Assistive Listening Devicess Can Improve Quality of Life

Just  listening to a show on the television and radio, using a phone, or even answering the doorbell are activities that many of us take for granted, but if you are hard of hearing these things are a real challenge. Assistive Listening Devices (ALD) can help improve your daily life. Here is a look at how to choose the best device to suit your particular  needs.

Hearing Aids

Many people who are hard of hearing often wear hearing aids to improve their listening in their everyday life, but these might not always work very well, especially if you are driving or are in a noisy environment such as a restaurant. Hearing aids, unfortunately, are not 100% perfect and may you need an additional device such as an Assistive Listening Device to help hear clearly. Using the two together will bring about a significant improvement.

The Benefits of Assistive Listening Devices

Assisted Listening Devices have several benefits for those who are hard of hearing

* Wide range of devices to choose from. From phone amplifiers to TV listeners, there are devices to improve your everyday life. You can even get specific aids such as baby monitors and smoke alarms.

* ALDs bring distant sounds to your ears, so it almost appears that someone is talking into both of yours at the same time, making sound that much clearer.

* ALDs cut out background noise. Microphones are much closer to the speaker’s mouth than other devices, so you only pick up the sounds going into the microphone, not anything else. Meetings, restaurants and parties become much more enjoyable with an ALD.

* Many ALDs are portable. You can take a personal amplifier wherever you go.

The Downsides

There are some downsides to ALDs which users need to be aware of:

* Some ALDs can be expensive.

* Battery powered devices may need frequent battery changes.

* You may also still need to use a hearing aid with them.

Types of ALDs available

There are several kinds of ALDs available to buy. They use several types of technology to help you listen. No technology is absolutely perfect and you may find some types work better than others. Choose one suited to your needs, budget and accommodation/situation. Technologies available include personal amplifiers, radio systems, induction loop systems and Bluetooth systems.

* Personal amplifiers are small portable devices which amplify ambient sound that occurs in social situations such as in the cinema, group conversations and watching TV. These amplifiers can be used with an induction loop system for the hard of hearing in public spaces – you don’t even need to use your hearing aid.

If you are having a meeting or personal conversation, you can also clip a lapel microphone to the person you are speaking to, plug it into your personal amplifier, attach a neck loop and listen to the person through the t-coils in your hearing aids. This helps to significantly reduce any background noise. The downside to this is that you are wired together and can’t move around easily.

* Radio systems use radio waves to send sound to your device. Because they have no wires, you have greater freedom of movement and range. You can sit at the back of a lecture theatre, for example, and listen to the lecturer. You do need to ensure the speaker will wear your transmitter/microphone.

You can also buy TV amplifiers which use radio technology and are ideal if you don’t want to trip over any wires. Doorbells, telephones and alarms are other devices which use this technology.

* Induction Loop systems use magnetic fields to send sound from the speaker to your ears. These are often the most affordable devices. You need to have a hearing aid which has t-coils to use them.

You can buy neck loops to wear around your neck for personal use and install a room loop to help hear the TV. With these loops, you can hear it anywhere in the room.

* Bluetooth systems use Bluetooth technology to listen to devices even if they are in your pocket or bag. They are perfect for use with mobile phones and laptops.

* While not a technology, telephone amplifiers are available to help increase the caller’s voice.

It is probably fair to say on the evidence available that  ALDs can improve the quality of life for the hard of hearing. The range of devices available can help improve your listening wherever you are and make everyday tasks that bit more accessible once again.

The is a guest post from Samantha Harvey of Sarabec Hearing Products.

Emergencies and the Elderly

During the pst several years there have been an adbundance of natural disasters leading to widespread destruction, injury, and death. Fires cuased by persistent drought, floods, tornadoes, and earthquakes have brought about terrible consequences and demonstrated the need for all of us to be ready for natural disasters. Obviously, these events place elders at even greater risk, especially those who may suffer from chronic disease,s have limited mobility, or be dependent upon caregivers for daily support. The key to dealing with emergencies is to preparation and planning well before a disaster strikes. The U.S. Department of Health and Human Services offers these suggestions:

Step 1 – Know the basics. Learn about the risks your particular community faces; know how to do things like turning off your gas and electricity; get to know your neighbors.

Step 2 – Have your emergency supplies ready. This includes items you would need to survive in your home until help arrives; it should also include a personal evacuation bag, partially packed and ready to go.

Step 3 – Make a personal plan. Many older persons have special needs relating to medications, medical equipment, mobility, and support services; making a personal emergency readiness plan increases the likelihood that essential needs will still be met, even in an emergency situation.

GETTING STARTED

Somewhere in your home you probably already have an emergency readiness checklist – one you’ve clipped out of the paper, or a family member gave you, or you downloaded off the Internet. A checklist can help you get started and know you’ve taken the steps you should be taking. The form we include as a supplement to Aging in Stride is attached and is also available as a free download at www.AgingInStride.org.

As our Checklist suggests, emergency preparedness for yourself or your loved one doesn’t have to be complicated. Think of it as a simple, threestep process.

STEP 1: KNOW THE BASICS

As we’ve all learned from years of experience, the first ingredient in preparing for almost anything is a little practical information. Start by learning what kinds of risks your community faces. Do you live on the Atlantic or Gulf Coast where hurricanes are a concern? Are you in an earthquake zone? What about tornadoes? Do you live near a nuclear power plant or chemical storage complex? Knowing what risks you face will help you prepare. If disasters that strike with little or no warning (such as earthquake, tsunami, or tornado) are a risk for your community, you’ll want to know exactly what to do as your first response. These days, information on emergency planning for your community should be easy to find. Search on the Web; stop by the library or city hall; or ask at your area’s emergency management agency or fire department.

Our Checklist suggests you test your readiness by asking – and being able to answer – these questions:

❏  If there were an evacuation order, what is the recommended route from    where you live? If you don’t drive, what are your transportation options? Where is the nearest emergency shelter?

❏   Where are the shut-off valves for your household utilities (gas, electricity, water)? Do you know how to use them? If they take a special tool, is it kept right there, ready to use?

❏    In an emergency, local phone service may be down for an extended period. Have you designated someone out-of-area as your emergency contact? Do your loved ones know who your emergency contact will be?

❏    Neighbors helping neighbors can be critical in an emergency. Do you know your neighbors? Do they know you and any special needs you may have?

STEP 2: HAVE YOUR EMERGENCY SUPPLIES READY

Being ready for an emergency means having the supplies you would need.

There are two aspects to this: First, your “stay at home” supplies. These are the things you would need to survive safely in your home until help can arrive. In a major disaster, this can mean several days or perhaps even a week or more. For planning purposes, you need to assume you would be without power and would not be able to go out for food or water. Your household emergency supplies should include:

❏  enough water to last 3 to 6 days (recommended quantity: one gallon per person per day.)

❏ food – also enough for 3 to 6 days – consisting of high energy items that won’t spoil and don’t require cooking

❏ flashlight

❏ portable radio

❏ spare batteries

❏ first aid kit

❏ hand-operated can opener

❏ some light sticks (Along with your flashlight and spare batteries, these are a safe, inexpensive alternative to candles. Remember, any open flame in a post-disaster situation requires extreme caution, since the fire department will have its plate full and may not be able to respond quickly, or at all.)

❏  waterproof matches

❏ a 3 to 6 day supply of your prescription medications, together with an up-to-date list of the medications you’re taking

❏ cell phone, if you have one

❏ some cash or travelers’ checks

❏ your emergency contact list, including the names, phone numbers, and email addresses you would want to have and be able to give aid workers in an emergency.

Second, your “evacuation bag.” These are the things you would need to have for a safe evacuation, if that became necessary. Your evacuation bag should be a backpack or travel bag, preferably one that rolls, that has room for many of the items listed above and that is pre-packed with the following items:

❏ basic personal hygiene items, such as toilet paper, alcohol wipes, and gel hand sanitizer

❏ extra pair of prescription glasses

❏ change of clothing

❏ compact rain slicker

❏ good pair of walking shoes

❏ blanket or sleeping bag

❏ bottle or two of water, some breakfast bars, and some hard candy

❏ some disposable dust masks

❏ a copy of both your emergency contacts list and your current medications list.

Remember, the goal here is to give yourself a margin of preparedness to see you through until help can arrive, or to get you safely through an evacuation. So, think about what other items you might need, given your situation.

