September 2015 is the First Annual Go4Life Month

Once each decade for the last 50 years, the White House Conference on Aging has been held to examine the pressing issues of our nation’s older adults. During the July 2015 conference, special attention was paid to promoting healthy aging. The conference highlighted five ways our nation’s support systems can support people as they grow older: nutrition, preventive health services, managing chronic conditions, preventing injury and last, but certainly not least, physical activity.

As part of this emphasis on physical activity, September 2015 has been declared the very first annual Go4Life Month. The theme of the 2015 event is “Be Active Every Day.” Says NIA director Dr. Richard J. Hodes, “It’s never too late for exercise to have a positive effect on your health. We know that exercise can reduce the risk of heart disease, obesity, stroke, diabetes and other chronic conditions. One recent study found that even sedentary people in their 70s and 80s improved mobility and reduced risk of disability through a regular program of structured physical activity.”

Go4Life is named for the Go4Life campaign, begun in 2012 by the National Institute on Aging to promote exercise and physical activity for people age 50 and older, and in recognition that adults in the U.S. tend to become less active as they age.

During Go4Life Month, organizations who work with the older population are encouraged to get the word out about the importance of exercise and physical activity. You can visit the Go4Life website to find some great materials:

• Tip sheets
• A free exercise guide to order or download; the guide is also available as an audiobook
• A handy workout guide
• A free exercise DVD
• Flyers and posters organizations can use to promote the Go4Life goals.
• Many of the resources are also available in Spanish-language versions.

Visit the Go4Life website to learn more about Go4Life Month!

Source: IlluminAge AgeWise reporting on materials from the National Institute on Aging.

Medicare Turns 50 But Big Challenges Await

Kaiser Health News takes a look at this important program at the half-century mark.

Medicare, the federal health insurance program for the elderly and disabled, has come a long way since its creation in 1965 when nearly half of all seniors were uninsured. Now the program covers 55 million people, providing insurance to one in six Americans. With that in mind, Medicare faces a host of challenges in the decades to come. Here’s a look at some of them.

Financing – While Medicare spending growth has slowed in recent years – a trend that may continue into the future – 10,000 people a day are becoming eligible for Medicare as the trend-setting baby boomers age. Yet the number of workers paying taxes to help fund the program is decreasing. That means Medicare will consume a greater share of the federal budget andbeneficiaries’ share of the tab will likely climb. An abundance of proposals to curb federal expenditures on Medicare exist. They include increasing the eligibility age, restructuring benefits and cost-sharing, raising the current payroll tax rate and asking wealthier beneficiaries to pay more for coverage. Many Republicans have backed a “premium support” model — the government would give beneficiaries a set amount of money to purchase coverage from a number of competing plans — as a way to limit Medicare spending. Democrats say premium support would undermine traditional Medicare and shift more of the program’s financial risk to beneficiaries. They favor other reforms in the program. By at least two-to-one margins, majorities of Democrats, Republicans and independents favor keeping Medicare as it is rather than changing to a premium support program, according to a recent poll from the Kaiser Family Foundation. (Kaiser Health News is an editorially independent program of the foundation.)

Affordability — Most Medicare beneficiaries don’t have a lot of money and spend a large chunk of their finances on health care. Unlike many private health insurance plans, there is no cap on out-of-pocket expenditures in traditional Medicare, and the program does not cover services that many beneficiaries need, such as dental care and eyeglasses. (Private insurers that participate in Medicare Advantage may cover these and other items that traditional Medicare does not.) In 2013, half of all people on Medicare had incomes below $23,500 per person, and premiums for Medicare and supplemental insurance accounted for 42 percent of average total out-of-pocket spending among beneficiaries in traditional Medicare in 2010, according to an analysis from the Kaiser Family Foundation. Medicare does have some programs to help beneficiaries pay their Medicare expenses but the income limits can be as low as $1,001 per month with savings and other assets at or below $7,280 (limits are higher for couples).

Managing Chronic Disease — Illnesses such as heart disease or diabetes can ring up huge medical costs, so keeping beneficiaries with these conditions as healthy as possible helps not only the patients but also Medicare’s bottom line. An analysis from the Urban Institute finds that half of all Medicare beneficiaries will have diabetes in 2030 and a third will be afflicted with heart disease. Nearly half of the people on Medicare have four or more chronic conditions and 10 percent of the Medicare population accounts for 58 percent of spending. Reducing the rate of chronic disease by just 5 percent would save Medicare and Medicaid $5.5 billion a year by 2030 and reducing it by 25 percent would save $26.2 billion per year, the Urban Institute found. As beneficiaries age, many will want to remain in their homes and communities, requiring Medicare to identify ways to serve these beneficiaries as they face physical and cognitive impairments and to meet their needs for more personal care, according to the Commonwealth Fund.

