News You Can Use
- July 2017: Is sciatic nerve pain something I just have to put up with?
No, sciatic pain does not have to be a chronic condition. The medical condition called “sciatica” is a major cause of work absenteeism and a major financial burden to both employers and our health care system. Your sciatic nerve is the largest nerve in your body. It begins as a bundle of nerves in your lower back and passes through your pelvis and down the back of each thigh. In the back of the thigh, the sciatic nerve splits into two smaller nerves called the tibial nerve and the peroneal nerve. The sciatic nerve carries impulses from nerves in your lower back to the muscles and nerves in the buttocks, thighs, and lower legs.
Sciatica is a symptom. It consists of leg pain, which might feel like a bad leg cramp, or a ‘pinched nerve’. The pain can shoot down your leg to your foot, making sitting or standing very painful. Sciatica can occur suddenly, or develop gradually. You might feel a numbness, or a burning or tingling ("pins and needles") sensation in your legs or toes.
The term ‘sciatica’ has come to be used to describe any pain felt in the leg along the length of the sciatic nerve. The incidence of sciatica is related to age. It is rarely seen before the age of 20, and it peaks in the fifth decade and declines thereafter. Between 13% and 40% of Americans will have sciatica sometime in their life. The nerve might be pinched inside or outside of the spinal canal as it passes into the leg. Sciatic pain seems to involve a complex interaction of inflammatory, immune and pressure-related elements. Symptoms like paralysis or incontinence indicate a more serious problem like nerve damage or a disease, and should be reported immediately to your primary care doctor.
The exact nature of the relationship of sciatica to disc, nerve, and pain is not yet certain. For some people, the pain from sciatica can be severe and debilitating. For others, the pain might be infrequent and irritating, but has the potential to get worse. A herniated or ‘slipped disc’ is the most common cause of sciatica, but there is no one basic cause. Not everyone’s spinal disks age at the same pace. Spinal disks lose their elasticity over time as they lose fluid and become brittle and cracked. These changes are a normal part of aging.
Another cause can be a small muscle deep in the buttocks that becomes tight or spasms, which puts pressure on the sciatic nerve. Narrowing of the spinal column, or a vertebra that is out of line, can affect the sciatic nerve. Fortunately, most cases of sciatica are short term, and the pain resolves within a matter of weeks or months. But some cases do not resolve quickly, and 10% to 40% of cases can require treatment for chronic pain.
Most patients with sciatica can be treated by their primary care doctor without the need for further diagnostic testing. The goal is to reduce the pain and increase mobility. Physical therapy, with customized stretching exercises to improve flexibility of tight muscles, are often where treatment will begin, along with the use of NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin or ibuprofen to temporarily relieve pain and inflammation. In other cases, tests like Magnetic resonance imaging (MRI) or computed tomography (CT) scan are used to obtain images of the structures of the back. Spinal injections of an anti-inflammatory medicine, or surgery is available for people who do not respond to other treatments, and who have severe pain. Many people believe that massage, yoga or acupuncture can improve sciatica.
You can take steps to protect your back and reduce your risk for getting sciatica pain by:
- Practicing proper lifting techniques: Lift with your back straight, bringing yourself up with your hips and legs, and holding the object close to your chest. Use this technique for lifting everything, no matter how light.
- Avoiding/stopping cigarette smoking, which promotes disc degeneration.
- Exercising regularly to strengthen the muscles of your back and abdomen, which work to support your spine. Whether you are sitting or lying down, tighten your stomach muscles often, hold them tight, then release.
- Using good posture when you are sitting, standing, and sleeping. Good posture helps to relieve the pressure on your lower back. Wrap up a towel for lower back support in your car seat or desk chair.
- Avoiding sitting for long periods.
- June 2017: Does retirement have a positive or negative impact on health?
Retirement can have positive or negative impacts on health. One study by the National Bureau of Economic Research concluded that complete retirement leads to a 5-16% increase in difficulties associated with mobility and daily activities, a 5-6% increase in illness conditions, and a 6-9% decline in mental health. However, these negative health effects can be reduced if the retiree is married, has social supports, continues to engage in physical activity after retirement, or continues to work part-time after retiring. The negative health effects of retirement may be larger if a person is forced to retire.
The National Institute on Aging says that health problems have a big influence on the decision to retire early, but less research has been done on how retirement affects your health after you retire. According to the Harvard Health Blog, retirement for some people is a chance to relax away from the daily grind---but for others, retirement can be a period of declining health and increasing limitations. One study ranked retirement 10th on the list of life’s most stressful events. Losing a spouse was number 1.
The U.S Health and Retirement Study data shows that retirees were 40% more likely to have had a heart attack or stroke than those still working. The increase was greater during the first year after retirement, and leveled off after that. Another study from England concluded that retirement significantly increased the risk of being diagnosed with a chronic condition. In particular, retirement raised the risk of a severe cardiovascular disease and cancer.
There are other studies which link retirement with an improvement or a neutral effect on health. One study found that retirement did not change the risk of major chronic diseases, and brought about a substantial reduction in mental and physical fatigue and depressive symptoms among people with chronic diseases.
So the impact of retirement on health may depend on the individual. The Harvard Health Blog suggests that “moving from work to no work comes with a boatload of other changes.” If you loved your work, retirement can bring some emptiness of purpose. If you had a stressful job, retirement brings relief. Either way, researchers offer these tips for a rewarding retirement:
- Don’t ‘retire’ from daily contact with friends and colleagues
- Maintain Activities like sports or traveling, to keep a purposeful daily life
- Be creative: keep your brain healthy by painting, gardening, or volunteering
- Keep learning: explore new subjects you have always been interested in
Understanding what large group studies say about retirement is interesting, but studies can’t predict how retirement will affect your life. People who retire because of health problems may not enjoy retirement as much as someone who retires feeling healthy. But, it makes sense to view retirement as a process. Often it is just the need to stay connected, and be a part of something bigger, that truly gives us that fulfillment in our later years, not the complete absence of work or responsibility.
- May 2017: Are Dietary Supplements Worth Buying?
Unfortunately, the answer is often “No.” Advertisements for “dietary supplements” frequently claim they will keep you from getting sick, or help you live longer. But according to the National Institute On Aging, “Often there is little, if any, scientific support for these claims…Some supplements can hurt you. Others are just a waste of money because they don’t give you any health benefits.”
There are many “dietary supplements” on the market today that are sold over the counter, including vitamins, minerals, fiber, amino acids, herbs, and hormones. Some products, like drinks or energy bars, have supplements added to them. The Food & Drug Administration (FDA) does not review these supplements before they reach the market, only if they believe a product is considered unsafe.
The best way to get vitamins or minerals is through the food you eat, not added supplements. If you feel you can’t eat enough, ask your doctor if you need a multi-vitamin and/or mineral supplement. It does not have to be labeled for “seniors,” and it does not have to be a large, or “mega dose” vitamin. The theory; “if a little is good, a lot must be better,” does not hold for supplements. Taking more than 100% of the daily value of a vitamin or mineral could be harmful, and your body may not be able to use the entire supplement, so you are wasting your money. People over the age of 50 may need supplements for certain purposes, such as vitamin B12, Calcium, vitamin D, extra Iron for women, and vitamin B6.
Antioxidants are natural substances found in food. There is no proof that large doses of antioxidants will prevent chronic diseases like diabetes, cataracts or heart disease. Rather than taking a supplement, try eating at least 5 servings per day of fruits and vegetables, or using vegetable oil and eat nuts (in moderation). These foods can give you the antioxidants you need.
There are also herbal supplements, like ginseng, Echinacea, or ginkgo biloba, which come from certain plants. When you use any herbal supplements, you are using them as a drug, and they can interfere with other medications you may already be taking. Some herbal supplements can cause high blood pressure, nausea, diarrhea, constipation, headaches, seizures, heart attacks, or stroke. Some supplements can increase the risk of bleeding or, if a person takes them before or after surgery, they can affect the person’s response to anesthesia. Dietary supplements can also interact with certain prescription drugs in ways that might cause problems. Vitamin K, for example, can reduce the ability of certain blood thinners to prevent blood from clotting. Antioxidant supplements, like vitamins C and E, can reduce the effectiveness of some types of cancer chemotherapy.
Before you start taking a dietary supplement, talk with your doctor or a registered dietician. Do not go on the recommendation of a friend or an internet site. Consider the source of any information you read: is it from a group that stands to make money from the sale of this product? If something worked for your neighbor, it does not mean that it will work for you. Don’t take supplements in place of, or in combination with prescribed medications without your health care provider’s approval.
All products labeled as a dietary supplement carry a Supplement Facts panel that lists the contents, amount of active ingredients per serving, and other added ingredients (like fillers, binders, and flavorings). The manufacturer suggests the serving size, but you or your health care provider might decide that a different amount is more appropriate for you.
There is a federal Office of Dietary Supplements (ODS), part of the National Institutes of Health, which publishes fact sheets that give consumers an overview of individual vitamins, minerals and other dietary supplements. ODS says if you don’t eat a nutritious variety of foods, some supplements might help you get adequate amounts of essential nutrients. However, supplements can’t take the place of the variety of foods that are important to a healthy diet. You can contact ODS at (301)435-2920, or visit their website at https://ods.od.nih.gov/HealthInformation/DS_WhatYouNeedToKnow.aspx
- April 2017: As I get older, does it really matter to stay physically active?
Absolutely. Regular physical activity and exercise are important to the physical and mental health of almost everyone, including older adults. There are many benefits from physical activity including:
- Maintains and improves your physical strength and fitness.
- Improves your ability to do the everyday things you want to do.
- Improves your balance.
- Manages and improves diseases like diabetes, heart disease, and osteoporosis.
- Reduces feelings of depression and may improve mood and overall well-being.
- Helps you fall asleep faster and deepen your sleep but don’t exercise too close to bedtime.
If you feel out of shape, but want to remain physically active, the key to success, according to the National Institute on Aging, is to build up slowly from your current fitness level. Health experts suggest that you consult your doctor before you start any new exercise program.
Start by determining your fitness level. Begin by asking these questions:
- How much time do you spend sitting?
- How much time and how often are you active?
- When you are active, what kinds of activities are you doing?
Here are 5 ways you can test your own fitness:
- Measure your endurance by picking a fixed course. Once around the block or from one end of the mall to the other. Time how long it takes you to walk it.
