Healthy Older Adults With Subjective Memory Loss May Be At Increased Risk For Mild Cognitive Impairment And Dementia

Forgot where you put your car keys? Having trouble recalling your colleague's name? If so, this may be a symptom of subjective cognitive impairment (SCI), the earliest sign of cognitive decline marked by situations such as when a person recognizes they can't remember a name like they used to or where they recently placed important objects the way they used to. Studies have shown that SCI is experienced by between one-quarter and one-half of the population over the age of 65. A new study, published in the January 11, 2010, issue of the journal Alzheimer's & Dementia, finds that healthy older adults reporting SCI are 4.5 times more likely to progress to the more advanced memory-loss stages of mild cognitive impairment (MCI) or dementia than those free of SCI.

The long-term study completed by researchers at NYU Langone Medical Center tracked 213 adults with and without SCI over an average of seven years, with data collection taking nearly two decades. Further cognitive decline to MCI or dementia was observed in 54 percent of SCI persons, while only in 15 percent of persons free of SCI.

"This is the first study to use mild cognitive impairment as well as dementia as an outcome criterion to demonstrate the outcome of SCI as a possible forerunner of eventual Alzheimer's disease," said Barry Reisberg, MD, professor of psychiatry, director of the Fisher Alzheimer's Disease Program and director, Clinical Core, NYU Alzheimer's Disease Center at NYU Langone Medical Center. "The findings indicate that a significant percentage of people with early subjective symptoms may experience further cognitive decline, whereas few persons without these symptoms decline. If decline does occur in those without SCI symptoms, it takes considerably longer than for those with subjective cognitive symptoms."

According to the authors, scientists and physicians can now target the prevention of eventual Alzheimer's disease in the SCI stage, beginning more than 20 years before dementia becomes evident

"These intriguing results more fully describe the possible relationship between early signs of memory loss and development of more serious impairment. This is critical to know, as we look for ways to define who is at risk and for whom the earliest interventions might be successful," said Neil Buckholtz, PhD, National Institute on Aging (NIA) which supported the research. "These findings also underscore the importance of clinicians' asking about, and listening to, concerns regarding changes in cognition and memory among their aging patients."

Co-authors of Dr. Reisberg at the NYU Alzheimer's Disease Center include Melanie B. Shulman, MD, Carol Torossian, PsyD, and Wei Zhu, PhD.

Primary funding for this study was provided by the NIA, which is part of the National Institutes of Health. Additional funding was provided by Mr. Leonard Litwin and the Fisher Alzheimer's Research Foundation.

Article Date: 08 Jan 2010 Source: NYU Langone Medical Center

Why Older Americans Will Have to Wait for Swine-Flu Shots by Betsy McKay

On a visit to his doctor last week for a blood-pressure check, Neil Johnson, a former mortgage lender, dutifully got his annual flu shot. Having suffered from flu in the past—"you ache, you cough...you have fever all over"—he wanted to make sure to get his shot early.

But Mr. Johnson, an 81-year-old resident of an assisted-living facility in Sandy Springs, Ga., will have to wait quite a while before he can roll up his sleeve for a vaccine against this season's best-known virus: the H1N1 swine flu. People age 65 and older are nearly last in line for that shot.

Older Americans are normally at the front of the queue for shots against the seasonal flu viruses that circulate every fall and winter, and public-health officials and doctors strongly urge them to get one each year. There's little wonder why: An estimated 36,000 people die in the U.S. every year from the seasonal flu, and 90% of them are 65 or older.

Perk of Age
But so far the new H1N1 flu is largely sparing the 60-plus demographic, instead hitting children and young adults the hardest. While it has spread like wildfire through secondary schools and colleges, and claimed more than 2,800 lives world-wide, few older people have even gotten sick.

That's because many people 60 and older were exposed to H1N1 viruses that circulated between 1918 and 1957. Those earlier viruses were similar to the new H1N1 virus, so the immunity that some people built up then is helping them now.