For example, if you have a car and would expect to use it if you had to evacuate, you’ll want to keep the gas tank at least half or even threequarters full. This will be a bit inconvenient, because you’ll need to fill your tank twice as often; but that clearly beats worrying about running out of fuel in a real emergency! And if you own a pet, you’ll want to add an extra supply of pet food to your list. Again, this just means getting in the habit of buying it at least a week or two before you run out. Keep in mind, by the way, that most emergency shelters do not allow pets, unless they are service animals, such as a seeing eye dog.

STEP 3: MAKE A PERSONAL PLAN

You’ve gathered the information you need. You’ve pulled together the emergency supplies you should have on hand. You’re ready, right? Not quite. The third step – and for many, the most important – is to make a personal emergency response plan. What special needs do you have? And how will they be met in an emergency?

No one knows your situation better than you. So, you are in the best position to plan ahead. If you have limited mobility or are disabled, you may be able to register with your local fire department or office of emergency services for special assistance. If you use an electric wheelchair or scooter, consider keeping your old, unpowered model around for emergency use.

If you are receiving health care services at home, ask your home health provider about emergency procedures. For example, if you depend on electric power for home dialysis or infusion, you’ll want to know your options for temporary emergency power or, in the case of home infusion, you may want to discuss having a back-up drip system.

If you live in a retirement community, assisted living facility, or adult family home, learn about emergency planning and procedures. How will you be kept informed? What will the facility or community expect of you and your fellow residents?

This is personal planning. But that doesn’t mean doing it all on your own. If you can, work through the checklist with a family member or friend. Chances are they’ll jump at the opportunity; and it will be a good reminder for them to be ready, as well.

NOTE:

The FEMA website includes a 204-page booklet to help you
prepare for specific emergencies (www.fema.gov/areyouready).
The site also offers information on assisting people with
disabilities during a disaster (www.fema.gov/rrr/assistf.shtm)

Photo:http://www.flickr.com/photos/koschi/193402564/sizes/m/in/photostream/

There has been considerable discussion of Medicare over the past year most focusing on how to finance this healthcare program in the future. But there are a number of changes that will take place in 2012, many of which will provide additional coverage. The bad news? Well, premiums will increase. Here are some of the major changes.

New enrollment periods
Beginning October 15 through December 7 of this year, you can enroll for both drugand health-plan benefits at the same time! The plans you enroll in during this time begin January 1, 2012. You can also disenroll from Medicare Advantage plans between January 1, 2012 and February 14, 2012 and switch to Original Medicare. Any changes go into effect on the first day of the following month. So if you disenroll January 15, 2012, the change is effective February 1, 2012.

New Medicare Monthly Premiums

Type of Monthly Premium

Amount of Monthly Premium

Part A monthly premium

 (for people who pay a premium)

$451

Part A Late Enrollment Penalty

+10%

Part B monthly premium

$99.90 Higher-income consumers may pay more.

Part B Late Enrollment Penalty

+10% for each full 12-month period that you could have had Part B, but didn't sign up for it

Part C monthly premium

Varies by plan

Part D monthly premium

Varies by plan

 Higher-income consumers may pay more

Part D Late Enrollment Penalty

Depends on how long you went without creditable prescription drug coverage

Preventive services

Medicare now covers screening and counseling for alcohol misuse, depression, and obesity.

Obesity Screening and Counseling

If you have a body mass index of 30 or more, Medicare covers intensive counseling to help you lose weight. This counseling may be covered if you get it in a primary care setting, where it can be coordinated with your comprehensive prevention plan. Talk to your primary care physician or practitioner to find out more.

Abdominal Aortic Aneurysm Screening

Medicare covers a one-time screening abdominal aortic aneurysm ultrasound for people at risk. You must get a referral for it as part of your one-time “Welcome to Medicare” preventive visit. You pay nothing for the screening if the doctor or other health care provider accepts assignment.

Alcohol Misuse Counseling

Medicare covers one alcohol misuse screening per year for adults with Medicare (including pregnant women) who misuse alcohol, but aren’t alcohol dependant and are competent and alert during counseling. People who screen positive can get up to 4 brief face-to-face counseling sessions per year. A qualified primary care doctor or other primary care provider must provide the counseling in a primary care setting. You pay nothing if the doctor or other health care provider accepts assignment.

Depression Screening

Medicare covers one depression screening per year for all people with Medicare. The screening must be done in a primary care setting that can provide follow-up treatment and referrals. You pay nothing if thedoctor or other health care provider accepts assignment.

Medicare Advantage improvements
If you’re enrolled in a Medicare Advantage “managed care” plan, rejoice. You’re about to get some protection from the higher out-of-pocket costs you faced compared with people who chose standard Medicare coverage. The areas affected are chemotherapy, kidney dialysis, and skilled nursing care.

Most chemotherapy is covered under Part B of Medicare (outpatient services). In 2012, the most you can be charged out of pocket is a 20 percent coinsurance or a $75 co-pay. If your chemotherapy is administered while in the hospital, it’s covered as part of your entire hospitalization.

Kidney dialysis is also covered under Part B and carries either a 20 percent coinsurance  or a $30 co-pay. In 2012, skilled nursing facility stays cost no more than $100 for the first 20 days, then $146 per day for days 21 through 100. After 100 days, you have to pay the entire daily cost.

Beginning in 2011, Medicare Advantage plans also had to set a maximum annual out-of-pocket amount for all hospitalization and outpatient services. They also had to cover more of your costs if you enroll in clinical trials.

Cheaper prescription drugs
If you’re covered under the Part D prescription drug benefit and regularly take medicine, get out your piggy bank; you’re due for some savings! Put simply, the well known “donut hole” will be shrinking.

In 2012, most people will hit a coverage gap for prescription drugs (called the donut hole) after $2,930 in total drug costs (what you spend plus what your drug plan spends for medications). Then you have to pay a percentage of all drug costs until you’ve spent $4,700. If you reach $6,657 in total drug costs before the end of the year, you pay a five percent coinsurance for drugs, or $2.60 for generic and $6.50 for branded drugs, whichever is more, for the rest of the year.

The good news is that the donut hole is shrinking. In 2010, you got a $250 rebate check to help cover costs in the donut hole. Beginning in 2011, drug manufacturers had to slash the cost of all brand-name drugs (i.e., Lipitor, Norvasc, Fosamax, etc.) in half for those who reached the donut hole. Also this year, generic drugs are being discounted by seven percent in the donut hole. In 2012, that doubles to 14 percent. By 2020, the donut hole disappears and you pay just 25 percent of any brand or generic drug once you reach the Part D coverage limit.

Another change: If you’re covered by both Medicare and Medicaid and are in a nursing home or receive long-term care services in your home, you don’t have to payany drug co-payments.

Photo: http://www.flickr.com/photos/72131668@N08/6510494453/sizes/m/in/photostream/

Quality Improvement Organizations (QIOs) work under the direction of the Centers for Medicare & Medicaid Services, an agency of the U.S. Department of Health and Human Services. There are 53 QIOs responsible for each U.S. state, territory, and the District of Columbia.

To get the address and phone number of the QIO for your state or territory, visit www.ahqa.org on the web and click on “QIO Locator.” Or, you can call 1-800-MEDICARE (1-800- 633-4227) for help contacting your QIO. TTY users should call 1-877-486-2048.

Examples of Quality of Care Concerns

Medication errors

Example: Being given the wrong medication, or being given medication at the wrong time, or being given a medication to which you are allergic, or being given medications that interact in a negative way

Unnecessary or inappropriate surgery

Example: Being operated on for a condition that could effectively be treated with medications or physical therapy

Unnecessary or inappropriate treatment

Example: Being given the wrong treatment or treatment that you did not need, or being given treatment that is not recommended for patients with your specific medical condition.

Change in condition not treated

Example: Not receiving treatment after abnormal test results or when you developed a complication, such as an infection after surgery or a bedsore while in a skilled nursing facility

Discharged from the hospital too soon

Example: Being sent home while still having severe pain

Incomplete discharge instructions and/or arrangements

Example: Being sent home without instructions for the changes that were made in your daily medications while you were in the hospital, or during an office visit, you receive inadequate instructions about the follow-up care you need.

Help with other health care concerns

A concern about an issue other than the quality of care you received needs to be addressed by an agency other than a QIO. The agency that can help you depends on the nature of your concern. (Some concerns can be addressed by more than one agency.)