Delivery-System Reform — Medicare hopes to better manage beneficiaries’ needs by revolutionizing the way in which it pays for medical care. Federal officials have taken several steps to better coordinate and improve medical care, including implementing the health law’s requirement to reduce preventable hospital readmissions and form accountable care organizations, or ACOs, where doctors and others band together to care for patients with the promise of getting a piece of any savings. Another federal effort uses bundled payments, where Medicare gives providers a fixed sum for each patient, which is supposed to cover not only their initial treatment but also all the follow-up care. Last year, 20 percent of traditional Medicare spending — $72 billion — went to doctors, hospitals and other providers that coordinated patient care to make it better and cheaper. Department of Health and Human Services Secretary Sylvia M. Burwell has said that by the end of 2018 Medicare aims to have half of all traditional program payments linked to quality.

The Growth of Medicare Advantage — Enrollment in these private plans that offer alternative coverage is growing sharply. But the health law seeks to cut the rate at which the government reimburses insurers to make it closer to what it spends on beneficiaries in traditional Medicare. Nearly a third of beneficiaries are enrolled in Medicare Advantage plans. Many of the plans provide benefits beyond what traditional Medicare covers, such as eyeglasses and dental care, as well as lower out-of-pocket costs. But as federal payment rates decline the plans may become less generous. Another factor to watch is concentration in the Medicare Advantage market with just a handful of insurers now accounting for more than half of enrollment.

Source: Kaiser Health News (KHN), a nonprofit national health policy news service. KHN’s coverage of aging and longterm care issues is supported in part by a grant from The SCAN Foundation.

Study Finds EMTs Are on the Forefront of End-of-Life Care

Paramedics and emergency medical technicians (EMTs) are trained to save lives. But they sometimes enter situations where a dying patient’s end-of-life wishes contradict their professional code. What do they do when faced with someone who is imminently dying and whose pre-hospital order is “do not resuscitate”? Until recently, the dynamics of that environment were a mystery.

“One way to gain perspective on these crises was to interview the paramedics and EMTs involved in them,” says Deborah Waldrop, a professor in the University at Buffalo School of Social Work.

Waldrop conducted a study along with UB collaborators Brian Clemency and Heather Lindstrom and Arizona State University’s Colleen Clemency Cordes. Published in the Journal of Pain and Symptom Management, the study is providing profound new insights into the complex, yet largely unknown juncture of emergency care and end-of-life care—the place where life meets death.

Waldrop, an expert in aging, end-of-life care and advance care planning and first author on the study, interviewed hundreds of families through a 16-year collaboration with Hospice Buffalo, in order to better understand the psychosocial needs of patients and their families faced with a life-limiting diagnosis.

She repeatedly heard that people didn’t know what to expect watching someone die. Providing end-of-life care, in fact, is among the most stressful human experiences. Emergency calls are often a way of coping with that stress, especially when a patient’s symptoms change suddenly for the worse.

“We are not born into this life knowing how to die or knowing how to care for someone who is dying,” Waldrop says.

And first responders are not trained in end-of-life care, yet Waldrop says they do a lot more end-of-life care than anyone gives them credit for. “They have to,” she says. “They’re usually the first medical personnel on scene.”

To learn the specific nature of these end-of-life emergencies, Waldrop interviewed EMTs and paramedics based in western New York, working with Rural/Metro, an emergency services provider in 21 states. The paramedics and EMTs expressed the need for more training in end-of-life care, but even in the absence of that training, first responders have developed ways of managing these situations. If a person is actively dying, that might include coaching the family through the process, clarifying what’s happening. Said Waldrop, “They fill the void for families looking for help, looking for knowledge about what’s happening and what to do.”

But it’s a challenge and conflicts are common. If there are no medical orders or they can’t be found, first responders are professionally bound to begin life-saving interventions and transport to a hospital even if family members say otherwise. “It’s why the end-of-life conversation needs to happen at the time of a life-limiting diagnosis or when something changes on the trajectory of that illness and why those documents have to be in a prominent place,” says Waldrop. “In the heat of the moment, families don’t want to be shuffling through files.”

All these things need to be in place well in advance of the emergency call to prevent unwanted actions and unnecessary treatments. “It’s someone’s life that may end differently than they intended if we fail to take these steps,” she says. “Those memories don’t easily go away.”

