Friday, June 15, 2018

The Menopause-Alzheimer’s Connection

By Lisa Mosconi
Dr. Mosconi is a neuroscientist.
April 18, 2018

In the next three minutes, three people will develop Alzheimer’s disease. Two of them will be women.

There are 5.7 million Alzheimer’s patients in the United States. By 2050, there will probably be as many as 14 million, and twice as many women as men will have the disease.
And yet research into “women’s health” remains largely focused on reproductive fitness and breast cancer. We need to be paying much more attention to the most important aspect of any woman’s future: her ability to think, to recall, to imagine — her brain.

When I first started in the field, Alzheimer’s was thought of as the inevitable consequence of bad genes, aging or both. Today we understand that Alzheimer’s has compound causes, such as age, genetics, high blood pressure and aspects of lifestyle, including diet and exercise. There is also scientific consensus that Alzheimer’s is not always a disease of old age but can start in the brain when people are in their 40s and 50s.

What we are only beginning to understand is why women are more susceptible. What factors differentiate women from men, specifically as we reach middle age?
The first and most obvious thing is fertility. Women are diverse, but we all experience the decline in fertility and the beginning of menopause.

It turns out that menopause affects far more than our childbearing potential. Symptoms like night sweats, hot flashes and depression originate not in the ovaries but largely in the brain. These symptoms are all caused by an ebb in estrogen. The latest research, including my own work, indicates that estrogen serves to protect the female brain from aging. It stimulates neural activity and may help prevent the build up of plaques that are connected to the onset of Alzheimer’s disease. When estrogen levels decline, the female brain becomes much more vulnerable.

To determine this, my colleagues and I used a brain imaging technique called PET on a group of healthy middle-aged women. This allowed us to measure neural activity and the presence of Alzheimer’s plaques. The tests revealed that the women who were postmenopausal had less brain activity and more Alzheimer’s plaques than premenopausal women. More surprising, this was also the case for perimenopausal women — those who were just starting to experience symptoms of menopause. And both groups’ brains showed even more drastic differences when compared with those of healthy men of the same age.

The good news is that as women mature into their 40s and 50s, there seems to be a window of opportunity when it is possible to detect early signs of higher Alzheimer’s risk — by doing a brain-imaging test, as we did — and to take action to reduce that risk.

There is increasing evidence that hormone replacement therapies — mainly, giving women supplemental estrogen — can help to alleviate symptoms if given before menopause. We need much more research to test the efficacy and safety of hormone therapy, which has been tied to an increased risk of heart disease, blood clots and breast cancer in some cases.

Perhaps in the next decade it will become the norm for middle-aged women to receive preventive testing and treatment for Alzheimer’s disease, just as they get mammograms today. In the meantime, research shows that diet can alleviate and mitigate the effects of menopause in women which could minimize the risk of Alzheimer’s.

Many foods naturally boost estrogen production, including soy, flax seeds, chickpeas, garlic and fruit like apricots. Women in particular also need antioxidant nutrients like vitamin C and vitamin E, found in berries, citrus fruits, almonds, raw cacao, Brazil nuts and many leafy green vegetables.

These are first steps, for women and for doctors. But the more we learn about what kicks off and accelerates dementia, the clearer it becomes that we need to take better care of women’s brains. A comprehensive evaluation of women’s health demands thorough investigations of the aging brain, the function of estrogen in protecting it and strategies to prevent Alzheimer’s in women specifically.

No one needs to be reminded that many things make a woman unique. We are working to help make sure that the risk of Alzheimer’s is not one of them.

Lisa Mosconi is the associate director of the Alzheimer’s Prevention Clinic at Weill Cornell Medical College and the author of “Brain Food: The Surprising Science of Eating for Cognitive Power.”

