Aging with Grace CareConnection

Stop the re-hospitalization revolving door

noreply@blogger.com (Patricia Grace) — Wed, 25 Jan 2012 20:38:00 +0000

People are hospitalized with acute heart failure when congestion, or fluid build up worsens to the point that it causes severe leg or abdominal swelling and makes it difficult for them to breathe. Treatment is mostly focused to relieve symptons.

Because of inconsistent follow-up care and difficulty getting patients to take prescribed medication properly and to follow a good diet and exercise regimen, many of them relapse and wind up back in the hospital or in some cases die.

The following tips can reduce that risk:

Review medication upon discharge -medical errors often occur during the transition from the hospital to home. Make sure that you review your medications with a health care professional before leaving the hospital. If you are unsure about any aspects of the instructions ASK FOR CLARIFICATION...don not assume anything. If possible try and fill the prescriptions before you return home or within 24 hours.

Schedule a follow-up visit - schedule an appointment with your physician within a week or tow of discharge. Do not be surprised if your primary care doctor does not have all of the facts at your follow up appointment. Make sure to bring all of hospital discharge instructions with you!

Continue to treat symptons - even if your symptons improve enough for your to go home, you still need ongoing care monitoring and medication.

Treat other medical conditions - failure to control contributing conditions such as high blood pressure and kidney disease are just a few reasons why re-admissions are high.

Walk your way to good health

noreply@blogger.com (Patricia Grace) — Mon, 23 Jan 2012 22:23:00 +0000

Regular walking, a favorite exercise for senior citizens, is one of the most effective forms of physical activity that delivers substantial health benefits and improves heart health, says the American Heart Association. The latest addition to their tools for persuading people to exercise or Walking Clubs, which are quickly being formed in communities across the U.S.

Walking is also easy to start and continue and it has the lowest dropout rate of any physical activity. By joining or forming an American Heart Association Walking Club you can connect with others who share your goals, lifestyles, schedules and hobbies – and do it all free. Walgreens is the national sponsor.

An American Heart Association study revealed that American adults are 76 percent more likely to take a walk if another person is counting on them.

In contrast, research shows 45 percent of gym members will quit going to the gym in a given year and 30 percent will cancel their membership. Gym fees per member average about $765.40 a year.

“I encourage our patients to engage in regular exercise, including moderate-to-vigorous intensity walking programs, and the American Heart Association’s new Walking Clubs are a great resource,” said Barry A. Franklin, Ph.D., Director of Cardiac Rehabilitation and Exercise Laboratories at William Beaumont Hospital in Royal Oak, Mich.

“The accountability and camaraderie Walking Clubs provide will help those that struggle with a regular exercise commitment. Numerous studies have now identified a sedentary lifestyle and/or a low level of fitness as independent risk factors for cardiovascular disease.

Accordingly, for many people, Walking Clubs may provide a safe and effective lifestyle intervention to prevent heart disease and stroke.”

Hospital chaplains - a patients greatest advocate

noreply@blogger.com (Patricia Grace) — Fri, 20 Jan 2012 15:38:00 +0000

Hospital chaplains have long been a source of comfort and solace for patients facing daunting illness. Patients who had a spiritual discussion while hospitalized reported being more satisfied with their overall care.

Studies indicate as many as 40% of patients with serious illnesses like cancer struggle with spiritual concerns, which can harm emotional and physical well-being, says George Fitchett, research director in the Department of Religion, Health and Human Values at Rush University Medical Center Chicago.

Patients who have negative thoughts—say, questioning God's care for them—are more likely to develop worse health outcomes than patients who show positive spiritual coping, such as turning to religion for solace.

Chaplains "are patients' greatest advocates," says Harold Koenig, director of Duke University's Center for Spirituality, Theology and Health. They should work closely with other medical professionals, he says, and help them understand how spiritual beliefs influence patients' treatment decisions and response.

Studies indicate that chaplain visits can result in less patient anxiety, shorter hospital stays and higher satisfaction. Still, a review in the Journal of Health Care Chaplaincy concludes that many studies haven't been rigorous enough to test effectiveness and define the best practices of chaplains' care.

A study published online in July in the Journal of General Internal Medicine found that among 3,000 patients hospitalized over a three-year period at the University of Chicago Medical Center, 41% wanted a discussion of religious and spiritual concerns, yet only half of that group reported having one.

Patients may hesitate to ask for a chaplain's services out of concern that chaplains will proselytize—even though in many cases they don't use explicit theological language and "are there to be companionable and offer support," says Wendy Cadge, associate professor at Brandeis University.

How Often Do Women Really Need Bone Density Tests?

noreply@blogger.com (Patricia Grace) — Thu, 19 Jan 2012 14:54:00 +0000

Screening for osteoporosis can protect against fractures, but many women may be getting tested too often.

Older women are at higher risk of developing osteoporosis and bone loss, which can lead to potentially debilitating bone fractures. To gauge bone strength in these patients, many doctors order bone mineral density tests every two years — which is how often Medicare reimburses the test — but a new study finds that such screenings can be delayed much longer.

The latest research, published in the New England Journal of Medicine, suggests that most women with normal or near-normal scores of bone density on an initial test may not need another one for up to 15 years.

The study addresses a difficult question that many doctors caring for older patients face. Bone mineral density readings, or T scores, which measure bone thickness at certain spots, usually the hip and spine, compare patients’ bone density to that of a healthy young adult. So, a T score of -2.5 or lower qualifies as osteoporosis, and women at these levels are recommended to continue testing regularly and begin drug treatments to strengthen their bones. But what about women with slightly higher readings? Do they need to be monitored as often?

Read full Time Magazine article:

85 and older outpacing all other age groups in America

noreply@blogger.com (Patricia Grace) — Wed, 18 Jan 2012 14:17:00 +0000

The 65+ senior population in the United States has outpaced the growth of all other age groups over the course of the last decade, and Census data released Wednesday indicates that the trend toward an aging America—including for the country’s “oldest old” population—is continuing.
The most recent Census data finds that there were 40.3 million people who were 65 years or older as of April 2010, up 15% from 35 million a decade earlier. As of April 2010, that population represented 13% of the overall population in the United States.