• If you have a concern about a doctor, such as unprofessional conduct, incompetent practice, or licensing questions, you may also contact your state medical board.
• If you have a concern about conditions at a hospital, such as rooms too hot or cold, cold food, or poor housekeeping, you may also contact your state department of health services.
• If you have a concern about Medicare fraud, call the HHS Office of Inspector General Hotline at 1-800-447-8477.
• If you have a concern about billing, such as questions about charges and what Medicare does or does not cover, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-4

(photo:http://www.flickr.com/photos/neilransom/108803427/)

There is no doubt that if you have a chronic medical condition you are struggling with  the high cost of prescription drugs. Over the past decade, prescription drug costs have risen more than any other health care cost on a percentage basis. Certainly, not all prescription drugs are costly. For example diuretics, used to control blood pressure, are 6-10 cents a day. On the other hand, if you take Lipitor, you may be paying as much as $6.00 a day. Unfortunately, many elder adults are not familiar with a wide range of programs and discounts that can significantly lower your annual costs. Many of these programs have income limits, but others are open to most individuals. We have provided a rather lengthy description and links to these prescription drug cost reduction programs within this site. But given the importance of this information, here is a general overview of some of the programs that are available.

Programs Offered by Pharmaceutical Industry

Many individual drug companies offer free or discounted drugs. These programs vary among the companies, but generally they require that you have no prescription drug coverage and that you have limited income. In addition, most provide the drug for a limited period of time and require that you make an application directly with the company. If you qualify, your drugs are sent to your doctor. To see if you would qualify for any of these programs you can see a listing of pharmaceutical companies and the programs they offer at Needy Meds, a non-profit organization dedicated to providing assistance to lower income families and individuals in need of prescription drugs.

Discount Drug Cards

Discount drug cards offer discounts on various medical services including medicine. They are not a form of insurance. Some are free while others may involve a hefty fee. They are offered by state governments, drug companies, non-profit and for-profit businesses. Here are some of the options you have for obtaining drug cards.

The NeedyMeds Drug Discount Card

NeedyMeds ( a non-profit organization) offers a drug discount card that provides a savings up to 80% on many medicines. The card is free and open to everyone. There is no registration and your entire family can use the same card. To download a card and learn more about its benefits click HERE.

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Problems with Long Term Care Insurance

In a previous addressing the challenges faced with the upcoming increse in the proportion of the popultion over 65 we discussed the issue of financing future health care costs. As we have noted, planning is an essential element of addressing future needs to provide individuals with financial security and peace of mind,

One proposed solution to rising health care costs and the fact that individuals are living longer and thus more likely to require some form of care as they age is long term care insurance.  And given that about 70% of older adults over age 65 require some services. the older you get, the greater the chance that you will need long-term care. Nationally, an estimated 4-7 % of people in the U.S. over the age of 45 have purchased long-term care insurance.  Most of these people tend to of higher income. Individuals who have pre-existing conditions generally have difficulty obtaining policies. Is there a future for long term care insurance for those who can afford it?

A month ago, MetLife announced it would stop underwriting new long-term care policies for individuals after Dec. 30. The company will also cease new enrollments to group and employer plans. Two of the leading companies in the long-term care business are proposing huge increases in the premiums of their policies. Genworth Financial has proposed an 18 percent increase on older policies held by about 25 percent of its customers. John Hancock has filed for permission to raise premiums for about 80 percent of its customers by an average of 40 percent. It has also temporarily stopped offering new long-term care insurance plans through employers while it tries to figure out what to charge. While state regulators may not approve these requests, the proposed increases point out the problems the insurance industry is having in projecting the rise in costs of their policies.  When most insurance companies were writing their long-term care policies they did not anticipate a number of factors. One, most projected a certain percentage of policy holders would stop making premium payments and give up their policies each year. As it turns out, the projected number of individuals stopping payment was far greater than the number who actually stopped paying premiums. Note the premiums for those stopping payment would remain with the insurance company as pure profit. Insurance companies also underestimated the number of people who first had claims for assisted living and home care and then ended up in a nursing home therefore increasing the insurer’s costs. Finally, the money generated from premiums is not drawing significant rate of returns with interest rates being so low while at the same time health care costs continue to rise. The biggest problem with policies now is the cost the premiums being out-of-reach for most seniors and the refusal of insurance companies to guarantee their rates on a yearly basis. Again, it is important to note that yearly insurance premiums can increase thus as one gets older paying for those premiums becomes more and more difficult. And if you stop paying premiums all of your contributions to this type of insurance are lost.  Another problem with long-term care insurance is that by the time many people purchase policies, they are uninsurable due to health problems. All told, these and other factors raise questions as to the viability of long term care policies to meet the needs of older adults. Accordingly, there is a small but attractive option that is offered by some states referred to as partnership policies.

Partnership Policies

Many middle-income people have too many assets to qualify for Medicaid but can’t afford a pricey long-term care insurance policy. In an effort to encourage more people to purchase long-term care insurance, the Deficit Reduction Act of 2005 (DRA) created the Qualified State Long Term Care Partnership program. The program expands to all states the partnership programs that were previously available only in four states: California, Connecticut, Indiana and New York.

The program offers special long-term care policies that allow buyers to protect assets and qualify for Medicaid when the long-term care policy runs out. Private companies sell long-term care insurance policies that have been approved by the state and meet certain standards, such as having inflation protection. The program is intended to provide incentives for people to purchase long-term care insurance policies that will cover at least some of their long-term care needs. As of June 1, 2009, 29 states had implemented partnership programs: Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho, Indiana, Kansas, Kentucky, Maryland, Minnesota, Missouri, Nebraska, Nevada, New Jersey, New York, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, South Carolina, Tennessee, Texas, Virginia, and Wisconsin. For more information on partnership programs and on long-term care insurance in general from the National Clearinghouse for Long-Term Care Information,

Under the new Qualified State Long Term Care Partnership program and California’s and Connecticut’s programs, the asset protection offered by partnership policies is dollar-for-dollar: for every dollar of coverage that your long-term care policy provides, you can keep a dollar in assets that normally would have to be spent down to qualify for Medicaid. So, for example, if you’re single, you would normally be allowed only $2,000 in assets in order to qualify for Medicaid coverage of long-term care. But if you buy a long-term care insurance policy that provides $150,000 in benefits, you would be allowed to retain $152,000 in assets and still qualify for Medicaid. (These states set limits on the assets that can be protected.)

In New York, the partnership policy benefits are even more significant. Once you have exhausted the benefits from your long-term care partnership policy, you can qualify for Medicaid coverage no matter your level of assets. In other words, an unlimited amount of assets can be protected.

Indiana offers either of the above models, depending on when the policy was purchased and the policy’s design.

Bear in mind that currently the Medicaid asset protection will only work if you receive your long-term care in the state where you bought the policy, or in another partnership state that has a reciprocal agreement with the first state.

The purpose of the partnership programs is to reduce Medicaid costs, however a study by the Government Accountability Office indicates that any cost savings will be limited. Hopefully modifications to the partnership program or hybrids of this model will offer a viable long-term care option in the future.

Photo: http://www.flickr.com/

The Centers for Medicare & Medicaid Services (CMS) recently announced that Medicare is adding coverage for a number of preventive services to reduce cardiovascular disease.

This new coverage policy will add to the existingportfolio of free preventive services that are now available for people with Medicare, thanks to the Affordable Care Act.

It contributes to the Million Hearts initiative led jointly by CMS and the Centers for Disease Control and Prevention in partnership with other HHS agencies, communities, health systems, nonprofit organizations, and private sector partners across the country to prevent one million heart attacks and strokes in the next five years.

Under this coverage decision, CMS will cover one face-to-face visit each year to allow patients and their care providers to determine the best way to help prevent cardiovascular disease. Intensive behavioral therapy for cardiovascular disease (referred to below as a CVD risk reduction visit) consists of the following three components:

• encouraging aspirin use for the primary prevention of cardiovascular disease when the benefits outweigh the risks for men age 45-79 years and women 55-79 years;
• screening for high blood pressure in adults age 18 years and older; and
• intensive behavioral counseling to promote a healthy diet for adults with hyperlipidemia, hypertension, advancing age and other known risk factors for cardiovascular and diet-related chronic disease.

We note that only a small proportion (about 4%) of the Medicare population is under 45 years (men) or 55 years (women), therefore the vast majority of beneficiaries should receive all three components.  Intensive behavioral counseling to promote a healthy diet is broadly recommended to cover close to 100% of the population due to the prevalence of known risk factors.