- Test your upper-body strength by how many arm curls you can do safely in 2 minutes.
- Test your lower-body strength by how many times you can stand from a seated position safely in 2 minutes. If you are unsteady, have someone there with you.
- Test your balance by how long you can safely stand on one foot. (Stand next to something sturdy that you can hold onto if you lose your balance).
- Test your flexibility by sitting toward the front of a sturdy chair, and stretching one leg straight out in front of you with your heel on the floor and your toes pointing up. Bend the other leg and place your foot flat on the floor. Slowly bend from your hips and reach as far as you can toward the toes of your outstretched foot. How far can you reach before you feel a stretch?
Write down your results. If these exercises were hard to do, just do what is comfortable and slowly build up. If they were easy, you know your level of fitness is higher. Now you can be more ambitious and challenge yourself. You can do these simple fitness tests once a month, and measure your progress at each session.
If you feel any pain or dizziness while exercising, stop. Muscle soreness lasting a few days and slight fatigue are normal after doing muscle-building exercises, at least at first. After doing these exercises for a few weeks, you will probably not be sore after your workout. For some exercises, you may want to start alternating arms and work your way up to using both arms at the same time. Breathe out as you lift or push, and breathe in as you relax. Don’t hold your breath during strength exercises. Holding your breath while straining can cause changes in blood pressure. Breathe in slowly through your nose and breathe out slowly through your mouth. Talk with your doctor if you are unsure about doing a particular exercise, especially if you have had hip or back surgery.
Some exercises for older adults, or those who are sedentary, include: brisk walking, stationary bike riding, low impact aerobics, swimming, and water aerobics. Safety during exercises is always important. Walk during the day or in well-lit areas at night, and be aware of your surroundings. Try not to walk alone or in secluded areas. To prevent injuries, be sure to use safe equipment. If you are exercising outdoors, dress in layers so you can add or remove clothes if you get cold or hot. Drink plenty of liquids when doing any activity that makes you sweat. Before and after you exercise, do a little light activity to warm up and cool down.
Each year, more than 2 million older Americans go to the emergency room because of fall-related injuries. You can learn exercises that will improve your balance and make you steadier on your feet. You can see pictures and short videos of any of these exercises, plus get more fitness tips by going to the National Institute On Aging website: https://go4life.nia.nih.gov/exercises. Go4Life is an exercise and physical activity campaign from the National Institute on Aging that is designed to help you fit exercise and physical activity into your daily life.
- March 2017: Is there more to using a drug plan than just selecting one?
Yes. Many people select a drug plan and then forget about it. But older adults report that medication costs and not understanding their drug benefits are major challenges. Older adults want easy to understand information on cost, coverage and provider networks to get the most out of their drug benefits.
People on Medicare are receiving their new prescription drug plan materials. It may be a Medicare Part D plan, or a Medicare Advantage Plan (Part C), but you can save money and avoid medication mistakes by understanding your benefits.
According to the National Association of Area Agencies on Aging (n4a), as many as 88% of Medicare recipients have not chosen the lowest possible total plan cost for their Medicare prescription drug coverage. These people could save money by choosing a plan that has a lower premium and the lowest possible out-of-pocket costs. N4a and Walgreens have teamed up to provide older adults and people with disabilities the education and programs they need to help maximize their Medicare pharmacy benefits.
Proper medication adherence is one of the keys to maintaining good health. Too many older adults may not have enough information about how to take their medications as prescribed for fear of incurring additional out-of-pocket expenses.
Here are some tips for getting the most out of your drug benefits, and for lowering your out-of-pocket costs:
- Every prescription drug plan has a list of covered drugs called a “formulary.” This list is divided into “tiers,” which vary by plan. Typically, a drug in a lower tier will generally cost you less than a drug in a higher tier. Ask your doctor or pharmacist if there are lower-cost options, such as lower-cost brands or generic substitutes on your plan’s formulary, or even over-the-counter options that can properly treat your medical condition.
- Many prescription drug plans have a “preferred pharmacy” network. If your plan has preferred pharmacies, you may save money and pay lower prescription copays if you use the preferred pharmacy.
- Some plans offer a mail order pharmacy that may offer lower drug prices. This may be a cost-effective and convenient way to fill prescriptions.
- Whether you are using a generic alternative, or a lower-cost brand alternative, if you are taking maintenance drugs, ask if you can get a less expensive 90-day supply instead of 30-day supply.
- At least once a year, ask your doctor or pharmacist to evaluate changes in your health and prescription needs, and about ways you may be able to reduce your medication costs.
- If you take medications for more than one medical condition, ask your doctor if you qualify for medication management therapy (MTM) from a pharmacist or other health professionals to ensure that your medications are working well together.
- Ask your doctor or pharmacist to review your prescriptions for falls risk. Some medications can interact together or affect you in a way that could increase your risk of falling.
- Talk to your doctor about ALL the medications you take, including over-the-counter (OTC) medications and “nutritional” supplements.
- If your prescription drug copayments are not affordable, ask your doctor if your drug manufacturers have a “patient assistance program” that reduces the cost of your drugs.
- The Prescription Advantage program provides financial assistance, based on income, for people with Medicare drug coverage. This program can help pay all or part of your Medicare drug co-payments, and can also provide an out-of-pocket spending limit. Once this limit is reached, Prescription Advantage will cover drug co-payments for the remainder of the plan year. Call 1-800-243-4636 and press “2” for details.
Choosing a drug plan is just the start. Learning more about your plan could help you save more.
- February 2017: What is the difference between hard of hearing and deaf?
Hard of hearing (HOH) refers to people who still have some useful hearing and can understand spoken language, in some situations, with or without amplification. Most HOH people can use the telephone, hearing aids and other assistive devices. The degree of hearing loss can vary, from mild to profound. Deaf people, on the other hand, have little or no hearing. They may use sign language or lip reading, and hearing aids may be used for both environmental awareness and to help make speech understandable. People who use spoken English to communicate are called “oral deaf.” Many individuals who are deaf lost their hearing before they learned to speak, and they view hearing loss, not as a medical condition that needs to be corrected, but as a cultural distinction.
People who are “late-deafened” are those who lost all or most of their hearing during or after their teen years, either suddenly or progressively. Most need sign language or lip reading to understand conversation, and cannot use the telephone. In many cases, doctors cannot definitively determine what causes deafness later in life. Some common causes include: exposure to loud noise, aging, meningitis, accidents, trauma, virus, Meniere’s disease, and tumors of the acoustic nerve. If you experience a sudden drop in hearing, unexpected dizziness, drainage from your ear, or significant pain in your ear or head, see a doctor as quickly as possible.
Acquired deafness is a traumatic loss, especially for people who lose their hearing suddenly. People who are born deaf never feel this overwhelming sense of loss, because they never experienced hearing. But for anyone who becomes deaf later in life, the sense of loss can be devastating and often report a feeling of isolation and loneliness. They may go through a grieving process that lasts months or even years. It is important to note that deafness does not mean that your recreational or social life has to stop. You can still do many of the same things you used to do, just differently.
There are some special concerns for older adults. The incidence of hearing loss increases dramatically with age. One third of all people over the age of 60 and 50% of people over 80 have some form of hearing loss. Hearing impairment is common and can seriously affect their safety, quality of life, and ability to live independently. Some seniors are not comfortable with new technologies like assistive listening devices or close captioned television and may lack the manual dexterity to manipulate the small controls on hearing aids and other devices. Seniors may be anxious about being able to remain living at home, and may be unaware of safety alerting devices and other assistive technology.
The Massachusetts Commission for the Deaf and Hard of Hearing can be used as a central point of contact for seniors and their caregivers. Their website is www.mass.gov/mcdhh. Much of the information in this article is taken from The Commission’s publication, The Savvy Consumer’s Guide to Hearing Loss. This publication lists organizations that offer supportive services, medical help, financial assistance and benefits programs, communications options, assistive technologies, and real life coping skills. To receive a copy of this book, call 1-800-882-1155, or 617-740-1700 (TTY).
- January 2017: Is it important for seniors to keep up with their vaccines?
Yes. A number of diseases, which can be prevented with vaccines, can cause significant illness, hospitalization, disability, and even death.
Older adults are more affected than most people by these diseases. According to the Alliance for Aging Research, more than half of the annual flu-related hospitalizations, and 90% of the annual flu deaths, are in people age 65 or over. Roughly half of the 1 million annual cases of shingles in the U.S. are in people over the age of 60. Even though seniors are hit harder by these illnesses, vaccination rates among older adults are dangerously low.
Your immune system is made up of cells that defend your body against a bacteria or virus, called a pathogen. It is your immune system which produces antibodies that destroy the pathogens. Every time your immune system reacts to a specific pathogen, it builds up a defense called immunity. The next time that pathogen shows up, your immune system “knows” the bacteria or virus, and removes it more quickly.
Vaccines imitate an infection, and tell your immune system to produce antibodies to protect you from a disease. By getting vaccinated, you also protect those around you who may not be vaccinated. This is called herd or “community immunity.” The more people who get vaccinated, the fewer chances a disease has to spread.
Here are some bacteria or viruses that can be treated with vaccines:
Influenza (flu) is a respiratory virus that spreads from coughing or sneezing droplets that land on you. Every year as many as 200,000 people are hospitalized from the flu.
Tetanus is a bacteria that enters the body through a deep flesh wound. It can interfere with the ability to breathe.
Diphtheria is a bacteria that attaches to the lining of the respiratory system and produces toxins. It can make it hard to breathe and swallow. This can lead to infections of the lung, blood, heart, kidney, and nerves.
Pertussis can lead to uncontrollable coughing, which often makes it hard to breathe.
Varicella is the chicken pox virus. Varicella zoster is a chicken pox virus that can be reactivated years later as a shingles infection. During their lifetime, 30% of Americans will develop shingles — around 1 million people each year.
Pneumonia is a bacteria or virus that infects the lungs. Every year, an estimated 53,000 people die and 1.1 million are hospitalized because of pneumonia.
Vaccines you received when you were younger (tetanus, diphtheria, and pertussis) can wear off, so you may need a booster vaccine. If there are vaccines you never received as a child (like chickenpox), it may be recommended that you get them as an adult.
As we age, our immune system weakens and puts us at a higher risk for certain diseases, like shingles and pneumonia. After age 60 there are additional vaccines that are recommended. Vaccines for measles, mumps, and rubella are not recommended for those ages 60 and up.
