January 22nd, 2009

A recent study shows that seniors who moderately consume alcohol lower their odds of developing physical problems. This finding applied to seniors in good health. Subjects in poor or fair health did not see any benefits from alcohol consumption.The study did not examine the causes of these findings.In the study, “seniors” referred to men and women over age 50. Light to moderate drinkers were defined as those who consumed fewer than 15 drinks a week and fewer than five per day (fewer than four daily for women); heavy drinkers were those who consumed 15 or more drinks weekly (or five or more per day); and abstainers were those who drank fewer than 12 alcoholic drinks during the last 12 months.

The researchers, led by Dr. Arun Karlamangla, a geriatrician at the University of California, Los Angeles, analyzed data taken from the National Health and Nutrition Examination Survey’s Epidemiologic Follow-up Study, which included self-reported data from more than 4,200 men and women. About 92 percent of study participants were white; the average study participant was 60 years old.

You can find the study at cnn.com

January 16th, 2009

LAGUNA NIGUEL, Calif.—An 82-year-old woman is missing from an Orange County assisted living home, and a sheriff’s official calls her disappearance “highly suspicious.”
Sheriff’s spokesman Jim Amormino said Wednesday Sara Mowry left behind her walker, purse, hearing aids and medication at the home in Laguna Niguel, making it unlikely that she left on her own.

Mowry’s son reported her missing on Tuesday, when he called her and she didn’t answer, then visited the home and couldn’t find her.

Amormino says Mowry has no dementia or other mental trouble that might lead her to disappear on her own.

Authorities say they are looking at inconsistencies in Mowry’s bank accounts, and searching for a silver 2002 Toyota Tacoma pickup, but would not say how it might be connected to Mowry’s disappearance.

January 16th, 2009

Senior Citizens that are able to sell their homes are increasingly turning to home care vs. assisted living. The national real estate crisis has affected all aspects of life, and long term care is no exception. For many seniors unable to sell their homes, moving to an assisted living facility is no longer financially possible. For this reason, the option of aging-in-place with retrofits is growing in popularity along with utilizing home care assistance. By using caregivers and modifying homes to be friendlier to the aging process, many seniors will be able to remain in their homes for as long as possible - which, according to an AARP housing research report, is exactly what 83 percent of older Americans would choose to do when given a choice.

December 30th, 2008

In more than half of the studies, published since the 1990s, moderate drinkers of wine, beer and liquor had lower dementia risks than nondrinkers. In only a few studies were there increased risks.

“Alcohol is a two-edged sword,” said Michael Collins, Ph.D., a professor and neuroscientist at Loyola University Chicago Stritch School of Medicine and lead author of the refereed report in the journal Alcoholism: Clinical and Experimental Research. “Too much is bad. But a little might actually be helpful.”

Moderate alcohol consumption generally is defined as 1 drink or less per day for women and 1-2 drinks or less per day for men.

The article will be published in the February 2009 issue of the journal, and is available on line now. The article summarizes a roundtable, organized by Collins, held at the Research Society on Alcoholism meetings in Chicago in 2007.

“The pathological damage and vast social havoc from addiction to and abuse of alcohol are well known, and of necessity should continue to receive primary attention by doctors, scientific researchers and health professionals,” Collins and colleagues write. “However, light-to-moderate responsible alcohol consumption “appears to carry certain health benefits.”

Long-term alcohol abuse can cause memory loss and impair cognitive function. It’s unknown why moderate alcohol use appears to have the opposite effect. One theory is that the well-known cardiovascular benefits of moderate alcohol consumption also can reduce the risk of mini strokes that cause dementia.

Collins and another Loyola professor, neuroscientist Edward Neafsey, Ph.D., suggest a second possible explanation. Small amounts of alcohol might, in effect, make brain cells more fit. Alcohol in moderate levels stresses cells and thus toughens them up to cope with major stresses down the road that could cause dementia.

For most people who drink responsibly and in moderation, there’s probably no reason to quit. But because of the potential for alcohol to be abused, Collins and Neafsey do not recommend that abstainers begin drinking. The researchers note there are other things besides moderate drinking that can reduce the risk of dementia, including exercise, green tea, education and a Mediterranean diet high in fruits, vegetables, cereals, beans, nuts and seeds.

Moreover, there are times when people should never drink, including adolescence, pregnancy and before driving, Collins said.

