Study confirms hospital stays decrease cognition in the elderly

Modern hospitals can fix a multitude of ailments. But for older patients, hospitalization may result in a downward slide in one important respect: cognitive function.

That's the finding of a new 12-year study in the journal Neurology, in which researchers interviewed 1,870 seniors periodically to gauge their thinking skills and memory.

Everyone slows down a bit with age, mentally speaking. But patients who were hospitalized during the study slowed down much faster, on average. Their average "global cognition score" decreased at a rate that was 2.4 times greater than the rate of decline for those who were not hospitalized.

Certain other factors also were linked to a faster mental decline, among them older age and severity of illness. But the apparent impact of hospitalization remained statistically significant even after those factors were taken into account. In other words, there seems to be some consequence of hospitalization itself, regardless of how sick the patient is to begin with, said Robert S. Wilson, the study's lead author and a neuropsychologist at Rush University Medical Center in Chicago.

"After hospitalization, on average, people's rates of cognitive decline were the equivalent of being more than 10 years older," Wilson said.

The study did not reveal what might be causing the accelerated decline. But Wilson said the answer is likely to have multiple elements, such as complications from surgery, the impact of medications, and simple inactivity.

"If you're in the hospital for a week or two or more, you're usually pretty physically inactive," Wilson said. "You may be pretty mentally inactive as well. That might not be a good thing."

The switch to an unfamiliar environment may also play a role. There are patients who function fairly well at home, where they know where everything is, but the switch to a hospital setting may "unmask cognitive symptoms in vulnerable older persons," the authors wrote. Even after returning home, such patients may not regain their prior level of function, Wilson said.

Further research could suggest strategies for better hospital care to keep patients sharp, the authors wrote. Or better yet, improvements in primary care so hospitalization is unnecessary.

CLASS Act going nowhere fast...

It seems that the CLASS Act might be cancelled—possibly permanently—after the program’s chief actuarial lost his job, with the remainder of the office’s eight-person staff likely being reassigned to different jobs, reports the Wall Street Journal.

The U.S. Department of Health and Human Services essentially shut down the Obama Administration’s Community Living Assistance Services and Supports office by disbanding the staff, effective last Friday, Sept. 22, chief actuarial Bob Yee told WSJ. However, he says his understanding is that HHS is “slowing” the program’s development, rather than scrapping it altogether.

Earlier, Yee emailed his colleagues informing them he’d be leaving his position after the HHS’s decision to “close down the CLASS office.”

“I believe I have made a contribution to CLASS to the best of my ability and hope I haven’t embarrassed the actuarial profession too much,” said Yee in the email, contained in a Forbes article.

However, HSS disputes that the office is being closed.

“While the staff of the CLASS office has been reduced, reports that the CLASS office is closing are not accurate,” the HHS statement said, included in the WSJ article. “We are continuing our analysis of this program. As we have said in the past, it is an open question whether the program will be implemented. A CLASS program will only be implemented if it is fiscally solvent, self-sustaining, and consistent with the statute.”

The office’s status remains unclear, though.

“Clearly, all the people are reassigned, I’m leaving, so there’s nobody else except maybe the head of the office,” Yee told WSJ.

The CLASS Act has faced opposition from the GOP as being “financially insolvent,” and its implementation has already faced delays.

Read full Wall Street Journal article

Minnesota State Legislature targets assisted living industry

Minnesotan Republican lawmakers are requiring seniors to get counseling prior to entering assisted living or other senior housing as part of a Health and Human Services budget bill meant to slow the state’s spending growth, upsetting many in the senior housing industry.

Section 14 of Minnesota Statutes 2010, section 256B.0911 has been amended to read, “Registered housing with services establishments shall inform all prospective residents of the availability of long-term care consultation and the need to receive and verify the consultation prior to signing a lease or contract,” effectively mandating counseling, rather than offering or recommending it.

This blanket requirement includes seniors who are intending to enter senior housing facilities as private pay residents, and thus demonstrates a governmental overreach, says Maribeth Bersani, the senior vice president of public policy for the Assisted Living Federation of America (ALFA).