Talk to your doctor about staying up-to-date with your vaccines. The flu vaccine can change each season and even change mid-season. Your immunity decreases over the year and certain diseases and conditions can make it harder to fight off infection. With some chronic diseases, the complications of infection can be more severe. Ask your doctor about your risk for meningitis and hepatitis A and B.
Whenever you get vaccinated, ask for an immunization record card, and have it sent to your doctor’s office. Medicare Part B pays for flu, pneumonia, and hepatitis B vaccines. Medicare Part D plans must include all commercially available vaccines (except those covered by Part B). Medicare Part D or Medicare Advantage Part C plans, that offer prescription drug coverage, may also cover a number of these vaccines. Medicaid covers some of these vaccines.
For more information about what vaccines are recommended for you, visit this website www.cdc.gov/vaccines.
- December 2016: Is drug abuse an issue with older people?
Yes. Little attention has been paid to the issue of substance abuse, both legal and illegal drugs, among older adults. Recent data demonstrates that drug abuse is increasing among elders, and is a larger proportion of all substance abuse among this population.
One study in 2011 reported that 6.3% of those age 50 to 59 reported they had used illicit drugs in the past month, more than twice the rate recorded in 2002. Baby boomers (born between 1946 and 1964) have a lifetime rate of illicit drug use higher than those of people older than them. The number of older adults needing treatment for substance abuse is estmated to increase from 1.7 million in 2000 to 4.4 million by 2020.
Nonmedical use of prescription drugs among people 50 years and older is predicted to increase to 2.7 million Americans by 2020, and one recent study of elderly men in hospital emergency rooms showed that 11.6% involved opioid use, a rate nearly 5 times higher than marijuana, and 6 times higher than cocaine.
One large study of emergency department admissions in 2008, for illicit substance abuse among adults over age 50 years, noted that nearly 60% were aged 50 to 54 years, while only 1.5% were over age 75 years. Substance abusers were 70% male. The substances most commonly abused include cocaine (50%–60% of cases), heroin (25%), and marijuana (20%).
Researchers define “early onset users” as individuals with a long history of substance abuse who continue to abuse as they age. “Late-onset” substance abuse is a less common pattern, accounting for less than 10% of substance abuse. Some older adults who start abusing drugs do so because of medical factors, like higher rates of painful medical conditions that push the elder toward self-medication, and the development of psychiatric conditions, like depression or dementia. Older adults also suffer from higher rates of many of the same risk factors found in younger adults, like bereavement, social isolation, financial difficulties, or poor support systems.
Some studies suggest that in recent years prescription opioids have replaced heroin as the opioid of choice, including among elders. But among people who were early users of illicit drugs, heroin has been a drug of choice for so long that changing trends are not immediately reflected among older adult users.
The most common addiction among elders is with legal substances, like nicotine and alcohol. Psychoactive prescription drugs come in third, and illegal drugs, like marijuana, cocaine, or narcotics, come in fourth. One study of alcohol use in assisted living found that 60% of residents drank alcochol, 34% drank daily, 19% had health impacts from drinking, and 12% had physical or psychosocial harm from alcohol. Alcohol abuse is a risk factor for psychiatric illness: older adults are 3 times as likely to develop a mental disorder if they have a lifetime diagnosis of alcohol abuse.
Some studies recommend that every 60 year old should be screened for alcohol and prescription drug use/abuse as part of their routine physical exam. But diagnosis of elder drug abuse is a challenge for primary care doctors. Older patients may feel compelled to hide their abuse. Doctors may become absorbed with other medical concerns and neglect to explore the possibility of substance abuse. Bringing more attention to elder drug abuse will hopefully encourage physicians to become more comfortable learning about treating older substance abusers.
- November 2016: Do I have to “improve” to keep getting home health care?
No. One of the biggest mistakes that nursing facilities, rehabilitation centers and home health agencies make is telling people covered by Medicare that they can’t get skilled nursing, home health care, or physical therapy because they have “reached a plateau,” or “failed to improve.” The courts have ruled that “improvement” is not a requirement for Medicare therapy or home health benefits. A federal judge recently ordered Medicare to do a better job of informing health care providers that the so-called “improvement standard” was no longer in effect.
Older patients with chronic and progressive diseases like Alzheimer’s, Parkinson’s, or congestive heart failure are unlikely to “improve” over time, but they can still get physical therapy or home health care. Rehabilitation therapy helps prevent declines in walking, eating, speaking, dressing and bathing. Denying someone access to these treatments can worsen their disability, threaten their independence and result in more expensive health care needs.
People on Medicare might get confused reading their Medicare & You booklet, which describes on page 50 that home health is “part-time or intermittent.” That does not mean it has to be short-term. It is true that a doctor must approve your care, and you must be “homebound,” which is defined as having trouble leaving your home without help, and that leaving your home is a major effort. But you cannot be denied care because you are not “improving.”
In a 2013 court decision in Vermont, Medicare was ordered to pay for home health services to prevent a deterioration in a patient’s condition. The "stability presumption" was found to be unlawful. The Judge wrote: “A patient's chronic or stable condition does not provide a basis for automatically denying coverage for skilled services. The determination of whether a patient needs skilled nursing care should be based solely upon the patient's unique condition and individual needs, without regard to whether the illness or injury is acute, chronic, terminal, or expected to extend over a long period of time. In addition, skilled care may, depending on the unique condition of the patient, continue to be necessary for patients whose condition is stable.”
The fact that skilled care in a nursing facility or at home has stabilized a person’s health, does not render that level of care unnecessary. A person need not risk deterioration of his or her fragile health to validate the continuing requirement for skilled care. Your “failure to improve” cannot be used as a reason to deny you Medicare therapies or home health services. Your care cannot be cut off because you “exhibit a decline in functional status.”
If you are on traditional Medicare or Medicare Advantage, and are receiving services from a nursing facility, rehab facility or home health agency, and you think your covered services are ending too soon, you can ask for a fast appeal; this is referred to as an “expedited determination.” Your provider will give you a notice, before your services end, that will tell you how to appeal. For more information or assistance, call 1-800-323-3205 and ask for the Medicare Advocacy Project.
- October 2016: Are elders at greater risk of housing improvement scams?
Yes. Older adults are targeted because they often own a home outright, and have good credit. They are considered less likely to report a scam, may feel ashamed to file a report, or are unsure of how to file a report on a scam artist.
Here is a typical scam: A contractor tells an elder her entire roof needs replacing, and gives her a cost estimate that includes a “senior discount.” He promises to arrange for the financing. He then removes most of the roof, and gives the elder a contract at a much higher cost, saying that the damage is much more extensive than originally expected. The homeowner is afraid that if she does not sign the contract, the contractor will abandon the project, and the loan company will put a lien on her house. The repairs are so shoddy that the roof leaks. The elder stops making loan payments, and the loan company serves her with foreclosure papers to scare her into payment.
Home improvement scams can jeopardize your independence by costing you thousands of dollars, reducing your home equity, or even leaving you without a safe place to live. Scam artists sometimes pose as building inspectors or other officials, and use high-pressure tactics to demand immediate repairs to a roof, sidewalk, or driveway. They charge inflated prices and deliver sub-standard work.
Scam artists often go door-to-door saying they are working on other homes in the neighborhood. They pressure the homeowner for an immediate decision, and say they only accept cash, and want the full amount up front or they often say they have a lender they work with who will loan you the money. They usually have no license to work in Massachusetts.
To protect yourself from scams, before you hire any home contractor, the National Association of Area Agencies on Aging recommends that you be sure to:
- Ask the contractor for local references of homeowners they have worked with.
- Obtain a written estimate from more than one contractor, and do not assume the lowest bidder will do the best work.
- Ask for a written contract, and pay by check or credit card—never cash.
- Research financing, if needed, through a local bank or a credit union you trust.
- Limit your down payment, and pay the balance after satisfactory completion of the work. Before you make the final payment, make sure your have inspected the work, and compared it to what your contract said would be done. If you have a problem with the work performed that was charged to your credit card, you can ask your credit card company to withhold payment until the problem is corrected.
The Massachusetts Office of Consumer Affairs and Business Regulation requires home improvement contractors who work on detached one and two family homes to be registered. You can search a registry online by the company name to make sure you are using a registered contractor. https://services.oca.state.ma.us/hic/licenseelist.aspx
To file a complaint about a housing contractor, call the Massachusetts Office of Consumer Affairs at 617-973-8700. FAX: (617) 973-8799 or go to: Office of Consumer Affairs and Business Regulation (OCABR)
- September 2016: Are seniors at greater risk for hyperthermia?
Too much heat is not safe for anyone, but most people who die from hyperthermia are over the age of 50. There are several heat-related illnesses grouped under the name “hyperthermia” including:
- Heat syncope: sudden dizziness while you are active in hot weather. If you are not used to being out in hot weather, or you take a beta blocker to slow down your heart, you are even more likely to feel faint. If you feel dizzy, find a cool place to sit down—air conditioning is best—put your legs up, and drink water to make the dizziness go away. Drink water throughout the day, especially on a hot day before you exercise or go for a walk.
- Heat cramps: painful tightening of muscles in your stomach, arms, or legs. Cramps can result from hard work or exercise. Your body temperature and pulse may stay normal, but your skin may feel moist and cool. Rest in the shade to cool your body down and drink plenty of fluids, but avoid alcohol and caffeine.
- Heat edema: swelling in your ankles and feet when you get hot. Put your legs up to reduce swelling. Check with your doctor if the swelling does not go down soon.
- Heat exhaustion: your body can no longer keep itself cool. You feel thirsty, dizzy, weak, uncoordinated and nauseated. You may sweat a lot, you may have a rapid pulse rate, your body temperature may seem normal, but your skin may feel cold and clammy. Look for a cool place, stop to rest, and drink water. If you do not feel better soon, contact your doctor. Heat exhaustion can lead to heat stroke.
- Heat stroke: a medical emergency. Older people living in homes or apartments without air conditioning or fans are at most risk. People who become dehydrated or those with chronic diseases or alcoholism are also at most risk. The signs of heat stroke are: fainting, feeling confused, agitated, staggering when walking, grouchy, or acting strangely; a rise in body temperature over 104°F (40°C); dry, flushed skin; a strong, rapid pulse or a slow, weak pulse; not sweating, even if it is hot.