Friday, June 1, 2018

2017 Profile of Older Americans

Reprinted from: ALCA Members Digest, April 30, 2018

A Profile of Older Americans: 2017, an annual summary of the latest statistics on the older population compiled primarily from U.S. Census data, is now available as a web-based publication in a user friendly format along with data tables and charts in Microsoft Excel spreadsheets. Here are some highlights from the 2017 Profile of Older Americans:
  1. Over the past 10 years, the population age 65 and over increased from 37.2 million in 2006 to 49.2 million in 2016 (a 33% increase) and is projected to almost double to 98 million in 2060.
  2. Between 2006 and 2016 the population age 60 and over increased 36% from 50.7 million to 68.7 million.
  3. The 85 and over population is projected to more than double from 6.4 million in 2016 to 14.6 million in 2040 (a 129% increase).
  4. Racial and ethnic minority populations have increased from 6.9 million in 2006 (19% of the older adult population) to 11.1 million in 2016 (23% of older adults) and are projected to increase to 21.1 million in 2030 (28% of older adults).
  5. The number of Americans aged 45-64 – who will reach age 65 over the next two decades – increased by 12% between 2006 and 2016.
  6. About one in every seven, or 15.2%, of the population is an older American.
  7. Persons reaching age 65 have an average life expectancy of an additional 19.4 years (20.6 years for females and 18 years for males).
  8. There were 81,896 persons age 100 and over in 2016 (0.2% of the total age 65 and over population).
  9. Older women outnumber older men at 27.5 million older women to 21.8 million older men.
  10. In 2016, 23% of persons age 65 and over were members of racial or ethnic minority populations -- 9% were African-Americans (not Hispanic), 4% were Asian or Pacific Islander (not Hispanic), 0.5% were Native American (not Hispanic), 0.1% were Native Hawaiian/Pacific Islander, (not Hispanic), and 0.7% of persons 65+ identified themselves as being of two or more races. Persons of Hispanic origin (who maybe of any race) represented 8% of the older population.
  11. A larger percentage of older men are married as compared with older women---70% of men, 46% of women. In 2017, 33% older women were widows.
  12. About 28% (13.8 million) of noninstitutionalized older persons lived alone (9.3 million women, 4.5 million men).
  13. Almost half of older women (45%) age 75 and over lived alone.
  14. The median income of older persons in 2016 was $31,618 for males and $18,380 for females. The real median income (after adjusting for inflation) of all households headed by older people increased by 2.1% (which was not statistically significant) between 2015 and 2016. Households containing families headed by persons age 65 and over reported a median income in 2016 of $58,559.
  15. The major sources of income as reported by older persons in 2015 were Social Security (reported by 84% of older persons), income from assets (reported by 63%), earnings (reported by 29%), private pensions (reported by 37%), and government employee pensions (reported by 16%).

Principal sources of data for the Profile are the U.S. Census Bureau, the National Center for Health Statistics, and the Bureau of Labor Statistics. The Profile incorporates the latest data available but not all items are updated on an annual basis.
This report includes data on the 65 and over population unless otherwise noted. The phrases “older adults” or “older persons” refer to the population age 65 and over.
Numbers in this report may not add up due to rounding.

Sunday, May 6, 2018


Republished from:

Everyone should know about these critical new statistics, because behind each number is a person affected by this disease. That is why, at the Alzheimer's Association, we are working every day to advance critical Alzheimer's and dementia care, support and research.
  • Today, more than 5 million Americans are living with Alzheimer's disease.
  • By 2025 — just seven years from now — the number of people age 65 and older with Alzheimer's dementia is estimated to reach 7.1 million, an increase of almost 29 percent from 2018.
  • This year the total national cost of caring for people with Alzheimer's and other dementias will reach $277 billion.
  • Two-thirds of Americans over age 65 with Alzheimer's (3.4 million) are women.
  • Every 65 seconds, someone in the United States develops Alzheimer's. By mid-century, someone will develop the disease every 33 seconds.

To learn more, please watch this video below:

Tuesday, May 1, 2018

7 Ways to Judge a Retirement Community’s Financial Health


Here are seven key items to focus on when considering a community’s finances.

1.    Occupancy. If 90 percent or more of a homes rooms are full  and have been that way for the past few years  that suggests its doing something right. This is especially important at C.C.R.C.s promising refunds, because you (or your heirs) often don’t get the money back until someone has moved into your old unit.

2.    Rate increases. Lately, most C.C.R.C.s have been increasing their monthly fees by about 3 to 3.5 percent a year, said Justine Vogel, president of RiverWoods, a New Hampshire retirement community. If you see anything above that, ask for an explanation. Similarly, if you find a home where monthly fees have remained unchanged for several years, it may be struggling to maintain its occupancy rate.

3.    Debt rating. Many communities issue bonds to fund expansions or other capital improvements, and Fitch Ratings evaluates them. Ratings of AAA to BBB are considered “investment grade” and should bring a measure of comfort to potential residents.

4.    Profitability. You want a community that usually brings in more cash than it spends. When looking at a retirement home’s financial statements, pay special attention to cash operating expenses as a percentage of cash operating revenue, suggested Amy Castleberry, a director at the investment bank Ziegler and a member of the Financial Advisory Panel of the Commission on Accreditation of Rehabilitation Facilities. A number below 100 means the home is generating enough cash to cover expenses. Communities whose debt gets an investment-grade rating from Fitch have a median score of 96.1 percent.