“I think we were shocked to see the scope of this bill include private pay residents as well as low-income Medicaid residents,” says Bersani, speaking as well for ALFA’s Minnesota affiliate.

“The fact that the state is requiring [counseling] for private pay residents just seems above and beyond the authority they have,” she says. “As a private pay person you have the right to spend that money the way you want, and to make the long term care decision you want.”

There are many benefits to having people receive education as to long term care options so they can make the “best decision possible,” says Bersani, and ALFA supports this education as long as it isn’t biased toward one form of long term care over another.

The legislation requires the consultation to be performed in a “manner that provides objective and complete information,” but Bersani isn’t sure the Minnesotan lawmakers aren’t just thinking about their bottom line.

“Our concern is that, we’re not sure that the intent is to help people make the best decision for them, but rather for cost savings, and that’s disturbing to us,” she says. “For anybody, you should be able to live in the community that best meets your needs. If that’s the best option for you, you should be allowed to do that.”

Being placed in an appropriate facility is key, says Representative Jim Abeler, chairman of the House Health and Human Services Committee, in a Minnesota Public Radio News article.

“The challenge is to place people in the correct site,” Abeler says in the article. “If you actually do that, it’s actually less expensive and a better quality of life for the people.”

It’s difficult to find information about the range of long term care services, and this initiative helps meet that need, a spokesperson from the Department of Health and Human Services told SHN.

“It’s a service to help people find the services that are best for them,” she says.

Representative Abeler was not available for comment at press time.

Confused by Medicare? Join the club.

Only 46% of seniors and baby boomers have a solid understanding of how Medicare works, and half of people over the age of 60 say they have a poor understanding of healthcare reform, a new report finds.

What's more, 39% of all seniors say their ability to navigate the numerous Medicare options is fair to poor, according to a survey of 1,500 seniors released by UnitedHealthcare and the National Council on Aging.

This lack of knowledge leaves seniors poised to make uninformed choices about their own healthcare, particularly low-income seniors, investigators say. According to the survey, 47% of limited-income seniors have heard of Medicare's Extra Help program, and only 13% have ever applied for help, through it. Fewer than 31% have heard of the Medicare Savings Program.

Depending on the state they live in, seniors who have trouble meeting Medicare premiums and deductibles can apply Medicare Extra Helpand the Medicare Savings Program for assistance with coverage.

Enrollment Period for Medicare Starts Early This Year

The open enrollment period for Medicare will begin earlier this year, so seniors need to start looking at their current plans to decide what coverage they want in 2012, U.S. health officials said Thursday.

The good news is that while benefits will remain essentially the same for the 99.7 percent of Medicare recipients who have access to Medicare Advantage, premiums for that program will fall 4 percent, according to the U.S. Department of Health and Human Services (HHS), which oversees the program.

Meanwhile, overall enrollment is expected to increase 10 percent, health officials said. Although the enrollment period will last longer this year it will end earlier, on Dec. 7 instead of Dec. 31, they added.

"As we continue to implement the Affordable Care Act, we are taking the right approach to Medicare," HHS Secretary Kathleen Sebelius said during a Thursday morning news conference. "An approach that begins by improving benefits instead of cutting them, and continues to slow the growth in costs."

All beneficiaries will have access to Medicare-covered preventive services without a co-pay or deductible, including Annual Wellness Visits, in 2012, Sebelius added. Also, people who reach the donut hole in their drug coverage will get discounts on brand name drugs and expanded coverage for generic drugs as part of the Affordable Care Act, she noted.

Premiums for the Medicare Part D, the prescription drug plan, will remain the same, Sebelius said.

"The Centers for Medicare & Medicaid Services [CMS] is encouraging beneficiaries enrolled in Medicare Advantage and Medicare Prescription Drug plans to review their current health and drug plan coverage for any changes their plans may be making for 2012 before the annual open enrollment period begins on Oct. 15," the agency said.