Therefore, CMS will cover one face-to-face CVD risk reduction visit each year for Medicare beneficiaries:

• who are competent and alert at the time that counseling is provided; and whose counseling is furnished by a qualified primary care physician or other primary care practitioner and in a primary care setting.

The behavioral counseling intervention for aspirin use and healthy diet should be consistent with the Five As approach that has been adopted by the USPSTF to describe such services:

• Assess:  Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
• Advise:  Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
• Agree:  Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
• Assist:  Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
• Arrange:  Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

The visit must be furnished by primary care practitioners, such as a beneficiary’s family practice physician, internal medicine physician, or nurse practitioner, in settings such as physicians’ offices.  During these visits, providers may screen for hypertension and promote healthy diet as part of an overall initiative to reduce the burden of cardiovascular disease in the United States.

Cardiovascular disease characterizes conditions affecting the heart and blood vessels, including hypertension, coronary heart disease, heart failure and stroke.  Cardiovascular disease is also the leading cause of mortality in the United States. Today’s new coverage policy does not change current Medicare coverage for beneficiaries diagnosed with cardiovascular disease to receive assessment and intervention services.

Earlier this year, the U.S. Department of Health and Human Services announced its Million Hearts national initiative, aimed at preventing a million heart attacks and strokes in the U.S. by 2017. Through Million Hearts, CMS, the CDC and other HHS agencies are working together with public and private sector organizations to make a long-lasting impact against cardiovascular disease.

Photo: http://www.flickr.com/photos/doug88888/5539136193/

Cancer Death Rates Decline

A recent report by the National Cancer Institute (NCI) shows continuing declines in death rates from cancer for both men and women. The following is a summary provided by the NCI.

Rates of death in the United States from all cancers for men and women continued to decline between 2003 and 2007, the most recent reporting period available, according to the latest Annual Report to the Nation on the Status of Cancer. The report also finds that the overall rate of new cancer diagnoses for men and women combined decreased an average of slightly less than 1 percent per year for the same period The drop in cancer death rates continues a trend that began in the early 1990s. The report finds, for the first time, lung cancer death rates decreased in women, more than a decade after rates began dropping in men.

The report is co-authored by researchers from the North American Association of Central Cancer Registries (NAACCR), the National Cancer Institute (NCI), part of the National Institutes of Health, the Centers for Disease Control and Prevention, and the American Cancer Society. It appeared online March 31, 2011, in the Journal of the National Cancer Institute, and in print on May 4, 2011.

Of special note, childhood cancer incidence rates (rates of new diagnoses) continued to increase while death rates in this age group decreased. Childhood cancer is classified as cancers occurring in those 19 years of age or younger.

Overall cancer incidence rates in men were essentially unchanged. There was a very small uptick in prostate cancer rates, and if these rates were excluded from the analysis, there would be a continued decline in overall male incidence rates.

In the Special Feature section of the report, the authors explore the diversity of brain tumors and other nervous system cancers beyond those that are identified as malignant, including those that are borderline and benign. The researchers analyzed data between 2004 and 2007 and found that in adults, non-malignant tumors were about twice as common as malignant tumors.

“Our new data show that non-malignant brain tumors are far more common than malignant brain tumors, and affect different population groups. Brain tumors have a far-reaching effect on our families and friends, yet they are difficult to study due to their diversity,” said Betsy Kohler, executive director, NAACCR. “We hope that the collection of both malignant and non-malignant brain tumors by central cancer registries will continue to provide a significant source of information and insight to researchers.”

Other highlights from the report show that, in men, incidence rates have declined for cancers of the lung, colon and rectum, oral cavity and pharynx, stomach, and brain (malignant only) while rates have risen for kidney, pancreas and liver cancers, as well as melanoma of the skin. In women, incidence rates decreased for breast, lung, colorectal, uterine, cervical, bladder, and oral cavity cancers, but increased for kidney, pancreas, and thyroid cancers as well as for leukemia and melanomas of the skin.

“It is gratifying to see the continued steady decline in overall cancer incidence and death rates in the United States — the result of improved methods for preventing, detecting, and treating several types of cancer,” said Harold Varmus, M.D., NCI Director. “But the full repertoire of numbers reported today also reflects the enormous complexity of cancer, with different trends for different kinds of cancers, important differences among our diverse people, and different capabilities to prevent, detect, and treat various cancers. Moreover, as our population continues to age, we have an obligation to discover and deliver better ways to control all types of cancers.”

Among racial/ethnic groups, cancer death rates were highest among black men and black women, but this group also showed the largest decline for the period between 1998 and 2007 compared with other racial groups. For new cancers, black men had the highest incidence rates in the 2003 to 2007 period studied. Among women, white women had the highest overall incidence rates. Breast cancer was the most commonly diagnosed cancer among women regardless of race or ethnicity. The differences and fluctuations in death rates by racial/ethnic group, sex, and cancer site may reflect differences in risk behaviors, socioeconomic status, and access to and use of screening and treatment.

“As we work towards reducing the cancer burden in the population as a whole, it is important that we apply what we know about prevention, detection and treatment of cancer to populations at highest risk,” said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society. “While it’s promising that mortality gaps are closing for some racial/ethnic groups, continued efforts are needed to prevent the avoidable deaths that these gaps represent.”

Despite the drop in lung cancer deaths among women nationwide, lung cancer still kills more people than any other type of cancer. “Lung cancer can become a rare disease if states support well-funded tobacco control programs,” said CDC Director Thomas Frieden, M.D. “Aggressive ad campaigns that show the impact of smoking, combined with higher cigarette prices and strong state laws that protect nonsmokers from secondhand smoke, will decrease the number of adult smokers and save lives.”

In the Special Feature section, the authors note that non-malignant tumors make up two-thirds of all adult brain tumors and one-third of childhood brain tumors, with meningiomas being the most common type of brain and other nervous system tumor in the U.S. Changes in diagnostic techniques, including the introduction of computed tomography, or CT, scans in the 1970s and magnetic resonance imaging, or MRI, in the 1980s, have led to less invasive methods for diagnosing brain tumors, but also have had a strong influence on incidence rates over the past decades. Newer molecular studies have improved classification of brain tumors for treatment and prognostic purposes.

Of note in the discussion of trends in malignant brain tumor incidence is the relative stability of long-term trends for tumors of neuroepithelial tissue, which arise from glial (support) cells in the brain and other tissues. Incidence rates for glioblastoma, the most common, as well as highly fatal, form of these malignant tumors, increased from 1980 through 1991, likely due to increasing use of aggressive diagnostic procedures in elderly patients, but since 1991 the rates have been stable. The report notes that the relatively low variation in incidence and mortality rates over the past several decades for brain cancers suggest that external risk factors in the environment do not play a major roles in this disease.

###

Reference: Kohler BA, Ward E, McCarthy BJ, Schymura MJ, Ries LAG, Eheman C, Jemal A, Anderson RA, Ajani UA, Edwards BK. Report to the Nation on the Status of Cancer, 1975-2007, Featuring Tumors of the Brain and Other Nervous System. JNCI; May 4, 2011.

To view the full report, go to http://www.oxfordjournals.org/our_journals/jnci/press_releases/kohlerdjr077.pdf

For a Q&A on this Report, go to http://www.cancer.gov/newscenter/qa/2011/ReportNation2011QandA

For Spanish translations of this press release and Q&A, go tohttp://www.cancer.gov/espanol/noticias/ReportNation2011SpanishRelease

NAACCR: http://www.naaccr.org

NCI: http://www.cancer.gov and SEER (NCI’s Surveillance, Epidemiology, and End Results program):http://www.seer.cancer.gov

CDC’s Division of Cancer Prevention and Control: http://www.cdc.gov/cancer ; National Program of Cancer Registries: http://www.cdc.gov/cancer/npcr; and the National Vital Statistics System:http://www.cdc.gov/nchs/nvss.htm

ACS: http://www.cancer.org

Central Brain Tumor Registry of the United States: http://www.cbtrus.org

Photo: http://www.flickr.com/photos/81538501@N00/6171494989/sizes/m/in/photostream/

Shingles is considered an extremely painful virus that can affect elder individuals.

Here is what you need to know about the virus and how you can potentially protect yourself against it.

What is shingles?

Shingles comes from the varicella-zoster virus (VZV the same virus that causes chickenpox. When a child recovers from the chickenpox, the VZV virus remains in the body for life. As one ages, their immunity to VZV begins to decline. At older ages, the virus can travel back up the nerve to the skin where it causes a painful rash. Which is called shingles. Generally this rash is limited tto a small area on one side of the body, often the face or torso. Clusters of small bumps become fluid filled blisters which later drain and form scabs. In addition to the painful rash, shingles can also cause chills, fever, upset stomach, or headache.