There are certain health problems that put you at greater risk for hyperthermia: heart or blood vessel problems; poorly working sweat glands or changes in your skin; being very overweight or underweight; heart, lung or kidney disease; drinking alcohol; conditions treated by drugs, such as diuretics, sedatives, tranquilizers, and some heart and high blood pressure medicines, which may make it harder for your body to cool itself.
If you live in a home or apartment without fans or air conditioning, try to keep your house as cool as possible. Limit use of your oven. Keep your shades, blinds, or curtains closed during the hottest part of the day. Open your windows at night.
If your house is hot, go to a cooler place—like a shopping mall, movies, library, senior center, or a friend’s house. Do not stand outside in the heat waiting for a bus. Dress for the weather: some people find that cotton is cooler than synthetic fibers. Do not try to exercise or do a lot of activities outdoors when it is hot.
Listen to weather reports before going outside. Shower, bathe, or sponge off with cool water. Lie down and rest in a cool place.
Heat and humidity can be especially hard on older people, so be mindful of the risk that hot days can bring. Use these tips to keep yourself cool when the heat is on.
- August 2016: Should I Buy Prescriptions Online? Are the cheap medications offered through online Canadian pharmacies for real?
The U.S. Food & Drug Administration (FDA) is very clear: “If you cannot confirm that an online pharmacy is licensed in the United States, you should not use that online pharmacy.” The FDA has no jurisdiction over prescription medications from other countries, and can’t guarantee their safety or effectiveness. Only 3% of online pharmacies reviewed by the National Association of Boards of Pharmacy are in compliance with U.S. pharmacy laws and practice standards.
Many consumers are turning to the internet for medications because they can get instant access to information and services. Consumers are also looking for cheaper alternatives. According to an FDA survey, one in four of surveyed internet users reported having purchased prescription medicine online. About 29% of those in the survey said they were not sure how to safely purchase medicine online. Online pharmacies associated with your health insurance plan, or a local pharmacy, are generally safe to use. But medicines ordered through illegal pharmacies could have been made anywhere.
One large online pharmacy based in Canada says it handles over 300,000 orders per year and tells seniors that it sources its drugs from “partner pharmacies” in India, Singapore and Europe “which are under strict government regulations of their country.” But they are not U.S. regulated. The internet pharmacy says, “The only difference between these medications and ones you would receive from a pharmacy in the United States is the price.” And the price difference is dramatic: A bottle of 84 Atenolol 25 mg. pills is $80 in the U.S. and $11 online. A bottle of 84 Aricept 10 mg. pills in the U.S. is $1,090 and $64 online. A bottle of 90 Lipitor 10 mg. pills in the U.S. is $399 and $60 online. You just go onto their website, place an order, pay by credit card, and fax your prescriptions toll-free.
But the FDA warns that buying prescriptions from fraudulent online pharmacies can be dangerous, or even deadly: “Counterfeit medicines should be considered unsafe and ineffective. These medicines may be less effective or have unexpected side effects.” These sites may also sell your information to other illegal websites and internet scams. “The products they provide may be fake, expired, and otherwise unsafe” the FDA says. In fact, many online pharmacy scams are so sophisticated that even health care professionals can have a hard time detecting illegal sites at first glance.”
Here are some warning signs of a fake online pharmacy:
They allow you to buy drugs without a prescription
They offer discounts or cheap prices that seem too good to be true
They send unsolicited email or other spam offering cheap medicine
They ship prescription drugs worldwide
They are located outside of the U.S. and say your drugs will be shipped from a foreign country
They are not licensed in the U.S. and by the board of pharmacy in your state.
It is illegal to import drugs to the United States for personal use, but the FDA does not object to personal imports of up to a 3-months’ supply of drugs that are not FDA approved if the following are true: if the drug is for a serious condition for which effective treatment is not available in the U.S.; if there is no commercialization or promotion of the drug to U.S. residents; if the drug does not represent an unreasonable risk; and if the person importing the drug states in writing that it is for his or her own use, and provides contact information about the doctor providing treatment. Drug products must be listed with the FDA before they may be imported for commercial use in the U.S. The foreign manufacturer is required to register with the FDA, and to identify a U.S. Agent. For more information, go to: www.FDA.gov/BeSafeRx
- July 2016: If I think I’m not ready for a hospital discharge, can I appeal?
Yes. If you are on Medicare, and you think your hospital services are ending too soon, you can file an appeal and gain some extra time from Medicare. You can ask questions about or challenge the quality of the health care you have received, your access to appropriate health care, your discharge from the hospital, or your termination from skilled services.
For example, if you are in a hospital, and you are told that you are going to be discharged, but you feel too sick to leave, you can appeal the discharge to the Medicare-designated Quality Improvement Organization (QIO). Livanta is the company for Massachusetts.
When the hospital is going to discharge a person on Medicare, they will give the patient a notice in writing called “An Important Message from Medicare,” which will explain how to file an appeal with Livanta. Medicare regulations require you to request a review no later than midnight of the day of discharge. On weekdays, Livanta’s Medicare Helpline is open 8 am to 5 pm, on the weekends the line is open 11 am to 3 pm. If you get a recorded message, leave your phone number. Once you appeal, you can then stay in the hospital without having to pay (except for copays and deductibles) until at least noon of the day after Livanta notifies you, the hospital, and the doctor of its decision. If you appeal to Livanta, you cannot be discharged without your consent. By appealing, you delay your discharge by at least a day or two.
To start your appeal, call Livanta’s HelpLine at 1-866-815-5440. Livanta will call and fax the hospital to request your medical records. A physician reviewer at Livanta decides whether or not you are healthy enough to be discharged from the hospital. When the review is complete, you will receive a phone call and letter from Livanta with the decision.
You can also file an appeal if you are enrolled in a Medicare Advantage managed care plan. You have the same appeal rights whether you are in traditional Medicare, or in a managed care plan. If you would like to have someone else explain your case to Livanta, you can appoint a representative to speak on your behalf. There are no fees to have your discharge appeal reviewed by Livanta.
Note: Be sure to ask your hospital: “What is my admission status?” If you are on “observation status,” you have appeal rights through the Medicare Administrative Contractor (MAC). The hospital should give you an Advanced Beneficiary Notice (ABN), which describes your appeal rights through the MAC.
You also have the right to appeal to Livanta over a termination of “skilled services,” such as home health, skilled nursing, hospice, and outpatient rehabilitation. Livanta will review your situation, and decide if continued skilled services are medically necessary, based upon standards of care.
This entire process must be completed within one day after Livanta receives all medical records for a hospital appeal request filed in a timely way, or within 24 to 72 hours (depending on the type of review) from your first call. If you are not satisfied with Livanta’s decision, you can request a further appeal---but any skilled services you receive after the termination or discharge date may not be paid by Medicare. This means you would be completely responsible for those costs.
For a link to the Livanta Medicare appeal process go to: http://bfccqioarea1.com/appeals.html
For more information about Medicare and Medicaid services go to: https://www.cms.gov/medicare/medicare-general-information/bni/ffsednotices.html
- June 2016: I am turning 65, how should I get ready for Medicare?
Between 2011 and 2030, 10,000 people each day will turn 65. That’s 73 million Americans who will be exploring Medicare health insurance for the first time. Medicare has several primary parts: Part A: is often called hospital insurance because it pays for your care while you are in the hospital. Part A also pays some of the costs if you stay in a skilled nursing facility or if you get health care at home. Part A also covers hospice care for people who are terminally ill.
- Part B: covers doctor visits, plus screenings, lab tests, outpatient hospital care and home healthcare which is not covered by Part A.
Parts A & B are known as “Original” Medicare, or “fee for service” Medicare. With Original Medicare, you can go to any doctor, hospital, skilled nursing facility or outpatient treatment clinic that accepts Medicare assignment.
- Part C: refers to private health care plans known as Medicare Advantage plans, which have contracts with Medicare. When you join one, you get your Medicare-covered healthcare services, all the same things as Medicare Part A and B. But Part C plans also may cover services that Original Medicare does not, such as eye exams, a pair of eyeglasses, or a hearing exam once a year. The plans may charge different amounts than you would pay through Original Medicare. Medicare Advantage plans may also cover prescription drugs. If they do, you cannot buy a separate Medicare prescription drug plan.
- Part D: provides prescription drug coverage to everyone with Medicare. To get Part D, you must join a plan run by an insurance company or a private company approved by Medicare. Each plan will vary in cost and the drugs covered, and plans can change from year to year. A plan that covers your prescriptions this year might change and not cover them the next year. If you take medicines now, or if you do not but your health changes or you need more medicines, this insurance will help pay for prescriptions and protect you from very high costs.
When you approach 6 months before your 65th birthday, here are some ways to prepare:
- Research the ABCD’s of Medicare and find out if you are eligible: Most people are eligible for Medicare when they reach the age of 65, or younger if they have certain disabilities that prevent them from working. Go to the website: www.MyMedicareMatters.org
- Learn when you can enroll: There are several times when you can enroll in Medicare.
- The Initial Enrollment Period is the first time you can sign up for Medicare. You can join Medicare Parts A, B, C and D at different times: The 3 months before your 65th birthday, the month of your birthday, and the 3 months after your birthday.
- If you were working for an employer and waited to sign up for Medicare, there is a Special Enrollment Period for Parts A & B any time you are working, or within 8 months following the month your employer health plan coverage ends, or when your employment ends (whichever is first). There is also a Special Enrollment Period for Part C & D, which is 63 days after the loss of employer healthcare coverage. If you miss your Initial or Special Enrollment Period, you can sign up for Medicare Parts A & B during the General Enrollment Period which is between January 1 - March 31 of each year. If you need to buy Part A, you must also enroll in Part B at this time.
- Finally, there is an Open Enrollment Period from October 15 to December 7th, when anyone with Parts A & B can switch to a Part C, or vice versa, and anyone can join, drop or switch a Part D plan, or change Part C plans. To help sort all this out, call 1-800-AGE-INFO, and press “3” to be connected to the free SHINE (Serving the Health Insurance Needs of Everyone) health counseling program in your area.
- May 2016: Are bladder problems a common concern for older people?
No. Bladder problems are not a common dinner table conversation, but urinary tract infection (UTI) is one common bladder problem that increases as people age. UTI is the second most common type of body infection. Every year, UTIs cause 8 million visits to health care providers.
