How to Live a Longer, Healthier Life

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

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

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...

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.

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

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

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

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...

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?

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?

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.