Speaking at the news conference, Jonathan Blum, deputy administrator and director of CMS, said that in 2012 Medicare Advantage patients will have "better benefits, consistent number of choices and lower average premiums."

For the first time, CMS will reward Medicare Advantage plans with high quality scores through its so called "Five-Star" rating system. Plans that earn these financial rewards will also be allowed to market to and enroll new patients all year long, Blum said.

Those currently enrolled in a Medicare Advantage plan will be automatically switched to original Medicare if they do not choose a plan. But to keep prescription drug coverage, everyone will need to enroll in a Part D plan, the agency stressed.

To learn more about Medicare and Medicare Advantage, visit the Medicare.gov.

Concern Is Growing That The Elderly Get Too Many Medical Tests

Kaiser Health News and The Washington Post collaborated on an article that appears on the KHN website today September 13.

My feelings on this article vary...certainly some very good points made on the issue of over testing. However, I struggle with the fact that the US Preventive Task Force is evaluating what tests are necessary and for whom. I believe this certainly embodies the slippery slope analogy.

Sandra G. Boodman - journalist, Kaiser Health News

Every year like clockwork, Anna Peterson has a mammogram. Peterson, who will turn 80 next year, undergoes screening colonoscopies at three- or five-year intervals as recommended by her doctor, although she has never had cancerous polyps that would warrant such frequent testing. Her 83-year-old husband faithfully gets regular PSA tests to check for prostate cancer.

"I just think it's a good idea," says Peterson, who considers the frequent tests essential to maintaining the couple's mostly good health. The Fairfax County resident brushes aside concerns about the downside of their screenings, which exceed what many experts recommend. "Most older people do what their doctors tell them. People our age tend to be fairly unquestioning."

But increasingly, questions are being raised about the overtesting of older patients, part of a growing skepticism about the widespread practice of routine screening for cancer and other ailments of people in their 70s, 80s and even 90s. Critics say there is little evidence of benefit -- and considerable risk -- from common tests for colon, breast and prostate cancer, particularly for those with serious problems such as heart disease or dementia that are more likely to kill them.

Too often these tests, some doctors and researchers say, trigger a cascade of expensive, anxiety-producing diagnostic procedures and invasive treatments for slow-growing diseases that may never cause problems, leaving patients worse off than if they had never been tested. In other cases, they say, treatment, rather than extending or improving life, actually reduces its quality in the final months.

"An ounce of prevention can be a ton of trouble," observed geriatrician Robert Jayes, an associate professor of medicine at George Washington University School of Medicine. "Screening can label someone with a disease they were blissfully unaware of."

Read full article...

Financial legacy...do all the kids get the same amount?

The following is an excellent article written by Rachel Emma Silverman, The Wall Street Journal, Weekend Investor section.

It is one of the toughest questions parents face when drawing up a will: Should they leave an equal share to each child?

No two members of a family are exactly alike—and parents may well take that into account when drawing up an estate plan. But there is a danger to uneven distributions beyond hurt feelings: Wills that favor one child over another and are executed haphazardly may be vulnerable to legal challenges.

Families take into account many different factors when determining how to distribute their property. One child may be far more successful financially than another. One may have three children of his own, while another may have just one child. You may have a close, loving relationship with one child and be estranged from another.

Many parents want to support children who need more financial help, while others want to repay children who have provided important support or caregiving. Some parents already may have helped one child considerably more than another during his or her lifetime, such as paying for a pricey graduate-school education or providing money for a down payment for a house. Other parents are reluctant to reward a particularly difficult or problematic child.

The upshot: What's fair may not result in an equal split. Read full article.

Older Americans reject senior housing to care for grandchildren

With U.S. households headed by baby boomers commanding almost half of the nation’s total household income, this group is increasingly being asked to step in an raise grandchildren as young adults struggle in the poor economy reports the Washington Post.