The aging of the baby boom bulge is “unprecedented,” said Carrie Werner, statistician, Age and Special Populations Branch, Population Division at the U.S. Census Bureau, in a call with members of the press Wednesday.
Of older Americans, the 85- to 94-year-old age group showed the greatest increase at near 30%.

Regionally, the Census shows that the South contains the greatest number of people 65 and older, but the percentage of those who are 65+ in the Northeast is greater than in any other region. Of 21 counties that saw their 65+ populations double over the past decade, five were located in Colorado, five in Georgia and five were in Texas. Additionally, the older population is more likely to live inside a metropolitan or micropolitan statistical area.

Can you die from a broken heart?

noreply@blogger.com (Patricia Grace) — Tue, 17 Jan 2012 20:11:00 +0000

There really is such a thing as heartbreaking grief, suggests new research that finds losing a loved one can increase the risk of heart attack.
Within a day of a significant other's death, heart attack risk was 21 times higher than normal, said researchers who looked at data on nearly 2,000 heart attack patients. And within the first week after death, the heart attack risk for the bereaved was still six times greater than usual.

"Extreme grief can trigger heart attacks," said lead researcher Dr. Murray Mittleman, director of the Cardiovascular Epidemiology Research Unit at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.
"For at least a month the risk remains elevated and likely stays up even longer," he added.

The stress and anxiety of losing someone close can trigger heart-damaging biological processes, Mittleman explained.
"All of this can cause a physiologic response with an increase in heart rate and blood pressure, and also can cause changes that makes blood a little bit more sticky," he said. "This can increase the risk of having a heart attack."
After a death, it is important for immediate family members and friends to be aware of this connection and watch for signs of distress, Mittleman suggested.

"When an individual is grief-stricken, they often ignore their own needs and may not be as compliant with medication, may not take care of themselves as well," he said.

If the bereaved individual develops unusual physical symptoms, "don't assume it's just stress and anxiety; it may be a heart attack and should be taken very seriously," Mittleman warned. These symptoms include chest or stomach pain, shortness of breath, nausea, lightheadedness or a sudden, cold sweat.

Senior housing - 2012 and beyond

noreply@blogger.com (Patricia Grace) — Thu, 12 Jan 2012 18:07:00 +0000

The economy is still the number one reason that many seniors have delayed moving into a senior housing community. Other reasons include: utilizing family, technology, medicine and community support to remain in their current environment.

This trend is forcing senior housing communities to accept residents with higher levels of acuity. This is turn can lead to a higher cost of care, and providers may need to raise their costs as a result of increased risk, or change their policies all together to avoid the consequences of higher acuity.

As the profile of senior housing residents change, so will the definition of types of senior care communities. The shift in resident profiles are giving way to a migration in communities:

• Independent Living Becomes More Like Assisted Living. As more home and community based services initiatives are implemented, seniors living in apartment complexes or 55+ communities will see a greater level of a la carte services offered that will resemble more of an assisted living “feel” at a lower cost delivery as services will be unbundled.

• Current Assisted Living Facilities will function more like Skilled Nursing. Current nursing homes will be handling the “sickest” seniors in the coming years as an alternative to hospital stays. The traditional model of nursing care will migrate to assisted living communities that can have differing levels of care within those communities. As part of this trend, many assisted living communities are finding that the average age of entry for its communities is increasing as people are living with less care longer.

• Dedicated Alzheimer’s care facilities will begin to re-appear in earnest in the next 12-24 months. This trend is similar to a period in the early 2000s when many dedicated memory care communities were established. At the time, there were funding problems and the trend was somewhat ahead of its time given the number of memory care patients. However, a decade later, the supply of ALZ/dementia care communities is low while the demand is steady and increasing, regardless of the funding issues.

Concepts such as multigenerational housing,senior villages, NORC's (naturally occurring retirement communities) co-housing, homes built with in-law apartments and other communal living solutions will continue to gain appeal as individuals and families learn about the costs of senior housing.

Older Americans will increasingly move in with their families—or each other— as the economics of co-housing/co-habitation make a compelling case for multigenerational housing. Each of these solutions provides maximum flexibility but as these models become more popular, regulation and funding to further develop these alternatives may stall future growth.

Those living in single-family homes will invest capital in their homes as more parents move in with their adult children. Using home office spaces, basements, attics and other existing solutions will make way for more formal renovations including the "granny flat" as either an add-on or standalone. Others may opt for prefab cottages or PODS as solutions that can be moved, stored or re-sold when a senior needs to move to a more comprehensive care community.

Renovation will be a key driver in adaptation for senior housing in both single family homes. The key will be the return on the investment (ROI) but given the uncertainty of the amount of time that an elder may live with their children, it is difficult if not impossible to have a sense of certainty with respect to time. And interesting fact that is emerging, is that the resale value of these modifications will have minimal effect on the value of the home unlike more popular renovations such as kitchens and baths.

As elder abuse grows, so does the need for shelters

noreply@blogger.com (Patricia Grace) — Wed, 11 Jan 2012 14:05:00 +0000

The following USA Today article sheds light on the growing issue of elder abuse.

They're weak, physically or mentally disabled or both, and often at the mercy of people they depend on the most: relatives and caretakers.

They're the nation's fast-growing elderly population, and many are prime targets for abuse — physical, financial, sexual or emotional.

Concern among the elderly and their advocates is mounting as the number of seniors soars and more of them live longer.

The Cedar Village Retirement Community in the Cincinnati suburb of Mason this month opened a long-term care facility to victims of abuse. It is the first elder abuse shelter in Ohio and one of only a half-dozen in the country, all of them funded by non-profit groups.

"There is a genuine recognition by those who are concerned by the abuse of elders that there need to be appropriate safe houses for them to get them out of immediate harm's way," says Sally Hurme, AARP's senior project manager in education and outreach. "Nationally, we've been aware of the need for elder abuse shelters, but they've been slow in coming into fruition."