A study by scientists at the Centers for Disease Control and Prevention found that about one-third of adults age 60 and older had antibodies that protected them against the new H1N1 virus. By contrast, children had none.

The pattern is similar to one seen in the deadly 1918 pandemic, in which death rates were highest among young adults, according to infectious-disease experts. One possible reason is that older adults had been exposed to similar flu viruses in the 1800s.

Be Patient
With the risk of infection lower for older adults, federal health officials are allotting the swine-flue vaccine first to pregnant women, children and young adults, and anyone under 65 with asthma, diabetes or another medical condition that can increase their risk of complications from the flu. The CDC says older adults should be offered the vaccine only when there's enough medicine for all the other priority groups.

That's likely to take a few months. The federal government expects to receive and distribute 195 million doses of swine-flu vaccine by year-end. Officials estimate that 159 million people make up the top-priority groups—not including older adults—though not everyone in those groups is likely to opt for a shot. The new vaccine is free, and many insurance companies have said they will cover administration fees for the shot.

Budgie Amparo, senior vice president of quality and risk management for Emeritus Corp., which operates senior-living facilities, including the facility where Mr. Johnson lives, says it's working on getting swine-flu vaccine for its residents as quickly as it can through its regular supplier of seasonal-flu shots. "We've taken some proactive steps," Mr. Amparo says. "We were reassured that once it's available, we're going to get it."

Extra Precautions
In the meantime, nurses at Emeritus properties plan to spend more time educating residents about ways to protect themselves from the flu, such as washing their hands, Mr. Amparo says. They will also more actively monitor residents' health, to reduce their chances of complications should they get the flu. "We want to make sure we're managing their overall medical condition," helping residents get medications in a timely fashion, or helping those with respiratory conditions such as asthma see doctors quickly, he says.

One reason for the extra precautions: While older adults account for the fewest U.S. cases of swine flu, the proportion of those who have died is higher than for other age groups, according to CDC data. "Once you do get infected, your risk is higher," says Charlotte Yeh, chief medical officer for AARP Services Inc., part of the Washington-based advocacy group. Many older Americans have chronic conditions that affect their immune status, making it harder to fight off any flu, she says.

Moreover, the seasonal-flu vaccine may not offer full protection this year against a long-circulating virus that traditionally is linked with more hospitalizations and deaths among older adults than other strains. A new variant of the H3N2 seasonal flu virus has been identified on several continents that differs from the H3N2 strain covered by this year's vaccine. So far it's in the minority of H3N2 circulating viruses, and it's unclear how widely it will circulate in the U.S. this flu season, particularly given the current dominance of the swine-flu virus. But officials at the CDC and the World Health Organization say they're keeping a close eye on it.

Doctors can't quickly determine what strain of flu a patient has. "If you come in with all the signs of flu, we can't tell you which flu you have," Dr. Yeh says. "The critical thing is that if you have fever, aches, congestion, cough, dizziness, that is something you should talk with your doctor about." A doctor may prescribe an antiviral such as Tamiflu, which can't cure the flu but can shorten its duration and severity if started early.

Read Why Older Americans Will Have to Wait for Swine-Flu Shots for more information.

By Betsy McKay is deputy chief of The Wall Street Journal's Atlanta bureau.

Irrevocable Trusts and the Reverse Mortgage Opportunity

Irrevocable trusts can now be used for reverse mortgages, according to Paul N. Lovegrove Esq., President of Attorney Trust Review.

While traditionally reverse mortgages have not been permissible if the home is in an irrevocable trust, Lovegrove says there is no basis for the policy, adding that there is, “Nothing in the HECM guidelines that says you can’t use an irrevocable trust.”

Although lenders cant sell a reverse mortgage with an irrevocable trust to Fannie Mae, the recent growth of Ginnie Mae’s HMBS program has provided an opportunity for HECMs.

Lovegrove, an attorney who has been closing reverse loans for thirteen years and performs trust reviews for many lenders, including MetLife, proposes drawing up an agreement to the irrevocable trust that is agreed upon by all parties as a way to comply with the guideline.