Now making up 1 in 4 adults, grandparents are growing in numbers at twice the rate of the overall population, staying in the work force and sticking close to families, according to new census figures. The latest trend of grandparent involvement, reflected in census figures released Thursday, is now being driven also by the economy and the graying U.S. population, including the 78 million boomers born between 1946 and 1964 who began turning 65 this year.

“We help out in terms of running errands, babysitting, taking the grandkids to doctors’ appointments, and for back-to-school shopping,” said Doug Flockhart of Exeter, N.H., listing some of the activities that he and his wife, Eileen, do for their five kids and seven grandchildren. But that’s just the start.

They also pitch in with health care payments for family members due to insurance gaps, and their pace of activity has picked up substantially since their daughter, who lives three blocks away, gave birth to her first child this month. Flockhart, a retired architect, likes the family time even if he and his wife worry about their grandkids’ futures. Their oldest grandchild is 16.

“It’s not so much the day in and day out, it’s the big picture as to how these young kids will grow up and pay for a college education and buy a house,” he said. “The middle class is so much less well-off than it used to be. We’ve put aside some savings for them, but with seven grandchildren it can only go so far.”

These grandparents reject living in senior communities in favor of “aging in place” in their own homes, near family. In 2009, households ages 55 or older spent billions of dollars on infant food, clothes, toys, games, tuition and supplies for grandchildren, according to the Bureau of Labor Statistics.

Once in donut hole, seniors buy less

About 12 percent of people receiving the Medicare prescription drug benefit in 2009 fell into the gap in coverage — the much maligned “doughnut hole” — according to a study released today.

While in the doughnut hole beneficiaries bought fewer drugs, including about 11 percent fewer monthly prescriptions in 2009, compared to when they’re still getting prescriptions subsidized, said the study by the Kaiser Family Foundation. Other studies have shown a similar effect.

Excluding low-income Medicare enrollees who qualify for financial assistance and are not subject to the doughnut hole, there were 19 percent of beneficiaries in the coverage gap in 2009, the study said. That percentage has been shrinking, most likely due to the increase in cheaper generic drugs being offered, the study said.

The doughnut hole in 2009, the latest data in this study, started after the plan and the beneficiary paid a total of $2,700. Then, an individual was responsible for all of their medication costs until he or she had paid $4,350 in out-of-pocket costs.

After they come out of the “hole,” Medicare picks up about 95 percent of the costs. Less than 3 percent of Medicare drug beneficiaries, excluding low-income beneficiaries, reach that catastrophic-coverage level, the study found.

This year, because of the federal health law, beneficiaries are getting a 50 percent discount off brand name drugs while in the doughnut hole. The benefit is important because few Medicare drug plans provide any gap coverage, and those who do charge much higher rates, according to a separate study released by the Kaiser Foundation. This year, beneficiaries also get a 7 percent discount off generic drugs.

In 2012, the 50 percent brand discount remains and the generic drug discount doubles from 7 percent to 14 percent.

Older Americans more comfortable with social networking

The number of adults using social media sites increased to 65%, according to a report from a new national survey by the Pew Research Center’s Internet & American Life Project.

It’s the first time more than 50% of all adults said they’re using the sites, and a dramatic increase from the first survey in 2005, which showed that just 8% of internet users or 5% of all adults said they used them.

While 61% of users aged 30 or older reported they use social networking site on a typical day, it remained relatively flat over the last year. Baby Boomers (ages 50-64) on the other hand reported that social networking site usage on a typical day grew a significant 60% (from 20% to 32%).

“The graying of social networking sites continues, but the oldest users are still far less likely to be making regular use of these tools,” said Mary Madden, Senior Research Specialist and co-author of the report. “While seniors are testing the waters, many Baby Boomers are beginning to make a trip to the social media pool part of their daily routine.”

Usage by those 65 and older grew more than any other group, with 33% of the cohort saying they use the sites, up from 26% last year.

In the past two years, social networking site use among internet users age 65 and older has grown 150%, from 13% in April 2009 to 33% in May 2011. Similarly, during this same time period, use by 50- to 64-year-old internet users doubled—from 25% to 51%.