The first in the nation, the Weinberg Center for Elder Abuse Prevention at the Hebrew Home at Riverdale in the Bronx in New York City opened just seven years ago and serves as a model for the few others.

Read full article at USA Today...

Is there a connection between aspirin and macular degeneration?

noreply@blogger.com (Patricia Grace) — Tue, 10 Jan 2012 23:30:00 +0000

A new study suggests that daily aspirin use among seniors may double their risk of developing a particularly advanced form of age-related macular degeneration, a debilitating eye disease.

The possible link involves the so-called "wet" type of age-related macular degeneration (AMD), a significant cause of blindness in seniors.

Aspirin use was not, however, found to be associated with an increased risk for developing the more common, and usually less advanced, "dry" form of AMD, according to the report published in the January issue of Ophthalmology.

Age-related macular degeneration affects the critical central vision required for reading, driving and general mobility. The damage occurs when the retinal core of the eye (the macula) becomes exposed to leaking or bleeding due to abnormal growth of blood vessels.

While the study uncovered an association between aspirin use and AMD, it did not prove a cause-and-effect relationship.

This point was also made by Dr. Alfred Sommer, a professor of ophthalmology and dean emeritus at the Bloomberg School of Public Health at Johns Hopkins University in Baltimore. He noted that while the study was "well executed," it should not be seen as definitive proof that aspirin use and AMD are linked.

"It is well known that aspirin [and other NSAIDs] can increase the risk of gastric distress and gastric ulcers," Sommer said. "Like any medicine, it should only be taken if needed. But those taking aspirin to prevent heart disease, particularly those at increased risk of heart disease, definitely do benefit and should not change what they do."

For more on age-related macular degeneration, visit the U.S. National Eye Institute

Working dogs...

noreply@blogger.com (Patricia Grace) — Fri, 06 Jan 2012 00:50:00 +0000

Assistance dogs can make life easier for seniors in need.

While most people are familiar with guide dogs that help people who are blind or visually impaired, there are also a variety of assistance dogs trained to help people with physical disabilities, hearing loss and other various medical conditions.

Unlike most pets, assistance dogs are highly trained canine specialists — usually Golden and Labrador retrievers, and German shepherds — that know about 40 to 50 commands, and are amazingly well-behaved and calm.

Here's a breakdown of the different types of assistance dogs and what they can help with:

Service dogs: These dogs are specially trained to help people with physical disabilities due to multiple sclerosis, spinal cord injuries, Parkinson's disease, chronic arthritis and many other disabling conditions. They help by performing tasks their owner cannot do or has trouble doing, like carrying or retrieving items, picking up dropped items, opening and closing doors, turning lights on and off, assisting with dressing and undressing, helping with balance, household chores and more.

Hearing dogs: For those who are deaf or hearing impaired, hearing dogs can alert their owner to specific sounds such as ringing telephones, doorbells, alarm clocks, microwave or oven timers, smoke alarms, approaching sirens, crying babies or when someone calls out their name.

Seizure alert and response dogs: For people with epilepsy or other seizure disorders, these dogs can recognize the signs that their owner is going to have a seizure, and provide them with advance warning, so he or she can get to a safe place or take medication to prevent the seizure or lessen its severity. They are also trained to retrieve medications and use a pre-programemd phone to call for help. These dogs can also be trained to help people with diabetes, panic attacks and various other conditions.

For more information on assistance dogs go to Working Like Dogs an educational website for people who are interested in getting an assistance dog.

6 Time Management Tips for Caregivers

noreply@blogger.com (Patricia Grace) — Wed, 04 Jan 2012 18:00:00 +0000

Caregiver stress is a popular topic these days, and for many caregivers burnout is a very real factor this time of year. I spoke with several people this week who are feeling that they can’t live up to what’s expected of them…that there simply aren’t enough hours in the day to take care of their children, their jobs, their ailing parents, their holiday plans etc.
In order to juggle caregiving responsibilities with all the other demands of daily life, time management strategies can be a life saver. Try these techniques next time you’re feeling overwhelmed:
• Unplug from technology: Laptops and cell phone with Wi-Fi are great, but they make us available to any and all who need us 24/7. Unless that’s part of your job responsibilities, it may be interfering with your ability to relax and enjoy whatever down time you have.
• Make a list: It’s hard to relax when you’re carrying around a mental “To Do” list. Before you go to bed each night, write down all the things you need to take care of the next day. That way you can put them on paper, and let the weight of responsibility go for the night.
• Mono-task instead of multi-task: Our brains can only focus well on one thing at a time. Trying to do too much at one time can cause silly mistakes that take time to correct.
• Start with the most dreaded task on your list: Avoiding an unpleasant task uses up a lot of emotional energy. Attack them first thing instead of worrying about them all day.
• Schedule time to recharge your batteries: Whether its 30 minutes with a cup of coffee and a good book, or 30 minutes at the gym, be sure you give yourself a little “me time” each day.
• Delegate what you can: No one can go it alone. Let your family, friends, and co-workers help when possible.

Weather and temperature changes can trigger COPD symptons

noreply@blogger.com (Patricia Grace) — Tue, 03 Jan 2012 17:50:00 +0000

Weather changes are one of many factors that can trigger your COPD (chronic obstructive pulmonary disease)symptoms. Symptoms of COPD, which include shortness of breath, cough, and phlegm production, tend to get worse for some people when the air is very cold and when it is hot and humid.

"Weather extremes are not good," says Barry Make, MD, co-director of the COPD program at the University of Colorado in Denver. Dr. Make says that temperatures below freezing or above 90 degrees Fahrenheit tend to cause COPD symptoms to flare up.

When It's Cold and Windy -

Cold air and strong winds are known triggers for the worsening of COPD symptoms. Many people with COPD find that cold air can make it harder to breathe, leading to shortness of breath and wheezing. Frigid temperatures can also cause fatigue. "COPD patients just feel like they are more tired after they've been in the cold," explains Make.