5.    Capital improvements. Is your community spending enough on its upkeep? One way to gauge this: Find the line for capital spending on its annual financial statement and compare this with the line showing depreciation. Ms. Vogel said she generally liked to see spending equal to at least 50 percent of depreciation, though she conceded that could be way too low if the community hadn’t spent anything in previous years. “You need to combine that info with a visit to the campus,” she said. “How does it look? Does it look like they haven’t replaced the carpet in a while? Is the dining venue outdated?”

6.    Reserves. Find out if the C.C.R.C. performs a regular actuarial valuation, which is a scientific study of its future risks and liabilities. The actuary’s report will give you a sense of whether the community has the reserves, income and cash flow to meet its promise of housing and health care for the rest of your life. You don’t have to read the whole report, said A. V. Powell, an actuary in Atlanta who specializes in retirement communities. “You want to know: Does the study say this community is in satisfactory actuarial balance?” Note that the report’s summary will reveal what kind of fee increases you can expect in the coming years.

7.    Residents’ role. How involved are residents in making major financial decisions? Do they have a couple of seats on the board or at least an active advisory council that works closely with management? “So many residents have extensive backgrounds in finance,” said Brad Breeding, a founder of the MyLifeSite service. “Is it being utilized?”

Sunday, April 15, 2018

One State’s Quest to Introduce Long-Term Care Benefits

Your Money

OLYMPIA, Wash. — For a few weeks this year, the rarest of things seemed like it was about to occur. A state, in this case Washington, was working to pass a bill that would institute a new payroll tax to help cover the cost of a much-needed service: long-term care in a nursing home, in a personal residence or elsewhere in the local community.
Rarer still: At least a couple of Republicans, including one of the bill’s primary sponsors, supported the tax proposal.

Eligible adults were to receive $100 a day from the revenue raised by the tax, for up to 365 days — not typically enough to pay the full cost of nursing home care but potentially helpful in keeping less affluent older people from obliterating their savings and ending up on Medicaid.
Alas, it was not meant to be. As the need to finalize the legislation approached, AARP, citing various unanswered questions, came out against it. Many of the questions involved who would qualify as a caregiver and could receive the $100 per day. Which just goes to show that no matter how great the desire to help America’s aging population, figuring out exactly who should get what and under what circumstances is an enormously complicated issue.

We have a big problem paying for long-term care in this country, although most people don’t wake up to the challenge until it affects their family directly. One in three people who live until at least 65 will reside in a nursing home at some point, according to the Kaiser Family Foundation. Once they settle in, most will be short on money. Medicaid covers at least part of the bill for 62 percent of people who live in a nursing home.

Given that states help pay for Medicaid, legislators are increasingly worried about the growing number of older residents, many of whom don’t even have enough money saved for a comfortable retirement, let alone nursing home bills that can sometimes top $100,000 per year.
A coalition of groups in Washington State saw the generational tidal wave crashing, and they got the ear of two state representatives in particular. The mother-in-law of one, Laurie Jinkins, a Democrat, is 92, has dementia and just qualified for Medicaid.

The father of the other, Norm Johnson, a Republican, used up much of his savings paying for in-home aides for Mr. Johnson’s mother. The elder Mr. Johnson spent so much on care for his wife that by the time he required care of his own, he, too, wound up on Medicaid.
So Ms. Jinkins and Mr. Johnson sponsored a bill calling for a payroll tax on state residents of 0.49 percent, or $22.30 a month on average. (Washington has no state income tax but does have a statewide sales tax.) People who paid into the system over a certain number of years would ultimately become eligible to access the $100-per-day benefit if they could not complete three or more activities of daily living, like dressing or bathing.

They could then take that $100 and put it toward in-home care, adult day care, nursing home fees or similar expenses. After 365 days, they would exhaust the benefit. At that point, Medicaid would still be an option.

Why would a member of the typically tax-averse Republican Party support such a measure? After all, people are supposed to save for their old age, and they can buy long-term care insurance to protect themselves, too.

Mr. Johnson, a former teacher, school counselor and principal, drew on his own life to answer the question.

“We had five sons in my family,” he said. “There is no way we could afford long-term care insurance and raising five kids and paying for a house and school.”

He knows that younger adults might resent the idea of elected officials reaching deeper into citizens’ pockets to pay for benefits that are probably decades away for them. But he said that his experience hd afforded him some perspective.

“You never think you’re going to get old,” he said. “But guess what? I didn’t think that either when I had kids at home, and now I will be 80 in July.”

The way Ms. Jinkins and Mr. Johnson tell it, AARP was supportive until suddenly it was not. “The two people who represent AARP here, neither one had darkened my door,” Mr. Johnson said. “And then the last day, they threw a wrench into things.”