Source: Loyola University

December 22nd, 2008

Emeritus Corp. said it’s closed on its $65 million purchase of five assisted living facilities. The Seattle company said it bought the facilities for $62.5 million, plus transaction costs of $3.3 million, from Ventas Inc., of Chicago. The facilities are located in four states and consist of 432 units.

“We are pleased that, despite the current turmoil in the financial markets, this transaction closed on time and with favorable financing,” said Granger Cobb, Emeritus president and co-CEO, said in a statement.

Emeritus now has 302 assisted living and Alzheimer’s care facilities in 36 states, with 26,700 units and 31,600 residents.

December 20th, 2008

A recent study done by North Carolina State University found that spikes in blood pressure are directly linked to diminished cognitive function among the elderly. This correlation holds especially true for those seniors with already high blood pressure, their report suggests. Study subjects with an average systolic blood pressure of 130 or higher experienced a significant decrease in cognitive function when faced with a sudden spike in blood pressure.

Typically, such spikes occur during stressful moments, report authors say. This suggests that some seniors may find it hard to think rationally or logically during stressful situations. Report authors note that seniors with normal or lower blood pressure do not experience the same diminished cognitive functions under stress. 

Source: Journal of Gerontology: Psychological Sciences.

December 18th, 2008

About 22 percent of the nation’s nearly 16,000 nursing homes received the federal government’s lowest rating in a new five-star system unveiled Thursday, while 12 percent received the highest ranking possible.

A home could obtain up to five stars based on criteria such as staffing and how well they fared in state inspections. The lowest ranking possible was one star. Such a simple rating for so complex a task as caring for the elderly has led to much anxiety in the nursing home industry.

Kerry Weems, acting administrator for the Centers for Medicare and Medicaid Services, said the agency was merely taking existing data already on the agency’s Web site and making it easier for patients and families to evaluate a nursing home. He said it can be difficult for people to understand all the aspects of an inspection.

“This should help consumers in narrowing their choices, but nothing should substitute for visiting a nursing home when making a decision,” Weems said.

Officials also see the new rating system as a way to challenge nursing homes to improve the care they provide to nearly 1.5 million patients nationwide.

“Transparency is key when it comes to nursing home quality,” said Sen. Herb Kohl, D-Wis.

Under the new system, five stars means a nursing home ranks “much above average,” four star indicates “above average,” three means “about average,” two is “below average” with a one indicating “much below average.” The rankings will be updated quarterly. The industry is already questioning their validity.

To nursing home operators, the five-star system is a great idea whose time has not yet come.

The system “is poorly planned, prematurely implemented and hamhandedly rolled out,” said Larry Minnix, president and chief executive officer of the American Association of Homes and Services for the Aging, an industry trade group.

The ratings are based on three major criteria: state inspections, staffing levels and quality measures, such as the percentage of residents with bed sores. The nursing homes will receive stars for each of those categories as well as for their overall quality.

Consumer groups like the concept, but agreed there are some potential problems with the data. For example, the staffing data is self-reported just before state surveys and is widely recognized as unreliable.

“From a consumer viewpoint, it’s not stringent enough,” said Alice H. Hedt, executive director of the National Citizens’ Coalition for Nursing Home Reform. “It’s basically taking information already available on Medicare’s Nursing Home Compare Web site and pulling it into an easier system for consumers to use, and that is a good thing.”

Hedt said consumers should consider the star ratings, but not solely rely on them when comparing facilities. Her organization also warned that nursing homes may appear in the ratings to give better care than they actually do.

“Our initial reaction is that consumers should probably avoid any facility with a one- or two-star rating and even a three-star rating unless people they trust convince them that the rating is inaccurate or unfair,” she said.

But, in Indiana, eight nonprofit nursing homes have reported getting one star for staffing even though they have some of the highest staffing levels in the state, said Jim Leich, president and chief executive officer of the Indiana Association of Homes for the Aging.

The Jennings Center for Older Adults in Garfield Heights, Ohio, got four stars for its nursing home, said Martha Kutik, the center’s president and CEO. Still, she’s worried that the rating system relies on surveys that measure cracks in the ceiling but not patient and family satisfaction.

“Any system that’s going to measure quality for consumers should keep satisfaction high on the list,” Kutik said.

Weems acknowledged that satisfaction levels are an important criteria.

“That’s something we would like to do in the future,” Weems said.