Windy days can be practically problematic. "If COPD patients go out when it is windy and have to walk against the wind, there is more resistance," says Make. Therefore, it requires more exertion to walk, which can be difficult for someone with COPD.

If cold and windy climates bother you, try wearing a scarf or face mask loosely over your nose and mouth, and breathe through your nose on wintry days. The winter muffler and breathing through your nose warms the air before it enters your lungs, which can help

Spinal Fluid May Help Diagnose Alzheimer's disease

noreply@blogger.com (Patricia Grace) — Mon, 02 Jan 2012 21:43:00 +0000

Searching for a better screen for early Alzheimer's disease, researchers think they have found a marker of change in the brain that precedes the onset of the disease by five to 10 years.

The indicator of trouble to come, they say, is a shift in the levels of specific components of the cerebrospinal fluid (CSF) in the brain and spinal cord. Among patients already diagnosed with mild cognitive impairment, a drop in such levels appears to be a sign of Alzheimer's years before symptoms develop.

The discovery, published in the January issue of Archives of General Psychiatry, could potentially aid in the use of disease-modifying therapies, which are designed to work best if applied when a patient is still in the early stages of disease.

"These markers can identify individuals at high risk for future [Alzheimer's disease] at least five to 10 years before conversion to dementia," study author Dr. Peder Buchhave, of Lund University and Skane University in Sweden, noted in a journal news release. "Hopefully, new therapies that can retard or even halt progression of the disease will soon be available. Together with an early and accurate diagnosis, such therapies could be initiated before neuronal degeneration is too widespread and patients are already demented."

The study results stem from more than nine years of follow-up to prior research that had involved 137 patients diagnosed with mild cognitive impairment, a mental state that often precedes dementia.

Over the course of the study, nearly 54 percent of the patients went on to develop Alzheimer's, while another 16 percent were ultimately diagnosed with different forms of dementia.

Specifically, among those who developed Alzheimer's, the researchers found that key aspects of their cerebrospinal fluid dropped off in the years before. In addition, other fluid properties actually went up.

The study team said that they believe that about nine out of every 10 patients with mild cognitive impairment who experience such fluid shifts will eventually go on to develop Alzheimer's disease.

Commenting on the study, one expert in the United States said that the new research "provides confirmation of the general concept that CSF can predict the progression of mild memory loss to mild dementia."

Dr. Sam Gandy, associate director of the Mount Sinai Alzheimer's Disease Research Center at Mount Sinai School of Medicine in New York City, added that the results of the European study largely echo those of a trial reported by researchers at the U.S. National Institutes of Health in 2010.

He noted that methods of early detection might prove valuable for research into the treatment of Alzheimer's disease.

"Most new Alzheimer's drugs are aimed at reducing amyloid [protein plaque] accumulation, and the general consensus is that these drugs will only work at early or presymptomatic stages of disease," said Gandy, who is also Mount Sinai Chair in Alzheimer's Disease Research. "The new paper strengthens the likelihood that CSF biomarkers can be useful for identifying that population of subjects with early or presymptomatic disease in order to recruit them into trials."

For more on early signs of Alzheimer's, visit the Alzheimer's Association.

How to Live a Longer, Healthier Life

noreply@blogger.com (Patricia Grace) — Wed, 28 Dec 2011 14:56:00 +0000

Back in 1946, when the first baby boomers were born, it was easy to imagine some sort of magic pill that would promise, if not immortality, at least a very long, happy, and healthy life.

Darn, another hoped dashed. We are living longer, but not always healthier and happier. Given that the ranks of Americans age 65 and older are soon to swell -- from 13 percent to 18 percent by 2030 -- geneticists, physicians, and psychologists are hard at work figuring out what it takes to thrive into old age.
Everyone is aware that they'll probably live longer if they exercise, eat right, and don't smoke. The trick is to get people to do what they know they should.
However, don't get your hopes up about living past 100, should you lack the right genes. Demographic experts had predicted that the proportion of U.S. centenarians would grow over the past decade, but they were wrong. Instead, from 2000 to 2010, the figure held steady: Only about one in 5,000 Americans reached age 100 or above.
For the other 99-plus percent of us, even the best genes will get you only so far. "Genes account for one-fourth to one-third of longevity," estimated Howard Friedman, a professor of psychology at the University of California (Riverside) and the coauthor of The Longevity Project, published this year. "That leaves well over half not accounted for."

Most of the rest, for better or worse, is up to you. "The importance of choices people make is in so many ways responsible for the quality of life in old age," said Charles Reynolds III, a professor of geriatric psychiatry, neurology, and neuroscience at the University of Pittsburgh medical school. "Many people think they should be entitled to a good-quality 25 years after age 60. Well, they're not necessarily entitled, but they can put the odds in their favor."

One way -- "the least speculative and the most obvious" -- is with exercise, according to Simon Melov, a Buck Institute biochemist. "More activity is better than no activity, and most people are not doing anything. They're just sitting there." Exercise, he said, reduces the risk of cardiovascular disease and perhaps even a decline in cognition. One needn't run a marathon. Gardening, walking, swimming, wood-working -- all of these are more active than just sitting.

Although physical fitness is important, so is psychological fitness. "The word I like to describe successful aging is active aging," said geriatric psychiatrist Reynolds. "That means socially, intellectually, and spiritually." Research has shown that people who maintain connections to others -- whether through family, friends, or work -- remain healthier in old age. A study of centenarians found that they had a purpose to their lives -- volunteer work or taking care of grandchildren and great-grandchildren.

But these rules aren't universal. "Everyone ages differently," the National Institute on Aging's Bernard pointed out. "If people who have been lonely and isolated their whole lives, and we say they need to be out and socializing -- but it's not in their nature -- it could be more stress than benefit."