When I contacted AARP, I was told that the group had a number of concerns with the bill and had been expressing them all along. Perhaps the thorniest one involved the question of who qualified as a caregiver and how he or she would become eligible to collect to benefit.
Eligibility is not in dispute in licensed adult day care centers or nursing homes. But many people prefer to stay in their own homes as long as they can, and in some parts of Washington there are not enough licensed in-home caregivers. That means family members pitch in, often sacrificing their own wages to do so.

Everyone in the coalition that supported the bill wanted the people who need care to be able to use the $100-a-day benefit to pay relatives. But not everyone is qualified to provide care, especially if doing so requires lifting a person or treating certain conditions.

Would a spouse have to take a 75-hour class at a cost of hundreds of dollars to qualify as a caregiver? If so, was that too much to ask? How best to train a novice? Could family members train for, say, only 15 hours just to learn the specific skills they needed to help a relative? And if in-person training was required, who would care for an ailing spouse in the meantime?

“The bill needed too much work, and we had too many questions and not enough answers,” said Cathy MacCaul, AARP’s advocacy director in Washington.

Without those answers, AARP would not support the bill as written. And without its support, and with emails arriving from AARP members encouraging “no” votes, lawmakers chose not to move the bill to a full vote.

The State Legislature met in a short session this year. Next year, its session will be longer, allowing more time for negotiation. All sides vow to redouble their efforts in the meantime. But the episode is a reminder of just how slowly new financial benefits creep across the country, hopping from state to state as new legislation is passed.

Hawaii offers some help to certain caregivers, but the Washington bill would establish the first payroll tax where the proceeds go to long-term care more broadly. It could be the difference between some families spending nearly all of their money and ending up on Medicaid or having something left after an older person’s death.

But precisely because it would affect so many people, it’s not going to happen very quickly. “Could we all have dropped everything in our lives and answered all these questions sooner?” asked Doug Shadel, AARP’s state director in Washington. “Maybe. But we’re inventing a new social system to fix a difficult social problem.”

He also offered an olive branch of sorts.

“These two legislators, I know they are frustrated, but I think they showed a lot of courage putting this forward as a bipartisan effort,” he said. “I think they’re going to be seen as pioneers going forward.”

Sunday, April 1, 2018

New Medicare Cards Are Coming Soon

The Centers for Medicare & Medicaid Services (CMS) is in the process of issuing new Medicare Beneficiary Identifiers and Medicare cards to help protect the identities of Medicare beneficiaries. The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 requires CMS to remove beneficiaries’ Social Security Numbers (SSNs) from Medicare cards by April 2019. CMS will be mailing new Medicare cards to current beneficiaries starting in April 2018. All beneficiaries should receive a new card by April 2019. The National Center on Law and Elder Rights (NCLER) has prepared a summary of what advocates need to know about the new Medicare cards to help beneficiaries prepare.

Thursday, March 15, 2018

Dementia & Driving Resource Center (Part 2)

Reprinted from:

Planning ahead
For people in the early stages of Alzheimer's, it is never too soon to plan ahead for how you will get around when you can no longer drive. Putting a plan in place can be an empowering way to make your voice heard.

Tips for planning ahead
Remember that each situation is unique. What works for one person may be different from what works for another. You can get the information and support you need from the Alzheimer's Association at 800.272.3900.
  • Involve family and close friends in the plan.
  • Confront resistance. Empathize with those who are uncomfortable having the conversation and stress the importance of preparing for the future.
  • Develop an agreement for all to share that includes practical safety steps, such as a periodic driving assessment, a GPS monitoring system for the car, and alternate transportation options.

Transportation options
Driving is not the only transportation option available. There are many options people can explore that will allow them to continue to travel independently and remain in control of their mobility.
  • Transition driving responsibilities to others. Arrange for family members and friends to provide transportation.
  • Arrange a taxi service.
  • Use special transportation services for older adults. Access local resources using the Eldercare Locator at or use our Community Resource Finder to search for transportation services.
  • Reduce the need to drive by having prescription medicines, groceries or meals delivered.

Driving evaluation
At the earliest stages, a person with Alzheimer's disease may begin to have difficulty with complex tasks such as driving. Although family and caregivers can watch for signs of unsafe driving, a proactive strategy would be to get a comprehensive driving evaluation by an occupational therapy driving rehabilitation specialist. The evaluation provides a more objective understanding of the current impact of the disease on driving capacity and results in a plan of options. The goal is always to retain the highest level of independence and mobility in the community. Initial recommendations may include strategies to reduce driving risk during the early part of the disease. The occupational therapist can offer strategies specific to the individual's goals and needs. The American Occupational Therapy Association website includes a national database of driving specialists as well as a wealth of resources for both persons with Alzheimer's disease and their families.