These calls are low frequency, but high intensity. Events happen quickly. First responders assess the patient, family and environment, identifying relationships to establish who might be serving in a decision-making capacity. The emotional intensity of the environment also raises safety concerns.

“The death of a loved one can bring out the worst in people,” says Waldrop. “Emergency personnel have to be mindful of the scene.”

Waldrop says there is so much that can be done, and the pre-hospital providers’ role in end-of-life care should be further explored to increase their ability to uphold end-of-life wishes while providing emotional support to families.

She offers the following tips for those facing end-of-life decisions:

• Following the diagnosis of a life-changing illness, initiate conversations about the person’s goals of care and wishes for life-sustaining treatment.
• Ask health care providers about what to expect over the course of a chronic, life-limiting illness. Information is key to making choices and upholding a person’s wishes.
• Revisit the person’s wishes periodically and when the situation changes, such as after a symptom crisis or hospitalization.
• Discuss wishes for resuscitation (or not) with all caregivers who are involved.
• Assure that all family members (those who are caregiving and those who are at a distance) are aware of the ill person’s wishes.
• Place copies of a Non Hospital Do Not Resuscitate Order or Medical Orders for Life Sustaining Treatment (known as MOLST or POLST in many states) in a prominent location such as on the refrigerator.

Source: University at Buffalo

Take the Plunge! Water Exercise Is a Great Choice for Seniors

We all know that exercise is necessary to keep the body and mind in peak working condition. According to the National Institutes of Health (NIH), staying physically active can help prevent or delay many diseases and disabilities. But as we grow older, exercise can become more challenging due to physical limitations such as joint pain, back problems, or a fear of becoming injured.

That’s where water comes in. Swimming, water aerobics and aquatic therapy are all excellent choices for seniors. These exercises not only provide a total body workout, building strength, endurance and flexibility, but also are low-impact activities, making them ideal for people with joint or back pain. Water buoys and supports the body, taking the pressure off muscles and joints. In addition to being easy on the joints, here are some other benefits of working out in water:

Build and tone muscles. Water is approximately 12 times denser than air, so when you move through water, you’re performing a resistance exercise, which builds and tones muscles. And, according to the NIH, resistance exercises appear to have the greatest positive effect on bone mineral density, lowering your risk for osteoporosis.

Increase your flexibility. Being in water (especially warm water) may lessen joint stiffness and pain, making it easier to move and increasing joint flexibility. Swimming is particularly helpful for increasing flexibility in the hips, arms, and legs. This increased flexibility reduces the likelihood of injury.

Improve your mind. Seniors who might avoid other types of exercise are more likely to keep up with a water exercise program. This is good news! In addition to improving the body, physical activity also is important for brain health. According to the Alzheimer’s Research & Prevention Foundation, physical exercise reduces the risk of developing Alzheimer’s by 50 percent. Other studies show that regular exercise can reduce stress and improve your mood.

Decrease your risk of falls. One of the reason seniors often avoid exercising is their fear of falling or injuring themselves. Water’s natural buoyancy supports the body, making falling virtually impossible and reducing the risk of injury. Additionally, the strength and flexibility you gain from working out in water also help prevent your risk of falling.

Keep your heart healthy. Swimming and water aerobics are great exercises for the heart, making it stronger and more efficient. According to the NIH, not only does regular aerobic exercise reduce the risk of coronary disease, but it also lowers inflammation by preventing fatty deposits in the arteries.

Finally, taking a water aerobics class or swimming in a public pool offers socialization opportunities for seniors, reducing their risk of isolation and loneliness.

So jump on in! The water’s fine!

People Who Live to 100 and Their Thoughts on Living a Long and Happy Life!

Will you live to be 100? Would you want to? More and more of us will reach that milestone, say experts. According to the Center for Retirement Research at Boston College, there are more than 67,000 American centenarians, and that number is expected to double by 2030.

The Boston College experts and other say that Americans should be prepared for these extra years—35 past the age of retirement and even beyond.

What will this longevity mean for our work life? Our relationships? Our ongoing education? Our financial health?

Other experts remind us that healthcare systems should be preparing for this increase in the oldest old. King’s College London researcher Nisha Hazra says, “As the number of people living to 100 continues to increase, it’s very important to understand the evolving health care needs of the oldest old.”

But perhaps some of the best advice comes from centenarians themselves! On their 100th birthday, people are frequently asked by friends, family and even the media to share their thoughts about living a long, happy life. This month’s puzzle contains the names of 20 things they often name.

Need some help? Click here for the solution.