She touts the advantage of preventive care as a larger part of the U.S. medical system, noting studies that show a greater incidence of cancer, heart attacks, strokes, diabetes, and lung disease in older Americans compared with Europeans. Preventive care can even ease depression, a serious problem among the elderly, albeit one that medical professionals often dismiss as natural and not worth treating. Not so, according to Reynolds. Depression can be treated with medication or psychotherapy, thereby improving a patient's physical health. The benefits -- and the downsides -- flow in both directions. "Disability can beget depression," Reynolds said, "and depression can beget disability."

But depression should be distinguished from garden-variety worrying -- and here's a provocative finding: People who fret about things may live longer. "[A] moderate amount of worrying can be good," particularly for men, said Leslie Martin, a psychology professor at La Sierra University in Riverside, California. Research has shown that men who think ahead and plan -- and, yes, worry -- tend to fare better after their wives die. In fact, men who were worriers faced a 50 percent lower risk of dying within the next few years after becoming widowers than men who weren't worriers, Martin reported.

Possibly the reason is that, in many marriages, "the wife is the protector -- telling the husband to get the doctor's checkup, to eat healthier, to wear a seat belt," she explained. "If a guy does more on his own, it may serve him well." This could also explain why men who are happily married tend to live longer than men who aren't, while wedded bliss seems to have no effect on women's longevity.
The role of dumb luck inspires experts to counsel: Don't be too hard on yourself. As federal administrator Bernard put it, "People shouldn't blame themselves if their aging isn't going exactly as they want."

Hey, relax (but not too much). Maybe you'll live longer.

Three ways to cut down on hospital re-admissions

noreply@blogger.com (Patricia Grace) — Tue, 27 Dec 2011 16:14:00 +0000

Hospitals are taking a close look at care transitions in preparation for reimbursement changes that will penalize hospitals for high readmission rates. To avoid Medicare cuts and penalties, hospitals across the country are experimenting with how to better care for patients after discharge.

Offer transition coaches
According to a recent study published in the Archives of Internal Medicine, a Journal of the American of Medical Association, programs designed to help older patients transition from the hospital to home can cut readmission rates. Hospitals that provided a transition coach for patients had a 12.8 percent readmission rate, compared to 20 percent for those without coaches.

New Jersey's Robert Wood Johnson University Hospital Hamilton in October launched a similar program, in which a transition coach visits patients at home, reports NJ Spotlight. The coach provides patients with a daily health record to monitor weight gain, track medication, write down questions for providers and map out personal goals. Although that responsibility has traditionally been on the healthcare provider, the transitional coach program encourages patients to actively manage their own care.

Implement post-discharge clinics
Some hospitals, including Boston's Beth Israel Deaconess Medical Center, are identifying patients who are likely to be readmitted and directing them to post-discharge clinics. At Beth Israel, providers at the post-discharge clinic, located near the hospital, check on patients to make sure they are taking medications and making follow-up appointments, reports Kaiser Health News.

Similarly, Barnes-Jewish Hospital in St. Louis recently launched its post-discharge program, called the Stay Healthy Clinic, for Medicare-eligible patients with chronic obstructive pulmonary disease, pneumonia, heart attack and heart failure. The Stay Healthy Clinic even goes as far as offering patients transportation to the clinic. Still, the program isn't a cure-all for one persistent challenge: Only half of patients show up to their appointments.

"We'll continue to try to tweak" the program, Barnes-Jewish Hospital Chief Medical Officer John Lynch said in the article.

Keep patients out of hospital from the start
Hospitals in areas that have high admission rates also have a high propensity for readmission rates, according a study published last week in the New England Journal of Medicine. The study suggests that more can be done in the beginning of patient care, that is, keeping patients out of the hospital from the get-go.

"I think the notion that we can do better at the point of transition are pretty obvious, but I think what this is saying is that it's really just a start of what we have to do," Dr. Arnold Epstein, one of the researchers at the Harvard School of Public Health, said in a National Journal article.

Researchers of the study don't discourage improvements in discharge planning, but they do suggest that Medicare and other payers reward hospitals for keeping patients out of the hospital altogether, according to the article.

Thinner might not be better when it comes to Alzheimer's disease

noreply@blogger.com (Patricia Grace) — Fri, 23 Dec 2011 14:08:00 +0000

New research suggests that the outer edges of the brain are thinner in older people who may be destined to develop Alzheimer's disease, but there's currently no way to use the information to help people fend off dementia.

Still, the findings could help researchers test Alzheimer's medications by allowing them to track the progression of the disease, said study co-author Dr. Brad Dickerson, an associate professor of neurology at Harvard Medical School.

Alzheimer's disease is the sixth leading cause of death in the United States, according to the Alzheimer's Association, and the number of deaths has risen in recent years. There's no cure for the disease.

In the new study, researchers focused on the thickness of the edges of the brain, known as the cortex. "We're looking at the parts of the cortex that are particularly vulnerable to Alzheimer's disease, parts that are important for memory, problem-solving skills and higher-language functions," Dickerson said.

Previous research found that several areas of the cortex were smaller in people with dementia from Alzheimer's. "It's like an orange that's shriveling. The thickness of the outer skin might get thinner as it dries out," Dickerson said.

In the new study, researchers examined the MRI brain scans of 159 people with an average age of 76; about half were men. Three years later, the participants took tests designed to measure how their brains were functioning.

The findings appear in the Dec. 21 online issue of the journal Neurology.

The 15 percent of participants with the thinnest brain areas performed the worst on the tests: About one in five of them experienced cognitive decline. They also showed increases in signs of abnormal spinal fluid, a possible sign of developing Alzheimer's disease.

"That suggests they may be developing symptoms," Dickerson said.

A lower number -- 7 percent -- of the participants in the middle range of brain thinness experienced cognitive decline. None of the people with the least thin brain areas developed problems.

So are the scans appropriate as tools to figure out whether patients are on the road to Alzheimer's?

Cost doesn't appear to be a major challenge at this point. It's not clear how much the MRI scans might cost at doctor's offices, Dickerson said. However, they're only a few hundred dollars each in the research world.

