty in the elderly, developing a simple assessment tool that uses five criteria to test for frailty. She also developed the concept of a “frailty syndrome,” and continues to guide younger colleagues in studies exploring how the frail respond to various stressors. In recent years, she has also collaborated with her husband, Dr. Joseph B. Margolick, an immunologist and H.I.V./AIDS expert, in studying frailty in H.I.V. patients. Dr. Margolick works at the Johns Hopkins Bloomberg School of Public Health and travels most weekends to New York to be with Dr. Fried. The couple has two grown sons.

    Dr. Fried’s findings have set new standards for the assessment and treatment of geriatric patients. Her work “has become core knowledge and core teaching in every geriatric program” in the country, said Dr. Christine K. Cassel, president and chief executive officer of the American Board of Internal Medicine and a leading expert in geriatric medicine.

    Embracing Complexity

    Dr. Fried, who is a native New Yorker, grew up in Stuyvesant Town, attended Hunter High School and went on to study history at the University of Wisconsin. After spending five years variously as a paralegal, social worker and a physical therapist, she enrolled in Rush Medical College in Chicago, graduating in 1979.

     

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