Your urinary tract is your drainage system: it removes wastes and extra water. Your urinary tract includes two kidneys, two ureters, a bladder, and a urethra. All of us use our bladder many times each day, but many of us do not know how to recognize problems with our bladder function.
A bladder is very much like a balloon. It is a hollow organ that stores urine. Muscles in the floor of your pelvis help hold urine in your bladder, which is located in your lower abdomen. When you eat or drink, your body can’t use all parts of what you consume. Your body takes what it needs from foods and drinks, then gets rid of the left over wastes. Your kidneys help remove these wastes and extra water by filtering them out of your blood to make urine. The urine made in the kidneys travels through the ureters to the bladder. The urine is stored in the bladder until you are ready to urinate. When you urinate, the urine exits the body through the urethra.
On a typical day, adults pass about a quart and a half of urine through the bladder and out of the body. That is the equivalent of four 12 ounce cans of soda. But the exact amount of urine made each day is different for every person. The amount of urine you make depends on how much fluid and food you take in, how much you lose by sweat, how much you lose from physical activity and breathing, and what medicines you take.
Your bladder changes as you get older. It becomes tougher, and less stretchy, which means it can’t hold as much urine, which causes you to go to the bathroom more often. Your bladder wall and pelvic floor muscles also can weaken making it harder to empty your bladder fully. Weak pelvic floor muscles can also make it difficult to hold urine in the bladder and can cause urine to leak.
These very common bladder problems can impact your quality of life. When people have bladder problems, they may avoid family events or other social settings. These problems can also make it hard to get tasks done at home or at work. Some of the most common bladder problems include trouble urinating, loss of bladder control, leaking of urine, and frequent need to urinate. The most common type of bladder infection (cystitis) is a urinary tract infection (UTI). When bacteria (or germs) get into the bladder you can get an infection, which brings on strong and sudden urges to urinate or frequent urinating.
Bladder problems occur more often in women, but they are also quite common in men, who have a prostate gland that surrounds the opening of the bladder. Most tissues get smaller with aging, but the prostate gets bigger. If it gets too big, the prostate can restrict the flow of urine through the urethra making it difficult to start urinating, causing the urine stream to be slow, and preventing men from completely emptying the bladder.
UTIs can happen anywhere in the urinary system, but UTIs are most common in the bladder. Infections in the bladder can spread to your kidneys, or less commonly to your urethra.
Most UTIs are not serious. But some, like kidney infections, can lead to severe problems. Bacteria from a kidney infection can enter your bloodstream, causing septicemia, which can be very serious. Frequent kidney infections can lead to permanent kidney damage, including scars, poor function, and high blood pressure.
If you are unable to hold your urine, or are leaking urine; if you need to urinate eight or more times in 24 hours; if you are waking up many times at night to urinate; if you have sudden and urgent need to urinate or have a weak stream while urinating; if you have pain or burning before, during, or after urinating, or have cloudy or bloody urine; if you are passing only small amounts of urine after strong urges to urinate—these are all reasons to set up an appointment with your doctor.
- April 2016: Do older people need less sleep than younger people?
No. Older adults need about the same amount of sleep as younger adults: 7 to 9 hours each night. But seniors tend to go to sleep earlier and get up earlier than when they were younger. Older people also may nap more during the day, which can sometimes make it harder to fall asleep at night.
How many times have you heard someone say, “All I need is a good night’s sleep?” There’s no question that getting enough sleep helps you stay healthy and alert. But many older people don’t sleep well. You shouldn’t wake up every day feeling tired.
There are two kinds of sleep: Rapid eye movement (REM) sleep and non-REM sleep. Our dreams occur mostly during REM sleep, and we have the deepest sleep during non-REM sleep. As you get older, you spend less time in deep sleep, which may explain why older people are often light sleepers.
If you are not getting enough sleep, you can feel irritable, have memory problems, feel depressed, have more falls or accidents, and feel very sleepy during the day. According to the National Institute on Aging, there are many reasons why older people may not get enough sleep at night. Feeling sick or being in pain can make it hard to sleep and some medicines can keep you awake.
The most common sleep problem in older adults is insomnia: having trouble falling asleep and staying asleep. It make take you a long time to fall asleep, or you may wake up several times in the night, or wake up early and not be able to get back to sleep, or wake up feeling tired. Insomnia can last for days, months, or even years. Sometimes insomnia may be a sign of other problems. Or, it could be a side effect of a medication or an illness. Being unable to sleep can become a habit.
Here are some tips for getting a better night’s sleep:
- Take time to relax before bedtime each night. It’s ok to watch television, read a book, listen to soothing music, or soak in a warm bath.
- Go to sleep and get up at the same time each day, even on weekends. Avoid napping in the late afternoon or evening, as it may keep you awake at night.
- Keep your bedroom dark, not too hot or too cold, and as quiet as possible. Have a comfortable mattress, a pillow you like, and enough blankets for the season.
- Don’t exercise within 3 hours of your bedtime, and try to get outside in the sunlight each day.
- Large meals close to bedtime can keep you awake, but a light snack in the evening can help you get a good night’s sleep. Avoid caffeine (coffee, tea, soda, or hot chocolate) late in the day. Alcohol will not help you sleep, and drink fewer beverages in the evening.
- After turning off the light, give yourself about 20 minutes to fall asleep. If you’re still awake and not drowsy, get out of bed. When you feel sleepy, go back to bed.
- Have a good lamp within reach that turns on easily, and put a glass of water next to the bed in case you wake up thirsty. Put nightlights in the bathroom and hall.
- Remove area rugs so you don’t trip on your way to the bathroom.
- Try counting slowly to 100, or relaxing your body by telling yourself that your toes feel light as air, and then work your way up the rest of the body saying the same words. If you feel tired for more than 2 or 3 weeks, you may have a sleep problem. Talk to your doctor about changes you can make to get a better night’s sleep. Some seniors who have trouble sleeping turn to over-the-counter sleep aids; but medicines are not a cure for insomnia. Developing healthy habits before bedtime may help you get a better night’s sleep.Another sleep disorder is sleep apnea---or short pauses in breathing while sleeping. These pauses can happen many times during the night. As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness and can lead to other problems like high blood pressure or stroke. Most people who have sleep apnea don't know they have it because it only occurs during sleep. A family member might be the first to notice signs of sleep apnea.You may need to learn to sleep in a position that keeps your airways open, or sleep with two pillows to elevate your head. There are also medical devices that could help. But start off by asking your doctor how to determine if you have sleep apnea. Alzheimer’s disease often changes a person’s sleeping habits. Some people with Alzheimer’s sleep too much, others don’t sleep enough. Some people wander or yell at night. Caregivers may have sleepless nights too. If you are caring for someone with Alzheimer’s, make sure the floor is clear of objects, lock up any medicines, install grab bars in the bathroom, and place a gate across the stairs.
- March 2016: Should older people worry about 'eating better'?
You are never too old to start “eating better.” No matter what your age, the food choices you make daily have an impact on how you look and feel.
Eating a balanced mix of foods has many health benefits. You can reduce your risk of heart disease, stroke, type 2 diabetes, bone loss, some kinds of cancer, and anemia. Even if you already have a chronic condition, eating well and being physically active can help you reduce high blood pressure, or manage diabetes. A proper mix of vitamins, minerals, protein, carbohydrates, fats, and water, can keep your muscles, bones, organs, and other parts of your body healthy as you get older.
Your doctor might suggest that you need extra vitamins, as well as the mineral calcium. It is usually better to get the nutrients you need from food, rather than a pill. Most older people do not need a complete multivitamin supplement. But if you don’t think you’re making the best food choices, look for a supplement sold as a complete vitamin and mineral supplement. It should be well balanced and contain 100% of most recommended vitamins and minerals. Read the label to make sure the dose is not too large. Avoid supplements with mega-doses. Too much of some vitamins and minerals can be harmful, and you might be paying for supplements you don’t need.
Here are some of the vitamin and mineral supplements recommended for people over 50 by the National Institute for Aging:
- Vitamin D: You can get vitamin D from fatty fish, fish liver oils, fortified milk and milk products, and fortified cereals. If you’re age 50–70, you need at least 600 international units (IU) of Vitamin D, but not more than 4,000 IU. If you’re over age 70, you need at least 800 IU, but not more than 4,000 IU.
- Vitamin B6: You can find B6 in fortified cereals, whole grains, organ meats like liver, and fortified soy-based meat substitutes. Men need 1.7 milligrams (mg) daily. Women need 1.5 mg daily.
- Vitamin B12: You can get vitamin B12 from fortified cereals, meat, fish, poultry, and milk. You need 2.4 micrograms (mcg) daily. Some people over age 50 have trouble absorbing the vitamin B12 found naturally in foods, so make sure you get enough of the supplement form of this vitamin, such as from fortified foods.
- Folate: You can get folate from dark-green leafy vegetables like spinach, beans and peas, fruit like oranges and orange juice, and folic acid from fortified flour and fortified cereals. You need 400 mcg daily. Folic acid is the form used to fortify grain products or add to dietary supplements.
Eating well also involves calories, which measure the energy you get from food. Your need for calories depends on your age, your gender, your height and weight, and how active you are. Eating more calories than your body needs for your activity level results in extra pounds, which can increase the risk for diseases like type 2 diabetes, heart disease, and joint problems. If you become less physically active as you age, you will probably need fewer calories to stay at the same weight. Choosing mostly nutrient-dense foods--which have a lot of nutrients but fewer calories--can give you the nutrients you need, but keep down calorie intake.
If you are not getting enough calories or nutrients, you can add healthy snacks during the day, like raw vegetables with a low-fat dip or hummus, low-fat cheese and whole-grain crackers, or a piece of fruit. Unsalted nuts or nut butters are nutrient-dense snacks that give you added protein. Try putting shredded low-fat cheese on your soup or popcorn, or sprinkling nuts or wheat germ on yogurt or cereal.
To learn more about how to shop for food that’s good for you, see: https://www.nia.nih.gov/health/publication/whats-your-plate/shopping-food-thats-good-you
If you eat too much of the wrong types of foods, you can put on too much weight. Obesity is a growing problem in the United States. But frailty is also a problem, and not just in thin people. As you get older, you can lose muscle strength, and add more fat tissue. Being overweight puts you more at risk for frailty and disability, but losing weight is not necessarily the answer. Sometimes when older people lose weight, they lose more muscle, which puts them at higher risk for falling, and having a broken bone after a fall. Exercise helps you keep muscle and bone. Also, for some people, a few extra pounds late in life can act as a safety net should they get a serious illness that limits how much they can eat for a while.