Also, many older people already receive MRI scans of the brain for other reasons, said Dr. Raj Shah, medical director of the Rush Memory Clinic, in Chicago.

But with no cure for Alzheimer's, the best use for the scans will be to help researchers figure out if medications work, Dickerson said.

Cathy Roe, an assistant professor of neurology at the Knight Alzheimer's Disease Research Center at Washington University School of Medicine, in St. Louis, said the findings could have value down the line. "Right now, there is not much we can do to delay the progression of dementia," said Roe, who's familiar with the findings. "But once effective treatments are identified, this research could help to identify which patients should receive that treatment and when they should receive it."

Calling all snowbirds...

noreply@blogger.com (Patricia Grace) — Wed, 21 Dec 2011 15:20:00 +0000

Here are several tips that can help snowbirds protect their finances and homes while they're away from home for several months.

Prepare your home for winter. Everyone should take some key steps to prepare their home for cold weather and snowstorms, to help avoid expensive damage or homeowners insurance claims. But it's even more important to prepare your house if it will be vacant during the coldest months of the year and you won't be there to notice problems -- such as a small leak that can cause a lot of water damage by the time you return in the spring.

1. Before you leave for Florida, inspect your roof for any damage or worn shingles that can lead to leaks. Also clean gutters and downspouts and checking for clogs that can cause water damage to interior walls. Insulate any water lines that run along exterior walls and open cabinet doors to allow heat from the room to get into concealed spaces, which can make pipes less likely to freeze. Also drain and shut off outdoor water faucets.

2. Trim trees. Winter's high winds and snowstorms can cause a lot of damage from fallen tree limbs -- which can be very expensive and may not be covered by your homeowners insurance policy.Remove dead trees or large overhanging tree limbs before you leave town.

3. Ask someone to shovel snow. Arrange to have a neighbor clean snow from your driveway, sidewalk, hatch cover and dryer vent opening when you're gone, says Montgomery-Baisden. That can prevent melting snow from leaking into the home and causing damage. It can also reduce slip-and-fall liability losses, and prevent your home from looking vacant and becoming a target of thieves.

4. Secure your home. Home security is a big issue if you're away from your house for months. Stop your newspaper delivery and forward your mail to your winter address or have it picked up on a regular basis. Also have someone check the house at least weekly to make sure any flyers or packages that are delivered while you're gone don't build up and make the house look unoccupied. Secure doors and windows with deadbolt locks, and install slide locks or other security locks on sliding glass doors or French doors. You can also install variable light timers, which turn lights on and off at different times to make it look like someone is home.

5. Monitor your house from a distance. Install smoke detectors on at least every floor, preferably tied to a centrally monitored fire alarm system so the fire department will be notified automatically if the alarm goes off. Otherwise, nobody will be home to hear the alarm if it goes off only inside your house. You can get a discount on your homeowners insurance premiums if you have a centrally monitored home-security system. You may even be able to hook up a water-flow sensor or low-temperature sensor to that system, which can alert your security provider of problems that could lead to freezing pipes. But nothing replaces the human touch. Share your winter contact information with a neighbor who can be your eyes and ears while you're gone, forward important mail to you in Florida, check for any problems and take action in an emergency.

6. Notify your bank. Give your bank your temporary address and contact information before you leave, which is important so you can continue to receive your statements and to alert bank representatives about out-of-state debit and credit card charges, says Joe Bednarik, PNC Bank's regional manager of retail banking for Southern New Jersey. Bank fraud departments have become proactive about preventing theft by spotting and denying unusual charges. It's better to let them know of your travels ahead of time rather than run the risk that your account could be frozen temporarily if your financial institution is unable to reach you with questions about charges from an unexpected location.

7. Sign up for online banking. This can be a good time to sign up to receive your bills online, so you don't miss any payment deadlines while your mail catches up with you during your transition from north to south. Check your credit card due dates before you leave to avoid any missed payments.

Technology is playing a greater role in caregiving.

noreply@blogger.com (Patricia Grace) — Fri, 16 Dec 2011 23:52:00 +0000

The senior care industry is increasingly relying on technology to better meet the needs of elders both in senior living facilities and at home. Here are some gadgets, applications, and systems that might be on caregivers’ Christmas lists this year:

1. Memo Touch: The iPad for Seniors

This tablet, a tech gadget similar to the iPad, is designed for seniors with short-term memory loss and provides reminders for to-do lists, taking medication, or keeping scheduled appointments. The Memo Touch also allows seniors or their caregivers to coordinate calendars and schedules, and is marketed as easy-to-use even for those without computer knowledge or skills.

2. Presto: Elder 911 & Elder 411 Applications for the iPhone

Developed by a gerontologist and Presto Services, Inc., these apps provide convenient mobile access to a variety of advice and insights for those who provide care and support to the elderly. Elder 411 is a resource for on-the-spot caregiving information and for planning ahead, covering a full spectrum of caregiving issues including managing financial and legal needs, considering housing options, and keeping the home safe. Elder 911 is for emergency situations like a fall or sudden illness, and provides important information for navigating a variety of crises.

3. eCaring: Home Health Care Management System

eCaring LLC recently launched a home health care management and monitoring system that coordinates seniors’ information about care, conditions, activities, and status among family members, home care providers, and doctors. The system utilizes digital media to allow home care providers to quickly and easily track a patient’s comprehensive information and share it with others outside of the home.

4. Virtual Health: Remotely Monitor Patients’ Vital Signs

Virtual Health now provides subscription-based services that are available nationwide to assist family members caring for seniors who are living independently at home. The platform works directly with an individual’s primary care physician, and allows for monitoring a patient’s vital signs such as blood pressure, weight, and glucose; it also includes video-conferencing technology capabilities.

5. Verizon Wireless: Digital Healthcare Suite for Mobile Care Management

Verizon Wireless has released a virtual care solution that uses smartphones, tablets, and video technology to provide a tool that virtualizes a healthcare visit, eliminating the need to physically visit a doctor’s office for routine consults. It allows healthcare professionals instant access to patient health records, images, and clinical reference information, leveraging high-speed mobile networks and devices to enable greater efficiency and productivity among clinicians.