An irrevocable trust may also not qualify for a reverse mortgage if one of the current beneficiaries does not meet HECM guidelines, amongst other things. All current beneficiaries of a trust must be HECM eligible for a HECM to be done on the home.

In addition, irrevocable trusts can pose a problem when the trust does not allow invasion of the principle by the settler. However, a lump sum distribution deposited into a bank account controlled by the estate can help solve this issue.

Lovegrove thinks that banks are not doing reverse mortgages on irrevocable trusts because they “never thought they could.” But Lovegrove adds, “By saying we can’t do it that’s closing out a lot of potential business that’s out there.”

By Reva Minkoff, Reverse Mortgage Daily, January 06, 2010

HBO Documentary Titled "The Alzheimer's Project"

One of the most devastating forms of memory loss is Alzheimer's disease, an irreversible and progressive brain disorder that slowly destroys memory and thinking skills. Today, Alzheimer's is the second most-feared illness in America, following cancer, and may affect as many as five million Americans. As the baby-boom generation moves through retirement, that number could soar to more than 11 million by 2040, and have a huge economic impact on America's already fragile healthcare system.

While there is no cure for the disease, THE ALZHEIMER'S PROJECT shows there is now genuine reason to be optimistic about the future. Created by the award-winning team behind HBO's acclaimed "Addiction" project, this multi-platform series takes a close look at groundbreaking discoveries made by the country's leading scientists, as well as the effects of this debilitating and fatal disease both on those with Alzheimer's and on their families.

Scientific research is gaining momentum in discovering ways to treat and possibly prevent Alzheimer's. Aiming to bring a new understanding, THE ALZHEIMER'S PROJECT features a four-part documentary series, 15 short supplemental films, a robust website, and a nationwide community-based information and outreach campaign. A book published by Public Affairs Books was developed by the producers as a companion to the project. HBO will use all of its platforms, including the HBO main service, multiplex channels, HBO On Demand, HBO Podcasts, hbo.com, HBO Channel on YouTube, and DVD sales to support the project. In addition, all films will stream free of charge on hbo.com and will be offered for free on multiple platforms by participating television service providers.

"The Alzheimer's research community welcomed the opportunity to collaborate with HBO, seeking to raise new awareness and understanding of this devastating disease," says Richard J. Hodes, M.D., director of the National Institute on Aging, the component of the National Institutes of Health leading the federal Alzheimer's disease research program. "There is a compelling story to tell of scientific discovery, of research advances and challenges, and of the human faces behind the disease."

The first of the four documentaries in THE ALZHEIMER'S PROJECT is "The Memory Loss Tapes" (debuting May 10), which provides an up-close and personal look at seven individuals living with Alzheimer's, across the full spectrum of the progression of the disease. "Momentum In Science" (May 11 and 12) is a two-part state-of-the-science film that takes viewers inside the laboratories and clinics of 25 leading scientists and physicians, revealing some of the most cutting-edge research advances. "'Grandpa, Do You Know Who I Am?' with Maria Shriver" (May 11) captures what it means to be a child or grandchild of one with Alzheimer's, while "Caregivers" (May 12) highlights the sacrifices and successes of people who experience their loved one's descent into dementia.

THE ALZHEIMER'S PROJECT is a presentation of HBO Documentary Films and the National Institute on Aging at the National Institutes of Health in association with the Alzheimer's Association®, Fidelity® Charitable Gift Fund, and Geoffrey Beene Gives Back® Alzheimer's Initiative. The series' producer is John Hoffman; the executive producers are Sheila Nevins and Maria Shriver.

Premieres May 10-12 on HBO. For more information, please visit http://www.hbo.com/alzheimers/index.html.

Little-known veterans benefit can really help

DALLAS - At 83, Byrdeen Goldsmith can still harmonize. To look at her, you wouldn't know she has Alzheimer's, but she can't live on her own.