For more information about vitamins and minerals, visit https://www.nia.nih.gov/health/publication/whats-your-plate/vitamins-minerals
Eating well promotes and helps to keep up your energy level. Your food choices also affect your digestion. For instance, not getting enough fiber or fluids may cause constipation. Eating more whole-grain foods with fiber, fruits and vegetables, or drinking more water may help with constipation. Drinking plenty of water every day may help with constipation. You can increase your intake of water by eating vegetables and fruits, which have a high moisture content.
Make One Change at a Time
Eating well isn't just a "diet" or "program" that's here today and gone tomorrow. It is part of a healthy lifestyle that you can adopt now and stay with in the years to come.
To eat healthier, you can begin by taking small steps, making one change at a time. For instance, you might:
- Take the salt shaker off your table. Decreasing your salt intake slowly will allow you to adjust.
- Switch to whole-grain bread, seafood, or more vegetables and fruits when you shop.
These changes may be easier than you think. They are possible even if you need help with shopping or cooking, or if you have a limited budget.
Checking With Your Doctor
If you have a specific medical condition, be sure to check with your doctor or registered dietitian about foods you should include or avoid.
You Can Start Today
Whatever your age, you can start making positive lifestyle changes today. Eating well can help you stay healthy and independent -- and look and feel good -- in the years to come.
- February 2016: Can I get financial help from Medicare for my prescription drug costs?
Yes. There is help for Medicare beneficiaries with Part D plans. Known as “Extra Help” this program can assist you in paying for prescription drugs if you meet certain income and resource limits.
Eligible Medicare beneficiaries with limited income can receive financial assistance with prescription drug costs — roughly $4,000 a year – associated with their Medicare drug plan. This program can reduce or eliminate the premium and deductible for Medicare prescription drug coverage.
You may qualify for Extra Help if your annual income and resources are below these 2015 limits:
- Single person with income less than $17,655 and resources less than $13,640 per year; or
- Married person living with a spouse and no other dependents with income less than $23,895, and resources less than $27,250 per year.
- NOTE: “Resources” means money in a checking or savings account; stocks; bonds; mutual funds; IRAs and second home(s). (Your primary residence, vehicle, household items, burial plot, irrevocable burial contracts, life insurance policies, and a maximum of $1,500 for burial expenses per person are NOT counted as resources.)
If you qualify for Extra Help and enroll in a Medicare drug plan, you can get help paying your monthly premium, deductible, coinsurance and copayments. You will have no coverage gap (the “donut hole”), or late enrollment penalty.
You automatically qualify for Extra Help if you are enrolled in MassHealth Standard, CommonHealth or a Medicare Savings Plan. You also qualify if you receive Supplemental Security Income (SSI) payments. If you automatically qualify, Medicare will send you a purple letter; you will not need to apply if you receive this letter. If you are not already in a Medicare drug plan, you will need to join one to use Extra Help. If you don’t join a plan, Medicare may enroll you in one, and will send you a yellow or green letter telling you when your drug coverage begins.
Different Medicare drug plans cover different drugs. Check your plan’s “formulary” (list of drugs) to see if the drugs you use are covered, what their price is, and if the pharmacy you prefer is part of the plan. If you don’t like the Medicare drug plan you are in, if you are in Extra Help, you can switch your Part D plan each month (or during the enrollment period of October 15th to December 7th).
In order to see what assistance you’ll receive from Extra Help, you’ll need to send to your Medicare plan some form of documentation indicating you qualify for Extra Help. In 2016, drug costs for most people who qualify for Extra Help are less than $2.95 for each generic, and less than $7.40 for each brand-name covered drug.
Note: If you have employer or union drug coverage, and you join a Medicare drug plan, you may lose your employer or union coverage even if you qualify for Extra Help. Call your employer’s benefit administrator before you decide to join a Medicare drug plan.
If you don’t automatically qualify for Extra Help, you can apply by calling Social Security at 1-800-772-1213 or visiting their website at www.ssa.gov. You can also call your area SHINE (Serving the Health Insurance Needs of Everyone) Counselor for assistance at 1-800-243-4636, then press option 3. Medicare gets information from your state or Social Security office that tells whether you qualify for Extra Help. If Medicare doesn’t have the right information, you may be paying the wrong amount for your prescription drug coverage. Give your Medicare drug plan proof that you quality for Extra Help—like your MassHealth card or copy of your award notice from Social Security. If you aren't enrolled in a Medicare drug plan and you already paid for prescriptions since you qualified for Extra Help, you may be able to get back part of what you paid. Keep your receipts, and call your plan.
Nearly all Part D plans now have preferred pharmacy networks. Filling your prescriptions with your plan’s preferred pharmacy provider will save you money, especially on mail-order prescriptions. Other ways to lower your drug costs include asking your doctor about generic drugs, and consider using mail-order pharmacies.
For more information on Extra Help, you can call the SHINE (Serving the Health Insurance Needs of Everyone) free health counseling program at 1-800-Age-Info (1-800-243-4636), and press option 3.
- January 2016: Is Watching TV or Reading Bad for My Eyes?
No. The Massachusetts Commission for the Blind (MCB) says our eyes are meant to be used, and they can benefit from “exercise” like reading or watching television. But, if your eyes feel tired or “strained,” you can refresh them with rest.
To maintain healthy eyes, you need to be your own health advocate. You rarely will feel pain with eye disorders, but there are some vision changes to notice; these may come on very gradually over months:
- You find yourself sitting closer and closer to the TV;
- You need to get stronger eyeglasses more often;
- You find it harder to read the newspaper;
- You are bothered more by bright lights;
- You no longer see as well at night;
- You trip over curbs and steps, or bump into chairs and doors.
There are 4 major eye diseases that are common in older people:
- Glaucoma - a condition described as “tunnel vision,” like looking at the world through a straw. Glaucoma can cause a vague ache in your eyes, or watery eyes and halos around objects, and affect your vision in dim light, so-called “night blindness.” If diagnosed early, this disease can be controlled with special eye drops.
- Age-Related Macular Degeneration - the central area of your retina, known as the macula, which gives you sharp focus, begins to degenerate, leaving your “straight-ahead” vison blurry. This is the most common eye disease among older people.
- Diabetic Retinopathy - a complication often caused by early childhood diabetes. This disease can change the level of vision from day to day, resulting in vision that fades or sharpens irregularly.
- Cataracts: a clouding of the clear lens of the eye, causing blurred or dim vision. Cataracts are usually age-related. Some cataracts never require surgery, and do not progress to any significant level. But a defective lens can be removed; this is one of the simplest and most successful eye operations currently known that can restore good vision using special lenses after surgery.
There is a difference between having “low vision,” and being “legally blind.” Low vision means that even with regular glasses, contact lenses, medicine, or surgery, you find everyday tasks hard to do---like reading your mail, shopping, watching television, or cooking. Vision changes like these can be early warning signs of eye disease. Regular dilated eye exams should be part of your routine health care. A specialist in low vision is an optometrist or ophthalmologist who can prescribe visual devices.
There are many services for people who have been determined “legally blind”. When your vision with the best eyeglasses leaves you with 20/200 vision or less in your better eye, or your peripheral vision is 10 degrees or less —you will be diagnosed as legally blind. State law requires all eye care providers to register legally blind people with the MCB within 30 days. If you do not want to be contacted by the Commission, you can ask your eye care provider to put a ‘Do Not Contact” on your legally blind report.
Being legally blind does not mean you are totally blind, because most people keep a significant degree of useful vison. But there are dozens of services available if you become legally blind --- from “talking books” to assistance in leading an independent lifestyle, increased Social Security payments, state and federal income tax exemptions/deductions, and an auto excise tax exemption.
Many people who are blind are able to live alone, and remain capable of caring for themselves. There are “Independent Living Social Services” to help a legally blind person with home management skills, or a referral to elder home care services, as well as orientation and mobility supports. There are also services for people who are deaf-blind, and for those who are blind and have cognitive impairments.
For any eye concerns, ask your doctor for a referral to an eye care specialist, or call the Mass Commission for the Blind at 1-800-392-6450.
- December 2015: I haven't had a flu shot yet--is it too late in the season to get one?
No it is not too late. The flu season usually peaks in January or February, and can continue well into the spring. It takes about two weeks following a flu shot to produce a protective immune response, so even if you have not had a flu shot yet—talk to your doctor—because you should get a shot every year. The 2014-2015 flu season recorded the highest hospitalization rates among people 65 years of age and older in recent history.
The National Council on Aging recently released the results of a survey with the drug-maker Sanofi Pasteur to uncover what people over 65 know about the flu and flu prevention. The survey included more than 1,065 older Americans. It found that many seniors underestimate the seriousness of the flu and are largely unaware of their vaccine options. The flu survey found that:
- Only 8% of older adults surveyed are concerned about getting the flu.
- Only 13% are extremely confident in their knowledge of possible flu complications.
- 30% are unaware that someone with chronic conditions like heart disease or diabetes would be at risk for complications from the flu.
- 62% got a flu shot in the past because their physician recommended it.
- 57% are unaware there is a flu shot specifically for older people.
About one-third of people 65 years of age and older are unaware that someone with chronic conditions would be at risk for complications from the flu. Yet influenza hits older adults the hardest. It can be severe and even life-threatening for older adults due to their weakened immune systems, and the flu is especially dangerous for people with chronic conditions like heart disease and diabetes. Up to 80% of adults hospitalized from flu complications in past seasons had a chronic health condition.
Many seniors reported that they get vaccinated against the flu every year, and do so because their health care professionals tell them to get the flu shot.
- 71% of older adults reported getting an annual flu shot to help maintain their health.
- 62% got a flu shot in the past because their physician recommended it.
- 57% are more likely to get a flu shot if their doctor recommended it because of their age.
- 41% got the type of flu shot they did because it was recommended by their physician.
But the survey found that many seniors remain unaware of their flu vaccine options: 65% think most flu shots are appropriate for all age groups. But there is a flu vaccine made specifically for people age 65 and older. It improves the body’s production of antibodies against the flu. This higher-dose vaccine contains four times the antigen compared with the traditional, standard-dose vaccine. Antibodies help your immune system protect you against infection when exposed to the virus. The higher-dose shot for seniors is available through your doctor, your workplace clinic, local pharmacies, or other flu shot clinics.