Brain Changes May Be Tied to Parkinson's Dementia

noreply@blogger.com (Patricia Grace) — Tue, 13 Dec 2011 22:17:00 +0000

Researchers say they've spotted brain abnormalities that may be linked to dementia in people with Parkinson's disease.

Many Parkinson's patients develop dementia and many of those who aren't diagnosed with dementia have mild cognitive impairment (a state that can precede dementia), according to background information in study.

The study used MRI scans of the brains of 84 Parkinson's patients -- 61 with normal mental abilities, 12 with mild cognitive impairment, and 11 with dementia as well as 23 healthy people.

The scans showed that the Parkinson's patients with dementia appeared to have more brain atrophy in the hippocampal, temporal and parietal lobes of the brain. People with Parkinson's and dementia also tended to have decreased prefrontal cortex volume compared to Parkinson's patients without dementia.

Parkinson's patients with mild cognitive impairment had a pattern of brain atrophy that was similar to those with dementia.

The study, which only found associations and cannot prove cause and effect, is published in the December issue of the journal Archives of Neurology.

As awareness of Parkinson's link to dementia grows, insights that can help further research and aid in the care of these patients will become increasingly important, Dr. Daniel Weintraub, of the University of Pennsylvania, Philadelphia, and colleagues said in the study.

Things to know about cold weather and heart disease

noreply@blogger.com (Patricia Grace) — Mon, 12 Dec 2011 15:40:00 +0000

The fall and winter seasons will bring cooler temperatures, and for some, ice and snow. It’s important to know how cold weather can affect your heart, especially if you have cardiovascular disease. People who are outdoors in cold weather should avoid sudden exertion, like lifting a heavy shovel full of snow. Even walking through heavy, wet snow or snow drifts can strain a person's heart.

Many people aren't conditioned to the physical stress of outdoor activities and don't know the dangers of being outdoors in cold weather. Winter sports enthusiasts who don't take certain precautions can suffer accidental hypothermia.

Hypothermia means the body temperature has fallen below 95 degrees Fahrenheit. It occurs when your body can't produce enough energy to keep the internal body temperature warm enough. It can kill you. Heart failure causes most deaths in hypothermia. Symptoms include lack of coordination, mental confusion, slowed reactions, shivering and sleepiness.

The elderly and those with heart disease are at special risk. As people age, their ability to maintain a normal internal body temperature often decreases. Because elderly people seem to be relatively insensitive to moderately cold conditions, they can suffer hypothermia without knowing they're in danger.

People with coronary heart disease often suffer angina pectoris (chest pain or discomfort) when they're in cold weather. Some studies suggest that harsh winter weather may increase a person's risk of heart attack due to overexertion.

Besides cold temperatures, high winds, snow and rain also can steal body heat. Wind is especially dangerous, because it removes the layer of heated air from around your body. At 30 degrees Fahrenheit in a 30-mile wind, the cooling effect is equal to 15 degrees Fahrenheit. Similarly, dampness causes the body to lose heat faster than it would at the same temperature in drier conditions.

To keep warm, wear layers of clothing. This traps air between layers, forming a protective insulation. Also, wear a hat or head scarf. Heat can be lost through your head. And ears are especially prone to frostbite. Keep your hands and feet warm, too, as they tend to lose heat rapidly.

Don't drink alcoholic beverages before going outdoors or when outside. Alcohol gives an initial feeling of warmth, because blood vessels in the skin expand. Heat is then drawn away from the body's vital organs.

Older Driver Safety Awareness Week is Dec. 5 – 9

noreply@blogger.com (Patricia Grace) — Tue, 06 Dec 2011 14:59:00 +0000

December 5 through 9 is Older Driver Safety Awareness Week and Aging with Grace wants to help keep older drivers and their families safe. The first of the baby boomers turn 65 this year, so the population of seniors will be increasing substantially over the next twenty years. According to the AAA most of us can expect to live 7-10 years past our safe driving ability, so safety is going to be a growing issue.

Matt Gurwell founder & CEO, Keeping us Safe, developed “Beyond Driving with Dignity” a workbook for the families of older drivers. It was specifically designed to help your family by providing you with a “road map to success” in your quest to overcome the challenges of an older driver’s safety. It can be used by families as a tool to meet the demands of a potential problem when you become suspect of the senior driver’s ability to remain a safe driver

Timely and appropriate use of this workbook and of all available resources will help keep families from making many of the common mistakes encountered by others as you move toward a possible driving retirement for your loved one.

Working through this instrument will help your family make driving-related decisions that are not only in the best interest of the older driver, but simultaneously find themselves in the best interest of highway safety in general. This workbook was designed to be used by your family in the confidence and comfort of your own home, most likely seated right at your family’s kitchen table.

Now you can give your hospital a check up...

noreply@blogger.com (Patricia Grace) — Mon, 05 Dec 2011 14:15:00 +0000

A new online tool from Medicare can help you evaluate some of the care that hospitals in your area provide to patients.

The service – called, appropriately enough, Hospital Compare – is part of a burgeoning effort within healthcare to give patients, families and medical providers access to more data about treatments and outcomes. At the same time, the information, ideally, encourages hospitals to improve the quality of care they offer.

In specific, the Hospital Compare tool helps users see whether medical facilities are providing some of the care that is recommended for individuals receiving treatment in five categories: heart attack, heart failure, pneumonia, asthma (children only), or patients having surgery.

Read full article.

Is your power of attorney aware of HIPPA regulations?

noreply@blogger.com (Patricia Grace) — Fri, 02 Dec 2011 15:31:00 +0000

With the New Year rapidly approaching now is the perfect time to start getting your financial and legal affairs in order. The following information will explain the differences between a Power of Attorney (POA) and a Durable Healthcare Power of Attorney; and how HIPPA affects both.

A power of attorney (POA) and a health care proxy are two of the most important estate planning documents you can have, but in some instances they may be useless if they don't comply with the federal privacy law.