Once shingles is present an anti-viral can be administered by a doctor to reduce the severity and duration of shingles but it will not eliminate the shingles. Anti-virals have been shown to reduce other complications, such as those involving the eye (ophthalmic herpes zoster). The rash may continue for two to four weeks, but eventually improves and the pain diminishes. The person then returns to a normal schedule.

Some people are not so fortunate and suffer indefinitely from shingles They develop chronic pain and serious complications that make it difficult to sleep, leave the house or shop  Sometimes they never return to normal activities, and become depressed and reclusive because of  long-term pain and disability.

Complications, which rise with the age of the individual, develop in somewhere between one-third and one-half of older adults with shingles. The most frequent complication is the chronic pain syndrome called postherpetic neuralgia (PHN). PHN is the occurrence of persistent pain after the shingles rash heals; it can last for months or even years. Only rarely does PHN cause disability and suffering for the rest of the patient’s life.

Research puts shingles and postherpetic neuralgia on a par with congestive heart failure, diabetes and depression for disrupting a person’s quality of life. Thus, shingles can have a major impact on morbidity, lost work productivity and quality of life in older adults.

In addition to the excruciating pain of PHN, other complications of shingles may include scarring, secondary bacterial infections, pneumonia, visual and hearing impairments and, rarely, death. If left untreated, 10% of patients whose shingles affects an eye will experience severe visual loss, eyelid scarring or chronic in-turning of the eyelashes.

Although shingles is not highly communicable, it is a public health concern because of the serious complications, the detrimental impact on quality of life and the cost of care. The Agency for Healthcare

Who gets shingles?

Each year it is estimated that 1 million individuals in the U.S. are affected by shingles. About 50% of those cases are among people aged 60 or older. Anyone who has previously had chickenpox is at risk of getting shingles. It is estimated that between 20% to 30% of people will develop shingles during their lifetime. People are more likely to get shingles if they are receiving chemotherapy, radiotherapy, immunosuppressant drugs, or steroids. Because the risk of acquiring shingles increases with age, likely because of lower immune systems, 50% of adults who reach 85 will acquire shingles. In addition, shingles tends to be more severe in older than younger people.

How is shingles treated?

Most cases of shingles can be managed in the primary care setting, but specialists are sometimes required if the eyes, lungs or other organs are involved, or if a pain specialist is needed.  Appropriate and immediate treatment of herpes zoster can control acute symptoms and reduce the risk of longer term complications. Starting anti-viral medication within 72 hours of the onset of shingles can reduce the pain and the length of time the outbreak lasts. Topical antibiotics may be prescribed if the blisters become infected. A medicated lotion (such as Benadryl or Caladryl) or astringent soaks (such as Bluboro or Domeboro) may relieve pain and itching, according to the American Academy of Family Physicians. Pain medicine (analgesics or opioids) also may be prescribed for shingles or PHN.

While shingles cannot spread to exposed persons the shingles rash can be transmitted to cause chickenpox in persons (mostly younger children) who have never had chickenpox or never been vaccinated with the varicella vaccine. Shingles is considerably less contagious than chickenpox, and it is generally not necessary to isolate the affected person while the rash is present.

The shingles vaccine

A preventive vaccine, Zostavax was approved by the FDA in 2006, Zostavax is licensed as a one-dose vaccine for people age 60 years or older. For adults aged 60 or older studies have shown the Zostavax vaccine reduced:

• the overall incidence of shingles in older adults by about 51% and

• the incidence of PHN by 67%.

The vaccine’s effectiveness in reducing the incidence of shingles drops with the age of the vaccine recipient. For example, Zostavax was 64% effective for those age 60-69 years, 41% effective for those ages 70-79 years and 18% effective for those age 80 years or older.

Paying for the vaccine

The shingles vaccine ranges between $165 and $300  and it is not covered by Medicare Part B. For other low-income adults without insurance, Merck offers a vaccine assistance program. (contact: 1-800-293-3881 or go to http://www.merckhelps.com).

(photo: http://www.flickr.com/photos/ringai/3173722475/sizes/z/in/photostream/)

Influenza is a viral infection that is highly contagious and affects people of all age groups. Seasonally, influenza reaches epidemic proportions in the autumn and winter months in temperate climates. Even though it reaches such proportions, it is not a major problem for most young, healthy people. It does however become a serious issue for those in the high-risk populations. High-risk populations for this disease are the very young, elderly, and the chronically ill. Worldwide, serious cases of influenza cases number between 3 to 5 million, and deaths range from 250,000 to 500,000. According the Center for Disease Control, one statistic that shows how dangerous influenza can be for those over 65, is that 90% of deaths related to influenza comes from people in this age group.

For preventing the disease, the World Health Organization recommends that nursing home residents, both those who are elderly and those who are disabled, receive the vaccine. Because they live in such close proximity and are thus very susceptible to contracting the disease if there is any occurrence of it at a nursing home, these residents are the highest priority under the WHO recommendations. The next group is the elderly. By nature of just being elderly, a person has a weaker immune system than someone much younger. Even if they do not live in close proximity with other individuals and thus have less of a risk of contracting the disease, older persons are urged to get the vaccine just by the nature of their immune systems not being as strong. In addition to receiving the flu vaccine, the Center for Disease Control provides the following suggestions to limit the spread of influenza.

After the age of 40, bone density decreases and can lead to osteoporosis. Although the elderly are particularly at risk for developing this disease, they are rarely assessed or treated for it.

One of the main risks of the disease is bone fracture or breakage due to a fall. Even elderly people who are in reasonable health should consider talking to their doctors about ways to improve bone health and whether they should be screened for osteoporosis.

Here are a few other things the elderly can do to promote good bone health.

Calcium and Vitamin D

Aging bodies cannot absorb calcium from the diet in the same way they could at a younger age. As a result, the elderly body produces a hormone called parathyroid that actually takes calcium from the bones to put into the bloodstream. For this reason, elderly people should consider taking calcium supplements to reduce the high level of parathyroid.

Another cause of osteoporosis is vitamin D deficiency. Besides bone loss, this can also lead to muscle weakness, which increases the risk of falls and fractures as a result. Vitamin D should therefore be taken as a supplement along with calcium.

Exercise

If an elderly person is not active, a special exercise program may help them to retain bone and muscle strength. Elder exercise also improves balance, posture, and coordination. Types of exercise include weight-bearing exercise like walking or dancing, resistance exercise like water aerobics or free weights, and flexibility exercise like stretching, yoga, and tai chi.

Preventing Falls

If a person has osteoporosis, a fracture can be caused by any minor trauma such as coughing, minor knocks or falls. Elderly people fall more often to the side because they have slower response times. This may cause direct impacts to the hip. Falls from fractures are intrinsic and caused by slow gait, unstable posture, muscle weakness, malnutrition, poor vision, or medications. Maintaining muscle strength and coordination in old age can significantly reduce the risk of fractures and falls.

An elderly person who is very frail may need to see a physiotherapist or occupational therapist. These types of therapists will perform physical therapy and provide types of assistance such as walking aids and installing rails in the home. In addition, they may recommend a hip protector to reduce the incidence of hip fractures.

After a First Fracture

The first fracture is a warning sign of deteriorating bones. However, action can be taken to prevent more fractures in the future. Medication for pain and osteoporosis should be started as soon as possible. Nutrition should include a healthy, balanced diet, with possible calcium and/or vitamin D supplements.

Protein and dairy consumption is also important, along with exposure to sunshine. A therapist can help improve mobility and muscle strength, which can also help relieve pain. Adjustments may also need to be made in the elderly individual’s daily activities and home life.

Lisa Livingston manages the site Radiology Technician Guide. She writes many articles related to healthcare and has been a radiologist for 7 years.

(photo:http://www.flickr.com/photos/keone/453348683/)

We have noted in several of our posts some of the issues raised by depression and alcohol use by elder adults. Alcohol can be a double edged sword. While there are some benefits for moderate consumption of alcohol, there are also are a number of risks depending on the medications you take, pre-existing conditions, and the level of dependence you have for alcohol. Depression can often be a seasonal malady for which there are some simple treatments,

Similarly, exercise can play a valuable role in diminishing the effects of depression as well as improving your health.  For aging Americans, a multitude of chronic illnesses can lead to depression. The Centers for Medicare & Medicaid Services (CMS) today announced two new national coverage determinations that cover alcohol misuse screening and behavioral counseling for Medicare beneficiaries as well as screening for depression. These new coverage policies add to the existing portfolio of covered preventive services, most of which are now available to people with Medicare at no additional cost.

