Aging Care, LLC is an experienced care management company providing assistance and guidance to individuals and families throughout Central Connecticut and outlying areas. Directed by Joanne Foss, a registered nurse with over 25 years of experience, our goal is to coordinate the right care delivered by the right person at the right time.
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
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.”
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
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.
Between 2006 and 2016 the population age 60 and over
increased 36% from 50.7 million to 68.7 million.
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).
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).
The number of Americans aged 45-64 – who will reach age 65
over the next two decades – increased by 12% between 2006 and 2016.
About one in every seven, or 15.2%, of the population is an
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).
There were 81,896 persons age 100 and over in 2016 (0.2% of
the total age 65 and over population).
Older women outnumber older men at 27.5 million older women
to 21.8 million older men.
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
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
About 28% (13.8 million) of noninstitutionalized older
persons lived alone (9.3 million women, 4.5 million men).
Almost half of older women (45%) age 75 and over lived
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
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.
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
Here are seven key items to focus on when considering a community’s finances.
1.Occupancy. If 90 percent or more of a home’s rooms are full — and have been that way for the past few years — that suggests it’s 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?”
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
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
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
“The bill needed too much work, and we had too many
questions and not enough answers,” said Cathy MacCaul, AARP’s advocacy director
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.”
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.
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.
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 www.eldercare.gov
or use our Community Resource Finder to search for transportation services.
Reduce the need to drive by having prescription
medicines, groceries or meals delivered.
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.