A POA allows someone you designate (your "agent" or "attorney-in-fact") to make decisions for you if you become incapacitated. A health care proxy specifies who will make medical decisions for you. For these documents to be effective, your agents may need to be able to access your medical information. However, medical information is private. The Health Insurance Portability and Accountability Act (HIPAA) protects health care privacy and prevents disclosure of health care information to unauthorized people. HIPAA authorizes the release of medical information only to a patient's "personal representative."

HIPAA can be a problem especially if you have a durable healthcare power (also known as a "springing POA) attorney. A springing POA doesn't go into effect until you become incapacitated. This means your agent doesn't have any authority until you are declared incompetent, but, under HIPAA, the person won't be able to get the medical information necessary to determine incompetence until the agent has authority.

To make sure your agent doesn't get caught in this "Catch-22", your POA and health care proxy should contain a HIPAA clause that explains that the agent is also the personal representative for the purposes of health care disclosures under HIPAA. You should also sign separate HIPAA release forms that explain what medical information can be disclosed, who can make the disclosure, and to whom the disclosure can be made.

Contact your elder law attorney to make sure your POA and health care proxy do not conflict with HIPAA.

Can you prevent Alzheimer's?

noreply@blogger.com (Patricia Grace) — Thu, 01 Dec 2011 15:17:00 +0000

If you’re like me, every time you forget your keys or the name of a favorite actor playing in an old movie, you start worrying that you’re starting down the long slide to dementia, if not Alzheimer’s disease.

Alzheimer’s and dementia are actually very different issues. Dementia refers to a set of symptoms that include memory loss, impairment of judgment, and difficulty with language. Alzheimer's is a brain disease that accounts for 60 to70 percent of the cases of dementia, but other disorders such as vascular disease and Parkinson’s can also cause dementia.

Over 5 million Americans suffer from Alzheimer’s. And experts estimate that with our aging population, the number of cases will more than triple to over 16 million by 2050.

It’s not surprising that the main risk factors for Alzheimer’s are the same ones that put you at risk for heart disease and overall poor health. The study named seven main pathways to Alzheimer’s: physical inactivity, depression, smoking, mid-life hypertension, mid-life obesity, low education, and diabetes.

Unfortunately, Alzheimer’s disease is still a mystery to medical science. Although there is clearly some genetic component, researchers do not understand what really causes the disease or even exactly what it is. Amyloid plaques are found in the brains of Alzheimer’s victims. But do the plaques cause the disease, or are they merely a symptom? Doctors are working on tests to predict whether or not you will develop Alzheimer’s, but so far there is nothing definitive.

So if you want to prevent Alzheimer’s, stop smoking, get treatment for depression or anxiety, and engage in some sort of physical activity like walking, biking, dancing, or swimming. Go take an adult education class at your community college, join a bridge club, or start doing crossword puzzles. And if you’re overweight, shed some of those extra pounds.

Aging in Place...still the option of choice.

noreply@blogger.com (Patricia Grace) — Tue, 29 Nov 2011 19:20:00 +0000

Retirement communities may have their perks, but Beryl O'Connor says it would be tough to match the birthday surprise she got in her own backyard when she turned 80 this year.

She was tending her garden when two little girls from next door — "my buddies," she calls them — brought her a strawberry shortcake. It underscored why she wants to stay put in the house that she and her husband, who died 18 years ago, purchased in the late 1970s.

"I couldn't just be around old people — that's not my lifestyle," she said. "I'd go out of my mind."

Physically spry and socially active, O'Connor in many respects is the embodiment of "aging in place," growing old in one's own longtime home and remaining engaged in the community rather than moving to a retirement facility.

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According to surveys, aging in place is the overwhelming preference of Americans over 50. But doing it successfully requires both good fortune and support services — things that O'Connor's pleasant hometown of Verona has become increasingly capable of providing.

About 10 miles northwest of Newark, Verona has roughly 13,300 residents nestled into less than 3 square miles. There's a transportation network that takes older people on shopping trips and to medical appointments, and the town is benefiting from a $100,000 federal grant to put in place an aging-in-place program called Verona LIVE.

Administrated by United Jewish Communities of MetroWest New Jersey, the program strives to educate older people about available services to help them address problems and stay active in the community. Its partners include the health and police departments, the rescue squad, the public and public schools, and religious groups.

Among the support services are a home maintenance program with free safety checks and minor home repairs, access to a social worker and job counselor, a walking club and other social activities. In one program, a group of middle-school girls provided one-on-one computer training to about 20 older adults.

Social worker Connie Pifher, Verona's health coordinator, said a crucial part of the overall initiative is educating older people to plan ahead realistically and constantly reassess their prospects for successfully aging in place.

"There are some people who just can do it, especially if they have family support," said Pifher, "And then you run into people who think they can do it, yet really can't. You need to start educating people before a crisis hits."

There's no question that aging in place has broad appeal. According to an Associated Press - LifeGoesStrong.com poll conducted in October, 52 percent of baby boomers said they were unlikely to move someplace new in retirement. In a 2005 survey by AARP, 89 percent of people age 50 and older said they would prefer to remain in their home indefinitely as they age.

That yearning, coupled with a widespread dread of going to a nursing home, has led to a nationwide surge of programs aimed at helping people stay in their neighborhoods longer.

Verona LIVE is a version of one such concept: the Naturally Occurring Retirement Community, or NORC. That can be either a specific housing complex or a larger neighborhood in which many of the residents have aged in place over a long period of time and need a range of support services in order to continue living in their homes.

Verona is an apt setting. Roughly 20 percent of its residents are over 65, compared with 13 percent for New Jersey as a whole.

Another notable initiative is the "village" concept. Members of these nonprofit entities can access specialized programs and services, such as transportation to stores, home health care, or help with household chores, as well as a network of social activities with other members.

About 65 village organizations have formed in the U.S. in recent years, offering varying services and charging membership fees that generally range between $500 and $700 a year.

Read full article...