Risks of Alcohol Abuse

Alcohol misuse puts individuals at risk for ill health as misuse is linked to diseases such as cancer, liver disease and cardiac disease, as well as mental and emotional problems. For society at large, alcohol-related problems include economic losses from illness and injury, and disruption of family and social relationships.

Annual alcohol misuse screening by primary care providers, such as a beneficiary’s family practice physician, internal medicine physician, or nurse practitioner, in settings such as physicians’ offices are covered under CMS’ new policies.  The benefit also includes four behavioral counseling sessions per year furnished by the primary care provider, if beneficiaries screen positive for alcohol misuse.

Effects of Depression

Depression is a medical disorder characterized by feeling sad, diminished interest in pleasurable activities, feelings of guilt, decreased ability to concentrate and other symptoms experienced nearly every day. Depression may also include thoughts of suicide. Among people 65 years and older one in six suffers from depression.

Annual screening for depression for Medicare beneficiaries is now covered in primary care settings that have staff resources to follow up with appropriate treatment and referrals.  The purpose of this screening is to assure accurate diagnosis, effective treatment and follow-up.

Among persons older than 65 years, one in six suffers from depression.  Depression in older adults occurs in a complex psychosocial and medical context, and the prevalence of clinically significant depression in later life is estimated to be highest (~25%) in those with comorbidities including cancer, arthritis, stroke, chronic lung disease and cardiovascular disease. 

Frequency of other stressful events such as the loss of friends and loved ones increases with age, and bereavement is an important and well-established risk factor for depression. Opportunities are missed to improve mental health and general medical outcomes when mental illness is under-recognized and undertreated in primary care settings. A significant number of older adults with depression are not diagnosed or treated in the primary care setting. Beliefs that depression is normal with older age, as well as difficulties presented by patients with cognitive deficits, make identification of depression in older adults challenging.

Depression wields significant public health impacts and economic costs. Pignone, et al. (2002), for instance, noted that depressive illness has substantial effect on healthcare utilization and is projected to be the second leading source of disability worldwide by 2020. In 2003, Greenberg, et al. reiterated that the economic burden of depression is substantial and estimated that the combined U.S. direct and indirect costs of depression were $83.1 billion, including $31.5 billion in direct costs and the remainder in indirect, mostly workplace costs.

Critically, older adults have the highest risk of suicide of all age groups. In fact, a 1992 NIH Consensus Development Panel on depression in older adults found most of these patients were experiencing their first episode of major depressive disorder, which had gone unrecognized and untreated. Such patients are important in the primary care setting because > 50-75% of older adults who commit suicide saw their medical doctor during the prior month for general medical care, and 39% were seen during the week prior to their death.

(photo: http://www.flickr.com/photos/32911376@N07/3146550561/)

According to the National Institute on Neurological Disorders and Stroke, stroke is the third leading cause of death in the United States and a leading cause of serious, long-term disability in adults. About 600,000 new strokes are reported in the U.S. each year.

The good news is that treatments are available that can greatly reduce the damage caused by a stroke. However, you need to recognize the symptoms of a stroke and get to a hospital quickly. Getting treatment within 60 minutes can prevent disability.

What is a stroke?

A stroke, sometimes called a “brain attack,” occurs when blood flow to the brain is interrupted. When a stroke occurs, brain cells in the immediate area begin to die because they stop getting the oxygen and nutrients they need to function.

What causes a stroke?

There are two major kinds of stroke.

The first, called an ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel or artery in the brain. About 80 percent of all strokes are ischemic. The second, known as a hemorrhagic stroke, is caused by a blood vessel in the brain that breaks and bleeds into the brain. About 20 percent of strokes are hemorrhagic.

What disabilities can result from a stroke?

Although stroke is a disease of the brain, it can affect the entire body. The effects of a stroke range from mild to severe and can include paralysis, problems with thinking, problems with speaking, and emotional problems. Patients may also experience pain or numbness after a stroke.

Know the Signs

Because stroke injures the brain, you may not realize that you are having a stroke. To a bystander, someone having a stroke may just look unaware or confused. Stroke victims have the best chance if someone around them recognizes the symptoms and acts quickly.

What are the symptoms of a stroke?

The symptoms of stroke are distinct because they happen quickly:

• Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
• Sudden confusion, trouble speaking or understanding speech
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden severe headache with no known cause

What should a bystander do?

If you believe someone is having a stroke – if he or she suddenly loses the ability to speak, or move an arm or leg on one side, or experiences facial paralysis on one side – call 911 immediately.

Act in Time

Stroke is a medical emergency. Every minute counts when someone is having a stroke. The longer blood flow is cut off to the brain, the greater the damage. Immediate treatment can save people’s lives and enhance their chances for successful recovery.

Why is there a need to act fast?

Ischemic strokes, the most common type of strokes, can be treated with a drug called t-PA, that dissolves blood clots obstructing blood flow to the brain. The window of opportunity to start treating stroke patients is three hours, but to be evaluated and receive treatment, patients need to get to the hospital within 60 minutes.

What is the benefit of treatment?

A five-year study by the National Institute of Neurological Disorders and Stroke (NINDS) found that some stroke patients who received t-PA within three hours of the start of stroke symptoms were at least 30 percent more likely to recover with little or no disability after three months.

What can I do to prevent a stroke?

The best treatment for stroke is prevention. There are several risk factors that increase your chances of having a stroke:

• High blood pressure
• Heart disease
• Smoking
• Diabetes
• High cholesterol

If you smoke – quit. If you have high blood pressure, heart disease, diabetes, or high cholesterol, getting them under control – and keeping them under control – will greatly reduce your chances of having a stroke.

The National Institute on Neurological Disorders and Stroke provides an informative video you can watch on-line. Just click on the link below.

Know Stroke video. This eight-minute video features experts in the field of stroke discussing the symptoms of stroke and what to do, as well as stories from people who have successfully recovered from a stroke. This presentation requires the latest free version of RealPlayer.

(photo:http://www.flickr.com/photos/reighleblanc/3854684694/)

What do We Know About Falls?

Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head traumas, and can increase the risk of early death. Soemtimes, falls can be indicative of a phsiyological condition such as a min-stroke. Fortunately, falls are a public health problem that is largely preventable.

The most immediate way to address falls is to examine the living environment to determine of modifictions will need to be made with carpets, rugs, wires, steps, or any architectural element taht may contribute to a fall. We have provided a discussion of whether home modifications are right for you.

One out of three adults age 65 and older falls each year1,2 but less than half talk to their healthcare providers about it.

Among older adults (those 65 or older), falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.

In 2008, over 19,700 older adults died from unintentional fall injuries.

The death rates from falls among older men and women have risen sharply over the past decade.

In 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 581,000 of these patients were hospitalized.

In 2000, direct medical costs of falls totaled a little over $19 billion—$179 million for fatal falls and $19 billion for nonfatal fall injuries.5 This equals $28.2 billion in 2010 dollars.

What Happens after a Fall?

Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.

Falls are the most common cause of traumatic brain injuries (TBI).8 In 2000, TBI accounted for 46% of fatal falls among older adults.

Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.10

Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities leading to reduced mobility and loss of physical fitness, which in turn increases their actual risk of falling.

Fall-related Deaths

In 2008, 82% of fall deaths were among people 65 and older.

Men are more likely to die from a fall.  After taking age into account, the fall death rate in 2007 was 46% higher for men than for women.

Older whites are 2.5 times more likely to die from falls as their black counterparts.

Rates also differ by ethnicity. Older non-Hispanics have higher fatal fall rates than Hispanics.

The chances of falling and of being seriously injured in a fall increase with age. In 2009, the rate of fall injuries for adults 85 and older was almost four times that for adults 65 to 74.3

People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.

Women are more likely than men to be injured in a fall. In 2009, women were 58% more likely than men to suffer a nonfatal fall injury

Rates of fall-related fractures among older women are more than twice those for men.

Over 90% of hip fractures are caused by falls. In 2007, there were 264,000 hip fractures and the rate for women was almost three times the rate for men.

White women have significantly higher hip fracture rates than black women.

How Can Older Adults Prevent Falls?

Older adults can remain independent and reduce their chances of falling.  They can:

Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good.

Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.

Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision.  Consider getting a pair with single vision distance lenses for some activities such as walking outside.

Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding stair railings and improving the lighting in their homes.

To lower their hip fracture risk, older adults can:

Get adequate calcium and vitamin D—from food and/or from supplements.

Do weight bearing exercise.

Get screened and treated for osteoporosis.

Photo: http://www.flickr.com/photos/slabsofabsence/363816582/sizes/m/in/photostream/

At a time when the age of the population is shifting upward, the number of doctors specializing in care for older Americans is declining.

Thus it is important  for older adults to become advocates of their own healthcare and be better prepared than ever when meeting with their doctor.We have noted how you can select a doctor that is appropriate for your are, but how does one go about preparing for each visit to the doctor? How can you know you are asking the right questions? How do you know you are serving as your own advocate?

Here are some suggestions from the Agency For Healthcare Research and Quality.

One way you can make sure you get good quality health care is to be an active member of your health care team.Patients who talk with their doctors tend to be happier with their care and have better medical results.

Before Your Appointment

• Bring all the medicines you take to your appointment. This includes:
  • Prescription medicines.
  • Non-prescription medicines, such as aspirin or antacids.
  • Vitamins
  • Dietary or herbal supplements.
• Write down the questions you have for the visit. Use the back of this brochure to list your questions.
• Know your current medical conditions, past surgeries, and illnesses.

During Your Appointment

• Explain your symptoms, health history, and any problems with medicines you have taken in the past.
• Ask questions to make sure you understand what your doctor is telling you.
• Let your doctor know if you are worried about being able to follow his or her instructions.
• If your doctor recommends a treatment, ask about options.
• If you need a test, ask:
  • How the test is done.
  • How it will feel.
  • What you need to do to get ready for it.
  • How you will get the results.
• If you need a prescription, tell your doctor if you are pregnant, are nursing, have reactions to medicines, or take vitamins or herbal supplements.
• Find out what to do next. Ask for:
  • Written instructions.
  • Brochures.
  • Videos.
  • Web sites.

After Your Appointment

• Always follow your doctor’s instructions.
• If you do not understand your instructions after you get home, call your doctor.
• Talk with your doctor or pharmacist before you stop taking any medicines that your doctor prescribed.
• Call your doctor if your symptoms get worse or if you have problems following the instructions.
• Make appointments to have tests done or see a specialist if you need to.
• Call your doctor’s office to find out test results. Ask what you should do about the results.

Free Tools

The Agency for Healthcare Research and Quality (AHRQ), an agency within the U.S. Department of Health and Human Services, supports research that helps people make informed decisions and improves the quality of health care.AHRQ offers these free resources to help you make decisions about your health care:

• Questions are the Answer: http://www.ahrq.gov/questions
  This Web site lets you make a list of questions that you can bring to your medical appointments and gives you tips on talking with your doctor.
• Consumers & Patients: http://www.ahrq.gov/consumer
  This page links to consumer information on staying healthy, getting high-quality health care, and more.
• Your Medicine: Be Smart. Be Safe: http://www.ahrq.gov/consumer/safemeds/yourmeds.htm
  This booklet answers common questions about getting and taking medicines and has a wallet card to help you keep track of your medicines. Order a free copy by calling 1-800-358-9295.

(photo:http://www.flickr.com/photos/thephysicianrecruiters/4138315446/)

Announced on September 13, 2011, Million Hearts is a national initiative to prevent 1 million heart attacks and strokes over the next 5 years.

Healthy aging is at the center of living a longer, more fulfilling life. By being aware of various diseases that could shorten your life and reduce the quality of one’s life older adults can take steps to prevent many of the consequences of chronic medical conditions. Certainly, heart disease is a major cause of death and chronic illness for older adults.

Leading the way

The Centers for Disease Control and Prevention and Centers for Medicare and Medicaid Services are the co-leaders of Million Hearts within the U.S. Department of Health and Human Services, working alongside other federal agencies including the National Institutes of Health, the Agency for Healthcare Research and Quality, and the Food and Drug Administration. Key private-sector partners include the American Heart Association and YMCA among others.

Preventing heart disease and strokes

Heart disease and stroke are two of the leading causes of death in the United States. Million Hearts aims to improve heart disease and stroke prevention by focusing on five pillars of action:

1. Prioritize focus and attention around the ABCS (Aspirin for people at high risk, Blood pressure control, Cholesterol management,Smoking cessation)
2. Encourage the meaningful use of health information technology (HIT) to drive improvement
3. Deliver care innovations
4. Foster community innovations
5. Measure successes and shortfalls in clinical and community prevention

Million Hearts brings together existing efforts and new programs to improve health across communities and help Americans live longer, healthier, more productive lives.

High blood pressure is one of the leading causes of heart disease and stroke. One in 3 U.S. adults has high blood pressure, and half of these individuals do not have their condition under control.

Similarly, high cholesterol affects 1 in 3 American adults, and two-thirds of these individuals do not have the condition under control. Half of adults with high cholesterol do not get treatment.

If your blood pressure or cholesterol is high, take steps to lower it. This could include eating a healthier diet, getting more exercise, and following your doctor’s instructions about medications you take.

Eat Healthy for Your Heart

What you eat has a big impact on your heart health. When planning your meals and snacks, try to:

• Eat lots of fresh fruits and vegetables.
• Check the labels on your food and select those with the lowest sodium. Too much sodium can increase your blood pressure.
• Limit foods with high amounts of saturated fat, trans fat, and cholesterol. You can find this information on the Nutrition Facts label.
• Cook at home whenever possible. This way, you’re in charge of the ingredients and you know exactly what you and your family are eating.

Get Moving

Obesity can increase your risk for heart disease and stroke. To keep your body at a healthy weight and to fight high blood pressure and cholesterol, make physical activity part of your daily routine. Try to fit in 30 minutes of moderate-intensity exercise on most days of the week. For example, you could take a brisk 10-minute walk 3 times a day, 5 days a week.

Quit Smoking

Cigarette smoking greatly increases your risk for heart disease. If you’re a smoker, quit as soon as possible, and if you don’t smoke, don’t start. You can also support smoke-free policies in your community and try to avoid secondhand smoke.

(photo: http://www.flickr.com/photos/face_it/900673849/)

Medicare provides older adults a wide variety of health care benefits. Despite the rising costs of healthcare, many older adults are not engaged in comparison shopping for Medicare coverage.

Shopping around, however, could result in big savings.

Shop around to save big

Under Part A and Part B of Medicare, individuals are provided comprehensive coverage for a variety of services and care. Under Medicare, individuals must pay for certain levels of coverage yet a newly released poll conducted by the National Council of Aging and United Health Care found that many older adults are not taking advantage of cost saving steps when making decisions on health care options.

According to the poll 46% of respondents indicated they have never shopped around for better Medicare coverage. Suprisingly,  41% did not do any comparison shopping because they believed  they couldn’t save any money. In addition, 35% reported they confused by Medicare and 16% reported they didn’t understand Medicare at all (16%).

Less than half of respondents were familiar with the Medicare prescription drug “donut hole” or coverage gap. AAnd when it comes to their understanding of the newly enacted health reform law, only 12% described their understanding of the health reform law as excellent or good.

Older adults who are on limited income, those who are in need of knowledge of financial assistance programs to save money on Medicare costs are often unaware of these programs. The poll revealed that 68& of the respondents were unaware of the Medicare Savings Program which assists those on limited income pay for Medicare costs and 53% were unaware of Extra Help which helps pay for prescription drug costs.

Resources

Older adults can ask questions, find resources, and get information about their Medicare coverage in a variety of ways including, but not limited to:

• · www.Medicare.gov – The official government site for Medicare
• · www.SHIPtalk.org – Here you can find assistance where you live from a network of trained counselors
• · www.BenefitsCheckUp.org –  The NCOA assists elder adults in identify all benefits for which they may qualify.
• · www.Eldercare.gov – Identified local assistance and referring agencies.

Additional information on Medicare and cost-saving options are available from United Health Care www.MediareMadeClear.com and from NCOA www.MyMedicareMatters.org.

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Medicare provides a wide variety of doctor, hospital,and pharmaceutical benefits.

Included in these are a wide array of preventive services for eligible beneficiaries, including cancer screenings, glaucoma screenings, an initial preventive physical examination, and certain immunizations, among others.

With upcoming changes to Medicare, some of these services are now covered under Medicare.