CMS used three year’s worth of inspections to rate nursing homes based on an annual survey designed to measure how well homes protect the health and safety of their residents. The measurement for staffing reports the number of hours of nursing and other staff dedicated per patient each day. The measurement for quality looks at 10 areas, including the percent of patients with bed sores after their first 90 days in the nursing home and the number of residents whose mobility worsened after admission.

States with the highest percentage of nursing homes with a one-star ranking were: Louisiana, 39.6 percent; Georgia, 32.4 percent; Virginia, 32.4 percent; and Tennessee, 30.9 percent.

States with the highest percentage of homes with five stars were: Delaware, 30.2 percent; Alaska, 26.7 percent; New Hampshire, 24.4 percent; and Hawaii, 23.9 percent.

Industry officials said surveys conducted in some states are stricter than others, so they cautioned against using the new ratings to conclude that one state’s nursing homes were better than another’s.

December 12th, 2008

Long before any doctor diagnoses the disease, most people who have Alzheimer’s have done something that is very out of character, embarrassing or even dangerous to themselves or others. The Alzheimer’s label rarely surprises family members or friends—rather, it just gives a name to the changes they have already been witnessing.

When will Alzheimer’s patients have the luxury of getting their diagnosis in the privacy of their doctor’s office, early enough so they can still comprehend the news in time to do something to stop the disease’s progress (assuming treatments become available)? Researchers who are developing the technology for early diagnosis predict that this may happen as soon as five years from now. Here are a few examples of what the scientists are working on:

With a type of magnetic resonance imaging (MRI) used primarily in research studies, researchers compared the brains of two groups of women. A high-risk group in their late 50s had both a family history of dementia as well as the apolipoprotein E4 allele (APOE4), a genetic variant that increases a person’s chances of getting Alzheimer’s. A comparison group in their late 60s had no extra risk factors. All of the women did fine on an extensive set of memory and intelligence tests.

The MRI assessed the brain’s white matter, which is made up of the fibers that connect one brain region to another. Myelin insulates these fibers, but that insulation thins as people age. Despite their normal cognitive abilities, the women carrying the genetic risk for Alzheimer’s had changes in these fibers that were not caused by aging and were similar to those seen in people with the disease.

December 12th, 2008

New research suggests that medical officials often fail to record severe dementia as a cause of death in patients with the condition.

This finding not only points to a lack of knowledge about how dementia — a hallmark of Alzheimer’s disease — can be a deadly illness, it suggests that deaths due to Alzheimer’s and dementia may be severely underestimated, said report co-author Dr. Susan Mitchell, an associate professor of medicine at Harvard Medical School.
“With dementia so underrepresented on death certificates, it further exacerbates the issue of dementia not being a terminal illness,” Mitchell said. In addition, she said, bad assumptions about dementia can lead doctors and relatives to make ill-informed decisions about patients at the end of life.
Alzheimer’s disease is the fifth leading cause of death among people 65 and older in the United States, according to 2004 federal statistics. Those figures were based on information from death certificates, Mitchell said, and some studies have suggested the numbers are too low.
In the new study, Mitchell and her colleagues examined the medical records and death certificates of 165 patients with advanced dementia who died between 2003 and 2007. They all lived in Boston-area nursing homes.
Thirty-seven percent of the death certificates didn’t list dementia as the main cause of death or a contributing factor. Just 16 percent listed dementia as the main cause of death.
In patients with diagnosed Alzheimer’s disease, one-third didn’t mention the condition as a cause of death or contributing factor, the study found.

December 5th, 2008

A new Medicaid regulation gives states “unprecedented flexibility” in configuring their Medicaid programs. Exempted from the rule are nursing home residents, Medicare beneficiaries and medically frail individuals who have freedom of choice in participating in coverage offerings.
The rule, which was issued by the Centers for Medicare & Medicaid Services Wednesday, allows states to place Medicaid beneficiaries in alternative benefit packages called “benchmark plans.” These plans are models states can use in designing their programs. They could carry benefits of a standard Blue Cross/Blue Shield provider plan under the Federal Employees Health Benefit Plan, or state employee coverage, as two examples.
The final rule incorporates some comments that the American Health Care Association made following the release of the proposed rule last February, according to Janice Zalen, senior director of special programs for the American Health Care Association. It states more explicitly that enrollment in a benchmark plan is optional for exempt individuals and they may opt out at any time, she said. AHCA was concerned that two states, which received approval to offer benchmark benefits, did not properly inform elderly people that inclusion was optional.