A year ago, her daughter Betty moved Byrdeen into an assisted living facility in Dallas, and got an unexpected assist from the government.

"It's thrilling," says Betty about the veterans' benefit that helps her mom. "It's a real blessing. It's just something you didn't expect."

Byrdeen's husband, Hubbard, served in World War II, a Navy medic in the invasion of Sicily. Because of that service, Byrdeen gets about $900 a month, one-quarter of the cost of her care. The other $3,000 comes out of Betty and husband Ted's savings each month.

"The financial burden is stressful enough, then you have the emotional stress on top of it," says Betty.

It's called the Aid and Attendance benefit, for at home, assisted living, or nursing home care. Facility director Michael Halliburton says it never fails to surprise families.

"It's shock and awe," he says. "Their eyes light up; their jaws drop. I've had people cry. I've had people hug and kiss me. It can really make the difference as to whether someone can afford the services."

But the program is little known. Today, just 143,000 veterans or surviving spouses receive the benefit. The government says hundreds of thousands more could be eligible.

"We know that about 36 percent of veterans either didn't know about the program or thought they weren't entitled," says Brad Mayes with Veterans Affairs.

Eligibility is based on need, but you don't have to be impoverished. The formula includes your income, minus medical expenses, and your net worth, excluding your house and car. The benefit is available to veterans who served during wartime and their spouses, if they cannot live on their own.

It's a benefit that is now one more part of Betty's father's legacy.

"I think he'd be proud of the fact that his service was being honored," says Betty.

Hubbard Goldsmith helped his country then; his country helps his wife now.

By Anne Thompson, Chief environmental correspondent, NBC News, Feb. 26, 2007

The unseen costs of eldercare: employers can help employees help their aging parents, and save money in the process

Sally the Sales Rep is a smart, dedicated worker who almost always provides her employer with excellent service. Sometimes she can't, though, because she's distracted by obligations relating to her elderly father. Does her company help her out? No. Does it wind up paying, anyway? You bet.

A new study prepared for Metropolitan Life Insurance Company quantifies how much employers are paying, whether they know it or not, for employees with eldercare responsibilities. MetLife's position is that offering eldercare benefits is fiscally wise. It finds that employers stand to save $3 to $5 for every dollar they spend helping employees find eldercare resources. "We tell employers: "This is a real problem for you,'" says James Weil, vice president of MetLife's mature market group. "If you think about the leading edge of baby boomers just hitting age 50, you can see that more and more employees are going to be affected by aging parents."

In a study that applied a model of eldercare costs to an anonymous manufacturing firm with about 87,000 salaried employees, Sally Coberly, director of the Washington Business Group on Health and Gail Hunt of Gibson-Hunt Associates, found that total annual employer costs ran to $5.5 million. The analysis prepared for MetLife estimates that 2 percent of the firm's employees provide actual physical help to older relatives in the form of assistance with eating, bathing, dressing, and so on.

The 2 percent estimate is conservative. It takes into account the fact that the manufacturer has a highly male-skewed work force; it doesn't include those who provide less intensive services to parents such as shopping and financial assistance, and it doesn't include costs incurred by employees who provide long-distance support to aging parents. Since women are much more likely than men to provide eldercare, organizations with larger shares of women employees can expect higher eldercare-related costs. Using a more liberal 12 percent prevalence of caregivers in the work force would crank up estimated employer costs for the study firm to $33 million.

Various factors feed into the price employers pay for eldercare. In the manufacturing case study, replacement costs stemmed from the estimated 1 percent of caregiving employees who quit their jobs altogether to care for an older parent. An estimated 11 percent of caregivers take off an average of six days a year to provide routine care, while over half of caregivers average three days a year dealing with eldercare crises. Other costs include extra managerial time needed to supervise caregivers, as well as the high demand placed by some caregivers on health insurance benefits and mental health services.