Starting in 2011, Medicare will cover some preventative services

Starting in 2011, in an effort to help seniors and their doctors prevent disease and identify and treat illness early, the Affordable Care Act eliminated Part B coinsurance and deductibles or the majority of preventive screenings and services. A list of the Medicare-covered preventive services, including information about eligibility, frequency, can be found at www.medicare.gov.

Annual wellness visits are covered

In 2011, Medicare began covering a new service, an Annual Wellness Visit with the doctor of their choice, at no cost to beneficiaries. As part of that visit, beneficiaries and their physicians can review the patient‟s health and develop a personalized wellness plan.

The new annual wellness visit can help spark the beginning of an ongoing conversation between patients and their doctors on how to prevent disease and disability. During this visit, beneficiaries can review their medical histories and make sure their primary care physician knows about all other providers and prescriptions. The Annual Wellness visit complements the Welcome to Medicare Exam, which is also available at no cost to Medicare beneficiaries within the first 12 months of enrolling in Medicare Part B.

Preventative services can make a big impact on overall health

Improving utilization of the Medicare-covered preventive benefits can improve the health and quality of life for Medicare beneficiaries, and potentially lower Medicare costs due to a decrease in preventable illnesses over time. One in six beneficiaries have utilized one of the free preventive services provided by traditional Medicare.

Between January 1 and June 10, 2011, over 5.5 million beneficiaries in traditional Medicare used one or more of the preventive benefits now covered without cost-sharing,  most prominently, mammograms, bone density screenings, and screenings for prostate cancer.

This is 16 percent – almost one in six – of the more than 33 million Americans who had traditional Medicare in June 2011. The Aging Network is critical to ensuring beneficiaries learn about and take advantage of their Medicare preventive services

The Administration on Aging network of service providers are the “boots on the ground” in reaching people on Medicare,” said Assistant Secretary for Aging Kathy Greenlee.  And to this end, the State Health Insurance Assistance Program (SHIP) and Information and Referral (I&R) services are vital to making sure beneficiaries have the tools and resources to access Medicare‟s preventive services.

New publicity to increase awareness

To increase awareness about Medicare’s preventive benefits, the Centers for Medicare and Medicaid Services (CMS) has launched a national multi-prong, multi-media publicity campaign, Share the News, Share the Health.  The campaign will run throughout the summer, with online advertisements and community events across the country starting in July. CMS is also releasing a nationwide public service announcement that is available on www.youtube.com/CMSHHSgov.

User-friendly information about prevention is also available for Medicare beneficiaries and their caregivers at http://Medicare.gov/sharethehealth , and in Spanish at http://es.Medicare.gov/sharethehealth. Also, Medicare’s dedicated caregivers’ website, “Ask Medicare” www.Medicare.gov/caregivers, now has a prevention section especially for caregivers.

(photo: http://www.flickr.com/photos/rmgimages/4882443472/)

Social Managed Care Plan

A Social Managed Care Plan is an organization that provides the full range of Medicare benefits offered by standard Managed Care Plan’s plus additional services which include care coordination, prescription drug benefits, chronic care benefits covering short term nursing home care, a full range of home and community based services such as homemaker, personal care services, adult day care, respite care, and medical transportation. Other services that may be provided include eyeglasses, hearing aids, and dental benefits. These plans offer the full range of medical benefits that are offered by standard Managed Care Plan’s plus chronic care/ extended care services. Membership offers other health benefits that are not provided through Medicare alone or most other senior health plans.

Current Social Managed Care Plan Sites

There are currently four Social Managed Care Plan’s participating in Medicare and each Social Managed Care Plan has eligibility criteria. These Social Managed Care Plans are located in: Portland, Oregon; Long Beach, California; Brooklyn, New York; and Las Vegas, Nevada. Listed below are the four plans and the criteria for joining each plan.

• Kaiser Permanente, Portland Oregon
  The enrollee must be 65 years of age or older, must have Medicare Part A and Part B, must continue to pay the Part B premium and must live in Kaiser Permanente’s Social Managed Care Plan service area. The enrollee cannot have end-stage renal disease, or reside in an institutional setting. In order to receive the long-term care benefit, an expanded care resource coordinator will visit you at home to determine if you qualify for nursing home certification based on criteria established by the State of Oregon Senior and Disabled Services. These criteria may include needing daily ongoing assistance from another person with one of the following activities of daily living: walking or transferring indoors, eating, managing medications, controlling difficult or dangerous behavior, controlling your bowels or bladder, or the need for protection and supervision because of confusion or frailty.
• SCAN, Long Beach California 
  The enrollee must be 65 years of age or older, must have Medicare Part A and Part B, must continue to pay the Part B premium and must live in SCAN’s service area. The enrollee cannot have end-stage renal disease. In addition, in order to receive extended home care services, members must have a Nursing Home Certificate which indicates that the members informal support system , such as a family member or care giver, is not sufficient to keep the member out of a nursing home.
• Elderplan, Brooklyn, New York 
  The enrollee must be 65 years of age or older, must have Medicare Part A and Part B, must continue to pay the Part B premium and must live in Elderplan’s service area. The enrollee cannot have end-stage renal disease. In order to receive chronic care benefits, the enrollee must meet state nursing home certifiable criteria.
• Health Plan of Nevada, Las Vegas, Nevada 
  The enrollee must be at least 65 years of age, or may under 65 if they are disabled. The enrollee must have Medicare Part A and Part B, must continue to pay the Part B premium and must live in Health Plan of Nevada’s service area. The enrollee cannot have end-stage renal disease. For the long-term care benefit, the beneficiary must meet certain criteria based on established medical, psychological, functional, and social criteria as well as needing to be medically necessary.

Your Cost

Each plan has different requirements for premiums. All plans have co-payments for certain services. To obtain cost and benefit information, examine the  Medicare Options Compare tool for specific details. Before making any health plan decisions, you should contact the plan directly using the phone number listed in the site.

Photo: http://www.flickr.com/photos/65801815@N07/5990113311/sizes/m/in/photostream/

Preventing Depression this Fall

When fall comes around, the majority of us start thinking of fall colors and apple pie, of coming in a little earlier and getting cozy around the fireplace at night.  But when it comes to the elderly in our life, fall is not always such a pretty picture.  Fall means less opportunity to sit out and soak in the sun, it means shorter days, colder days and often, depression.  Though we are aware that SAD (Seasonal Affective Disorder) often strikes the elderly, what many of us fail to realize is that it begins in the fall and only peaks in the winter.  However, realizing this and taking it into consideration now, we can help the elderly in our lives ease the transition from summer to fall and lessen the opportunity for depression.  Here are easy tips for prevention.

Plan Extra Social Activities

One of the most relished parts of summer by the elderly is the increased social activity.  There’s simply more “happening.”  It’s natural for us as human beings to be out more during the summer months and hanging closer to home during the winter ones.  For the elderly, this translates to fewer guests, things to fill a day and events to look forward to.  You can soften the break from summer to fall by making extra effort to keep the social activities coming.  While the activities may not look the same, there are still plenty of activities available.  Think crafting, painting, library trips, “indoor-picnics,” movie nights, etc.  More than that, if we don’t allow the busyness of our own fall schedules diminish the time spent with them, that itself can make a huge difference.

Invest in Lighting/Perhaps Blue Lights

Clearly you cannot keep the sun shining for more hours in a day, but you can make sure that their lighting is the very best it can possibly be.  Invest in quality lamps that more closely resemble natural sunlight.  You may even want to look into “blue lights,” specifically designed as light therapy to help those who suffer from SAD.  If the elderly are in an assisted living home, encourage the staff at the nursing home to turn the lights off later at night in their room; stretching the days out in this way can help lessen the sudden transition between summer and fall

Encourage Exercise

According to the American Psychiatric Association’s guideline for treating SAD, exercise[1] is one of the top four treatment options.  Remember that exercise does not need to mean anything strenuous.  It can consist of walks through the hallways, gentle weight lifting or even a slow swim.  Exercise has often been equated to produce the same level of mood-boosting serotonin that a mild anti-depressant would.  And, because fall and winter often have a habit of making the elderly feel trapped from outdoors because of the cold and safety hazards like ice, indoor exercise can help prevent that feeling of loss.  Try to make it a daily habit and by starting now, you may be able to prevent the pending frustration with fall and winter.

Freelance writer Jocelyn has always had a passion for the elderly and one of her favorite activities is playing chess with the elderly in assisted living homes.  She currently works for Heater Home, writing about safety with home heaters.