New Insights into the Health Damage of Loneliness

For years, researchers have confirmed the negative health effects of loneliness. Social isolation raises the risk of depression, heart disease, high blood pressure and a host of other health conditions that decrease both the length and the quality of our lives. University of Chicago’s Dr. John Cacioppo even says, “Chronic loneliness belongs among other health risk factors such as smoking, obesity or a lack of exercise.”

Recently, researchers from Brigham Young University confirmed the damage caused by social isolation, and added a few new interesting pieces to the puzzle. For example, the team, headed by Julianne Holt-Lunstad, found that spending a lot of time by yourself can hurt you even if you are something of a loner. The authors found that whether a person feels “lonely in a crowd” or opts to spend lots of time in solitary pursuits, “the effect on longevity is much the same.” It’s worth the effort to spend more time with other people even if you’re not a social butterfly by nature.

They also found that while seniors are at a higher risk of social isolation due to health challenges and changed circumstances, younger people today also face loneliness. Said study co-author Tim Smith, “Not only are we at the highest recorded rate of living alone across the entire century, but we’re at the highest recorded rates ever on the planet. With loneliness on the rise, we are predicting a possible loneliness epidemic in the future.”

What about electronic socialization? The researchers say it’s a mixed bag: “With the evolution of the Internet, people can keep in contact over distances that they couldn’t before. However, the superficiality of some online experiences may miss emotional context and depth.”

The overall good news is that while a lack of social connections can harm our health, having good-quality relationships can be a health plus. “The effect goes both ways,” according to Holt-Lunstad and her team.

Source: IlluminAge AgeWise reporting on a study from Brigham Young University appearing in Perspectives on Psychological Science.

Why Don’t Seniors Get Their Shots?

August is National Immunization Awareness Month, and the week of August 16–22 focuses on adult vaccinations.

The National Public Health Information Coalition sponsors this event to call attention to the importance of immunizations for adults. Their “Vaccines are not just for kids” campaign reminds us that seniors in particular are at higher risk of serious complications from a number of preventable diseases. Yet many seniors still fail to be immunized for the flu, shingles, pneumonia, tetanus and other diseases that can cause, at the very least, a miserable period of illness—and often, disability and even death.

Recently, the Alliance for Aging Research (www.agingresearch.org), a nonprofit organization dedicated to healthy aging, released a new report, Our Best Shot: Expanding Prevention through Vaccination of Older Adults. “Vaccinations are available for many of the most common and deadly infectious diseases in older Americans and can save countless lives and health care dollars,” said Alliance president and CEO Susan Peschin, MHS.

The report took a look at why seniors fail to be vaccinated, and made recommendations about how our public health and other agencies can promote full immunization of people older than 65.

Among the reasons seniors do not receive the recommended vaccines: they may not understand the need for vaccines or which shots are recommended; they may be unable to afford the cost of vaccines or a copay, or might be unaware that these vaccines are covered by Medicare; and they may not be under the care of a healthcare provider who encourages and enables them to get their shots.

Said Peschin, “We think there is lot of low-hanging fruit—in promotion of existing preventive health services, access and administration policies, and financial strategies—that would increase utilization and improve public health for older adults. We need to raise the level of importance of immunization among seniors to the level we currently have for children, and then we need to make some basic changes to support it.”

You can read the entire report here.

What immunizations are recommended for older adults?

Here are the vaccines recommended by the CDC and the U.S. Food and Drug Administration for most older adults. Of course, you should consult your healthcare provider before receiving any vaccines, and about which form of each vaccine is best for you.

Influenza (Flu). Seniors are at high risk of complications and even death from the flu. Get your annual flu shot as soon as the vaccine is available in your area. Ask your doctor which flu shot you should receive.

Pneumonia (Pneumococcal Disease). This disease can lead to serious infections of the lungs, blood and brain. One dose is recommended for all adults age 65 and older.

Tetanus/Diphtheria/Pertussis. Tetanus (sometimes called “lockjaw”) and diphtheria are severe, often fatal diseases. Pertussis (“whooping cough”) causes spasms of severe coughing. The vaccines for these three diseases are given in different combinations; consult your healthcare provider about the type that is recommended for you.

Shingles (herpes zoster). Shingles causes a painful skin rash, and can lead to long-term pain and disability. All adults 60 years old or older should get the shingles vaccine.

The CDC also recommends additional vaccines for people with certain health problems, immunization histories and lifestyles. These vaccines include the Measles/Mumps/Rubella (MMR) shot, vaccinations for Hepatitis A and B, and for Meningococcal disease. Your doctor can tell you if you should receive any of these immunizations.