Most people have minimal or no side effects after receiving the higher-dose flu vaccine. Your doctor can tell you if you are someone who should not get a flu shot. If you have an adverse reaction, you should contact your physician.
The flu survey concludes that further education and resources are needed when it comes to the flu:
- 92% of survey respondents are not concerned about getting the flu despite seniors’ high hospitalization rates.
- 88% of older adults take a proactive approach to their health.
- However, 82% are not extremely confident in their knowledge of the flu and where to get flu information.
Medicare Part B covers the full cost of one flu shot per flu season. You need to get a shot every year because the flu viruses usually change from season to season, and protection from the vaccine decreases over time.
One final fact: The flu shot does not contain live virus, so it is impossible to get the flu from the shot.
- November 2015: How can I make sure I get my full pension when I retire?
Workers who retire with a pension from their employer may never expect to get into a dispute over how much their pension is worth—but it can happen. To make sure your employer gives you all the money you are owed, you need to keep your own records.
The Pension Action Center at the University of Mass Boston Gerontology Institute works to improve retirees’ and workers’ standard of living in retirement through work with individual cases, as well as advocacy and analysis to reform of public policy. The Center recently published a paper called Protect Your Pension: Important Documents You Should Keep. Here are excerpts from that paper:
No matter what kind of pension or retirement plan your employer offers, you should keep certain documents indefinitely to ensure that you receive the retirement benefits you have earned. We recommend that you save the following information:
- The Summary Plan Descriptions for any and every plan in which you’ve participated
- Any and all benefit statements you have received from those plan(s)
- All other pension-related correspondence (such as letters saying you are vested.)
- Names, addresses, and phone numbers of employers where you earned a pension.
- Detailed records of your employment dates, pay status (hourly, salaried, union-covered), compensation (wages, retirement benefits), and breaks in service.
- Copies of union pension notices and union membership cards
- Tax returns (including W-2s, which show your wages, and 1099R forms, which would show your wages and any pension distributions). The Pension Action Center recommends that you keep your tax returns indefinitely—not just for 7 years—because resolving a pension problem in the future may depend on it. Many pension disputes hinge on whether an individual has been cashed out of a plan. If a pension plan is claiming that you were cashed out and therefore not entitled to benefits, you can verify this by reviewing your tax returns. Pension distributions will be shown on your tax return because they are considered taxable income. So, save your tax returns and avoid pension problems in the future.
- Notify your pension plan administrator of any address changes so that the plan has your most current contact information.
If you have a 401(k) or other retirement savings plan through your employer, look at your account statements: How frequently do you get account statements? Have you kept them? Do they come at regular intervals? Do the statements show your contributions going into the account on a regular basis? Does the statement show what the investments are? Are these the investments you authorized? Is there a significant drop in the account balance? Are there withdrawals from the account?
You should also understand the investments in your account: Does the statement show transactions you did not authorize, such as loans or withdrawals? Did you decide the account in which to invest? If so, do you get quarterly statements? Do you at least get annual statements? Is your account invested in employer stock? If so, what percentage is in employer stock? Are you allowed to change this? If you decided what account in which to invest, did you get information on the fees charged for each investment? Did you get a statement from your employer of any fees charged to individual accounts for administration of the plan such as legal or administrative fees?
- Do you know how your plan works? Did you receive a Summary Plan Description (SPD)?
- Do you have reasons to be worried about the plan? Is your employer having financial problems?
- Have your co-workers had difficulty getting information or distributions from the plan?
Making sure you are getting the pension payout you deserve is your responsibility. If you have concerns, The Pension Action Center can be reached at www.umb.edu/pensionaction or 888-425-6067. A fact sheet on understanding the specialized terms in retirement plans is available by clicking on the 1st announcement below the picture on this home page, or by clicking below.
- October 2015: Is it helpful to have a written family health history?
Yes. A written family health history creates a record that helps you and your loved ones, and your health providers. A history can show if you, your children, or your grandchildren might be at risk for developing serious health problems. Your health care providers can use this history to determine the risk of diseases that run in the family. For older adults, a family health history might help explain why you have developed certain health conditions.
A written health history includes information about any medical conditions in your family, as well as lifestyle habits, like smoking or drug use. There are some health problems that can run in a family, such as Alzheimer’s disease, arthritis, asthma, blood clots, cancer, depression, diabetes, heart disease, high cholesterol, high blood pressure, birth defects, and stroke. There are some ways to reduce the chance of getting some of these diseases.
A family health history can show if you or your children might have a higher risk of developing a serious health problem. There are also some less common diseases that a health history would reveal, like hemophilia, or sickle cell anemia. While you can’t alter the genes you’ve inherited from your parents — you can change your diet, your exercising, and your medical care to try to lower your chances of getting certain diseases. A thorough health history can help you adjust your lifestyle to avoid health problems. Many diseases result from more than just genetics. Your lifestyle and environment also play an important role. You can take actions to lower your risk of disease, like eating healthier foods, getting regular exercise, and taking effective medications. Doctors ask new patients for their health history, but it may be useful for you to create a broader, written history that includes your parents, grandparents, and your siblings.
Your doctor could use this to make specific recommendations to lower your chance of getting certain diseases. If one of your parents had diabetes, for example, your doctor might want you to monitor your weight and exercise more. If your daughter is considering having a baby, she might get tested to see if she carries a gene for any rare conditions that were listed in a family history.
To help you create a written family health history, there are some free tools to get you started. The U.S. Surgeon General publishes a free 'My Family Health Portrait' (print and online versions) that organizes your family health history information. Once you fill out your family health history, you can keep it for your records, share the completed form with your doctor and with family members. Any information you submit to the online version of 'My Family Health Portrait' stays private. It is not shared with the government or anyone else. You should collect your family’s health history in advance, to make it easier to fill out the forms. You can also use ‘My Family Health Portrait’ to calculate your disease risk based on your family history for certain common disorders like diabetes and colorectal cancer. If preferred, you can also just collect your family health history on your own paper.
From a family health history, your doctor may want you to take a genetic test to see if you have a mutation, or harmful change, in a gene inherited from a parent. A genetic test takes a small sample of blood, saliva, or tissue to examine. These tests can detect diseases that may be preventable or treatable, such as Huntington's disease, sickle cell anemia, and muscular dystrophy. Genetic tests can help you, or your children, take steps to lower your chance of developing a disease through earlier, or more frequent screening or changes in diet and exercise habits. Genetic testing can cost anywhere from less than $100 to more than $2,000. If your doctor wants to do some genetic tests, check with your health insurance company to see if they will cover part or all of the cost of testing. Most diseases that run in the family are not strictly genetic.
To see the Surgeon General’s health history tool, go to: https://familyhistory.hhs.gov/FHH/html/index.html
- September 2015: Zero COLA for Social Security?
In January, 2016, will elders get a cost of living increase for Social Security?
At this point, the answer is No. According to the recently released 2015 report of the Social Security Board of Trustees, the projections “do not have a cost of living adjustment for December 2015.”
Automatic benefit increases, also known as cost-of-living adjustments or COLAs, have been in effect since 1975. Previously, beneficiaries saw an increase in July each year, but since 1982, COLAs have been effective with benefits payable for December, which beneficiaries see as a higher check in January. But in January 2016, nearly 60 million Social Security beneficiaries will see no increase. This will be only the 3rd time since 1975 that people on Social Security have received a 0% COLA. The only other two years with no increase were in 2010 and 2011.
The reason that COLA is zero for January 2016 is because oil prices have dropped so much that there is no increase in the Consumer Price Index for Urban Wage Earners and Clerical Workers, the CPI-W, as calculated by the U.S. Department of Labor. The CPI-W is the basis for changing COLAs; inflation hasn’t been enough to justify a COLA. So, less costly gas at the pump and in the oil tank has translated into no Social Security check increase for 2016.
Annual COLAs are based on the percentage increase (if any) in the average CPI-W for the third quarter of the current year over the average for the third quarter of the previous year. If inflation rises during July, August, and September of 2015—things could change. But you shouldn’t rely on a COLA for this January.
In 2015, there was a 1.7% COLA for Social Security and Supplemental Security Income recipients. The largest Social Security COLA since the year 2000 was in 2009, when beneficiaries got a 5.8% increase—but that was followed by two years of no increase at all. In 2013, 2014 and 2015, the COLAs were 1.7%, 1.5%, and 1.7%—so not much change at all. Since 2010, the COLA has averaged only 1.4%. The Trustees are projecting that 2016 will be the only year with no COLA increase, and that in future years, like 2017, seniors and individuals with disabilities will get a COLA.
However, no COLA in 2016 will result in some good news. Elders enrolled in Medicare Part B will see no increase in their monthly premium of $104.90 deducted from their Social Security checks. New people coming onto Medicarewill see a premium rise, as will Medicare beneficiaries with higher incomes. And workers who pay into Social Security based on their earnings will also see no increase - when there isn't a COLA increase, there's also no increase in the upper limit on wage income subject to Social Security payroll taxes; the limit will remain frozen at $118,500 per year. In 2016, any wages earned above that level will not be subject to the Social Security payroll tax, known as FICA.
For many years, advocates have argued that the CPI-W, which only measures price changes in food, housing, gas and other goods and services, is not a good indicator of changes in the real cost of living for seniors. The U.S. Bureau of Labor Statistics has collected data since 1983 on the basis of an experimental index (CPI-E) for Americans 62 and older. The CPI-E measures a "basket" of goods and services more relevant to elders, who spend more of their money on items like medical care.
If Social Security benefits were measured by the CPI-E instead of the CPI-W, the annual COLA adjustments would be higher. But that would increase Social Security payments to elders—something that many members of Congress are reluctant to do.
By October of 2015, we will know for sure if the COLA will rise—but for now, it looks like seniors will have to live with another UN-COLA for 2016.
- August 2015: How Long is Long Term Care?
What is long term care, and how long is it needed?
Long term care refers to a variety of in-home services and supports designed to help someone with personal care needs, like eating, bathing, dressing, walking and toileting. It is predominately not medical care—and it can take place over a short or long period of time. The goal of these services and supports is to help you live as independently as possible when you need help doing some everyday activities. The term you will often hear now is “long term services and supports” (LTSS).