Partial absenteeism--late arrivals, long lunch breaks, early departures--takes its toll, too, but not nearly as much as the workday interruptions faced by caregivers who talk on the phone with loved ones and service providers. This situation can arise even with employees who don't physically care for parents or whose parents live elsewhere. Estimated at one hour per week per caregiver, this factor is the biggest drain of all on employee productivity, amounting to over half of the estimated total cost to the manufacturing firm analyzed in the study.

Employers can ameliorate many of these costs without too much trouble or expense by offering resource and referral hotlines that guide workers toward adult day care, meals on wheels, and other services. This type of benefit costs as little as 50 cents to $1 per employee, says MetLife's Weil. Today, about 1,200 corporations in the U.S. offer such resource programs. Two of the best, according to Hunt, are provided by Marriott International and IBM.

Since Mariott's business depends on customer service, the mood of its employees is extremely important, says Donna Klein, director of the corporation's worklife programs. Marriott tested its Associate Resource Line for nearly two years. Now, any of its 185,000 employees nationwide can dial a toll-free number any time of the day or night and consult in one of many languages with professional social workers about a wide range of personal problems.

"We want our resource line to handle anything and everything that may be happening in the employee's life that could affect his or her productivity," says Klein. The average Mariott worker is just 35, but 15 percent say they have eldercare responsibilities. During the test period, eldercare issues accounted for 8 percent of calls. As American workers and their parents get older, that number is bound to grow.

"The MetLife Study of Employer Costs for Working Caregivers" is available at no charge from MetLife Senior Services; telephone (203) 221-6580.

American Demographics, 06/01/96 by Tibbett L. Speer

Employee Assistance Program - The University of Vermont

Eldercare Resources

The American family is undergoing historic changes. Because of an unprecedented demographic shift, we are changing from a young to an old society. We live at a time of unprecedented increase in life expectancy the average expectancy is 76 years. The National Institute of Aging predicts that by 2040 the number of Americans 85 and over could grow to more than 30 million (UVM Center for the Study of Aging). This trend has been called the "age wave," and it is forcing critical changes in the way we live and work, and in how we care for those we love. One of the most dramatic changes is in the number of people who are responsible for elder care. A study by the American Society on Aging estimates that approximately 25 million Americans are now caring for a parent or older loved one. Between one-third to one-half of all caregivers are also employed outside the home.

Working caregivers sacrifice leisure time, and often suffer stress-related illnesses. Negative effects on working caregivers include time lost from work, lower productivity, quitting a job to give care, lost career opportunities and lower future earnings. Eventually, some 12 percent quit their jobs to provide care full-time. Recent research indicates the costs to employers averages $2500 per worker involved in care giving (Scharlach, Lowe and Schneider, 1991). Nationally, recent research indicates the loss in productivity costs businesses between 11.4 billion dollars and 29 billion dollars annually (Metropolitan Life, 1997). When elder care issues arise, you need to act as early as you can. You need to know what questions to ask, what kind of help is available and what is most appropriate. (For example, your elder may not need to go into a nursing home; all that may be required is to safety-proof his/her own home, or bring in someone to do household chores, for a fraction of the cost.)

Many faculty and staff find themselves in conflict with their career and job responsibilities and those of being parents and having aging and increasingly dependent parents. By offering these resources and EAP services at the workplace, you will be provided the information, support and consultation that will decrease your stress levels and allow you to give better care and support to your family.

The Strain on Caregivers

If you feel that caring for a loved one has increased your stress level, you are not alone. In fact, many caregivers are at a higher risk of illness and injury than their non-caregiving counterparts. Sixty percent of caregivers report physical strain as a result of caregiving, and many others report anxiety, depression, substance abuse and weight changes as a direct result of caregiving.

The stresses of caregiving are not just physical, they are emotional and financial as well. Eighty percent of caregivers report a great deal of emotional strain brought on by caregiving. Financial burdens and concerns about work surely contribute to this strain.

http://www.uvm.edu/~uvmeap/?Page=eldercare.html&SM=eldermenu.html