Vaccines are safe. The CDC says, “Vaccines are thoroughly tested before licensing and are carefully monitored even after they are licensed to ensure that they are very safe.” Side effects and allergies are rare and usually temporary. Talk to your healthcare provider about the vaccines that are right for you based on your age, health, lifestyle, occupation and other factors.

Learn More

Find an online, recently updated booklet about adult vaccines from the National Public Health Information Coalition (www.nphic.org/niam-adults).

Source: IlluminAge AgeWise, 2015, reporting on materials from the Alliance for Aging Research and the National Public Health Information Coalition.

Nurturing Your Spirit in the Later Years

Several studies over the past few years have shown that as we grow older, we benefit from thinking about higher things such as beauty, the meaning of life, the things that connect us, our place in the world—in short, the quality that is often referred to as “spirituality.”

In most cultures, the elders of the community are looked to as persons of wisdom and mature spirituality. The later years of life inspire many older adults to enhanced spiritual contemplation. Much of life’s work is done. Those past retirement age have already raised their families, been productive in society, given much to their communities. As we age, the reality and inevitability of the end of life grows more present. The pace of life can slow down, allowing for more time and leisure to reflect on life’s experience.

Wisdom, life experience, the movement towards completing life—all these combine to bring a rich spiritual possibility to our final decades. For most people, aging successfully will involve some attention to spiritual questions and spiritual life.

What Does It Mean to Nurture Your Spirit?

Spiritual reality is defined in very different words, depending on one’s religious or philosophical tradition. In all traditions, however, to pay attention to the realm of the spiritual is to pay attention to that which connects us. Spiritual reality connects us here in the world with other people, with creation, with the earth itself. Spiritual reality connects us to those who have gone before us and those who will come after. Spiritual questions are those that deal with the meaning of life, of death, of God, of the universe, of what holds us together and what pulls us apart. Nurturing our spirit means taking the time and effort to pay attention, to think, to begin articulating the meaning of what we have known. There are a variety of ways to do this, both within conventional religious communities and, for those who are not drawn to organized religion, outside of traditional religion institutions and concepts.

Spirituality and Religious Communities

If you are currently part of a religious community, use the resources your community offers to engage the spiritual questions that are important to you. If your worship tradition sustains you, then make a point of finding a way to attend worship regularly. If you have given up driving, most religious communities have volunteers who are pleased to give rides to other members. Many retirement communities provide transportation to places of worship; others provide worship opportunities within the facility. Even if it means calling a taxi, if religious observance is important to you, then make a point of going.

If you find yourself needing a more individual approach to spirituality than groups afford, make an appointment to see your religious leader. He or she may know of reading material that will be helpful to you, or may prescribe a spiritual discipline. Sometimes just one-on-one conversation is what you need to point you where you want to go.

Nontraditional Spirituality

Many people consider themselves to be spiritual, but not religious. For one reason or another, traditional religious communities do not meet their needs. That doesn’t mean they are without spiritual resources.

If the spiritual task of later life is coming to see life as whole, assessing the meaning and value of one’s own life, then there are a number of ways to approach this task outside of religious communities. Spirituality is a popular topic these days, and your local bookstore or public library will carry a variety of titles that approach spiritual reality from many perspectives. Look at the titles that interest you, read a few pages and select a few books to take home with you. Learn about groups of people that meet in your area to discuss the topics that are important to you. Some people find practices such as yoga and meditation to be meaningful and fulfilling. Spending time in nature, participating in the arts and in volunteer service are other ways to connect with the world and people around us.

A Word About Electronic Spirituality

Many older people who are homebound or who have not found a good fit in a religious community close to them find spiritual nurture through radio, television and Internet religious organizations. Television evangelists, religious talk shows and Internet chat rooms that focus on spirituality provide spiritual nurture and comfort for thousands of older adults.

Many of these organizations are legitimate religious and spiritual communities. They provide a valuable service to those who watch, listen and log on. However, a word of caution is in order. There are some so-called religious organizations that prey on vulnerable individuals, promising them spiritual benefit, but bombarding them with increasingly urgent pleas for money. It’s important to be cautious before you send any money to such an organization. If you feel that a loved one is being victimized by such an organization, you may need to step in. You can often find information online about a particular televangelist or faith group.

Taking care of ourselves spiritually can help us approach life more positively and build a resilience that can help us through many of life’s difficulties. Paying attention to our spiritual selves and our own unique spiritual needs helps us live life to the best we can, throughout every stage of life.