About 70% of people over age 65 need some type of long term care during their lifetime. Perhaps the best known form of long term care is nursing facility services – but most long term care is provided in the home, and most personal care is provided by unpaid family members and friends.
Many nursing facilities and hospitals offer short-term “rehabilitation” to help you transition back to the community. Many of these rehabilitation services can also be provided in your own home.
If you have had medical treatment for a stroke or a broken hip, for example, you may get some medical care after you return home, but you may also need some help with what are called “activities of daily living” (ADLs) like using the toilet, taking a shower, walking and dressing. Tasks like shopping, cooking, and transportation, known as “instrumental activities of daily living”, are also part of LTSS.
The need for LTSS may arise suddenly, such as after a heart attack, but more commonly the need for LTSS happens gradually, as you get older or have a disability that gets worse. Short-term care can last several weeks or a few months while you are recovering from an illness or injury. Long-term care can be ongoing, as with someone who is severely disabled from Parkinson’s or Alzheimer’s disease. Many people use LTSS for years from unpaid family members and hired caregivers.
It is hard to predict how much or what type of long-term care you might need, but here are some risk factors to consider:
- Age: The need for LTSS increases with age.
- Gender: Women are at higher risk for LTSS needs than men, because they often live longer.
- Marital status: Single people are more likely than married ones to need care provided.
- Lifestyle: Poor diet and exercise habits can increase a person’s risk.
A number of public programs, including Medicare and Medicaid, may help pay for some LTSS under certain circumstances. These programs have specific rules about what services are covered, how long one can receive benefits, whether or not you qualify for benefits, and how much you have to pay in out-of-pocket costs. Medicare only covers medically necessary care and focuses on medical “acute care” such as doctor visits, prescriptions, and hospital stays. Medicare will pay for some nursing facility costs up to 100 days; for the first 20 days Medicare pays 100% of your costs, but for days 21 through 100 Medicare only covers a small part of your expenses.
Medicaid is better at covering LTSS needs, but it only helps people with low income and assets pay for some of their LTSS expenses. Medicaid, known in Massachusetts as “MassHealth”, covers personal care services at home, and nursing facility care—but you still have to pay most of your income to the facility.
In addition to public programs, there are also private long term care insurance policies on the market. But people with certain medical or LTSS conditions may not qualify for such policies, even if they can afford the premiums. Someone buying LTC insurance in their 60s may not need to use it for 20 years; and consumers may not want to pay premiums for many years for a need that may never arise.
It’s important to start planning for LTSS now to maintain your independence in the future and to make sure you get the care you may need, in the setting you want. To learn more about long term services and supports in your community, dial 1-800-Age-Info, and press “1” for the Aging Services Access Point (ASAP) or Area Agency On Aging (AAA) nearest you.
- July 2015: Healthiest for Seniors: Is MA a healthy state for seniors?
Report Ranks Massachusetts 6th Yes. According to a new national study, Massachusetts ranks 6th in the nation as healthiest for seniors. Vermont came in 1st, and New Hampshire, 2nd. Connecticut ranked 10th, Maine, 11th, and Rhode Island, 14th. According to the United Health Foundation’s “America’s Health Rankings® Senior Report,” the New England states were one of the healthiest regions in the nation. The least healthy states were Louisiana (50), Mississippi (49), Kentucky (48), Arkansas (47) and Oklahoma (46).
The Foundation’s report is a comprehensive analysis of senior population health across 35 measures of elder health. Researchers evaluate a historical and comprehensive set of health, environmental and socioeconomic data to determine national health benchmarks and state rankings. The Report shows positive trends nationwide for senior health, especially for measures that look at whether seniors are getting the right care in a setting of their choice.
Key findings include:
- Preventable hospitalizations dropped 8.6% to 59.3% of discharges in 2015.
- More seniors are spending their last days in the setting they prefer. Hospice care increased to 50.6% of decedents aged 65 and older, while hospital deaths decreased to 22.8% of decedents.
- The number of home health care workers increased 9.3% compared to last year, as home care became an increasingly accessible option for today’s seniors.
- 62.8% of seniors took the flu vaccine this year, a 4.5% increase over last year.
- 85% of Massachusetts Medicare beneficiaries aged 65 to 75 with diabetes had a blood lipids test—the 2nd highest rate in the nation.
- Seniors in the report state they are feeling better: a 4.8% increase in self-reported high health status to 41.8%. But 58.2% of seniors say they are not feeling better.
The United Health Foundation study found there are challenges remaining in Massachusetts:
- Physical inactivity rates increased in 2015. One-third of seniors did not engage in any physical activity or exercise outside of work—a 15.3% increase in inactivity over last year.
- 37.6% of seniors have four or more chronic conditions.
- 26.7% of Massachusetts seniors are obese.
- 8.7% of seniors smoke.
- 16.1% of seniors have had all of their teeth removed due to tooth decay or gum disease.
- Per capita community-support spending for seniors that helps older adults stay in their homes, has fallen by 23.9% over the past two years.
Strong points in Massachusetts included:
- 5th in dental visits among people age 65+.
- 6th in home delivered meals to elders living in poverty.
- 3rd in community-support dollars spent on people age 65+ in poverty.
- 2nd in elders involved with diabetes management.
- 5th in the number of people 60+ in poverty receiving food stamp benefits.
- Hip fractures dropped 17% from 6.5 to 5.4 hospitalizations per 1000 Medicare members.
Negative points in Massachusetts include:
- 8th in the number of elders who are considered obese.
- 6th in food insecurity among elders.
- 4th in hospitalizations for hip fractures per 1,000 Medicare population.
- Smoking in adults aged 65+ increased from 8.4% to 9.6%.
- Physical inactivity in adults aged 65+ increased by 27% from 26.1% to 33.1%.
“Progress in key metrics such as preventable hospitalizations and hospice care show that more seniors are aging comfortably and receiving preferred types of support,” a medical adviser to United Health Foundation said.
See more at: http://www.americashealthrankings.org/Senior/MA
To see the state Rankings in full, visit: www.americashealthrankings.org/senior
About America’s Health Rankings Senior Report
The America’s Health Rankings Senior Report and the America’s Health Rankings Report are designed to identify health opportunities in communities as well as multi-stakeholder, multidisciplinary approaches to improving the health of the population. Through its programs and grants, United Health Foundation puts a spotlight on the health of America while promoting evidence-based solutions and means to improve it. To learn more about America’s Health Rankings — and to get information on how to help improve community health — visitwww.americashealthrankings.org.
- June 2015: Dealing with your Aging Skin
Are older people thin-skinned?
Yes, literally; as you get older, your skin changes too. It loses fat and gets thinner. It doesn’t look as smooth and plump as it did when you were a teenager. Scratches and cuts take longer to heal. If you spent a lot of time outdoors over the years, your skin may be more wrinkled and dry. Prolonged exposure to sunlight can cause age spots, and even cancer. But you can take steps to protect your skin.
Older people often have dry skin on their lower legs, elbows, and lower arms. Dry skin can be caused by something as simple as not drinking enough liquids, smoking, being in very dry air, feeling stressed, or losing sweat and oil glands. Diabetes or kidney disease also can cause dry skin. Using too much soap or antiperspirants, or perfume, taking hot baths—all can make dry skin worse.
Because older people have thinner skin, their skin may bleed more easily when scratched; bleeding can lead to infection. Some medicines can cause skin to feel itchy. Dry skin happens more often in the winter, because outside cold air and inside heated air cause low humidity. Forced-air furnaces in your home make skin even drier. When your skin loses moisture, it will crack and peel, or become irritated and inflamed. Bathing too frequently, and using harsh soaps, may make dry skin worse. If your skin feels very dry and itchy, talk to your doctor about how to relieve these symptoms.
Some tips for dealing with dry skin at home: take fewer baths; use milder soap; use warm water rather than hot water; don’t add bath oil to your water--it can make your tub too slippery; use a humidifier to add moisture to a room; apply moisturizers and emollients to wet skin; after washing pat your skin dry, then add moisturizers. Sweating can make dry skin worse, as will strong soaps, detergents, chemicals and solvents. Sudden changes in body temperature or stress may cause you to sweat, making your dry skin condition worse.
Bruising is another skin condition that happens more easily with older people. It also takes longer for the bruises to heal. Some medicines or illnesses can cause bruising. If you see bruises and you don't know how you got them, especially on parts of your body usually covered by clothing, talk to your doctor. Another condition of aging skin is wrinkling. Ultraviolet light from the sun will make your skin less elastic. Some things you can’t escape, like gravity, can cause your skin to sag and wrinkle. But there are also some habits you can alter, such as smoking that can wrinkle the skin. Some “cures” for wrinkles can be painful or even dangerous, and should be done by a doctor.
Age spots, once called "liver spots," are flat, brown spots often caused by years in the sun. They’re bigger than freckles, and show up frequently on areas like the face, hands, arms, back, and feet. Age spots are harmless, but using sunscreen can prevent more sun damage.
Another common feature of aging skin, especially for women, is “skin tags,” which are small, usually flesh-colored growths of skin that have a raised surface. They are most often found on the eyelids, neck, and body folds such as the arm pit, chest, and groin. Skin tags are harmless, but they can become irritated. A doctor can remove them if they bother you.
Shingles and pressure ulcers are two other conditions that will affect the skin. For more advice on how to deal with these two conditions, go to http://www.healthinaging.org/resources/resource:eldercare-at-home-skin-problems/
- May 2015: The Skinny on Eating Fats
Is it OK for me to eat some fat, what kind, and how much?
By Diana DiGiorgi
Yes, the National Institutes of Health (NIH) says it’s fine to eat some fats. But it’s recommended that you try to reduce your intake of solid fats, and instead use liquid oils, such as olive oil and canola oil, where possible.
Although fats generally have a bad reputation, your body actually needs some fats—for energy, for healthy organs, skin, and hair. Fats also help your body absorb vitamins A, D, E, and K. Fats also provide you with essential fatty acids, which your body can’t make on its own.
But certain fats can create problems. Fat contains more than twice as many calories as protein or carbohydrates. Eating too many high-fat foods will add excess calories—which leads to weight gain—and excess weight increases your risk of Type 2 diabetes, heart disease, and other health problems.
Not all fats are created equal. Some fats are healthier than others. Whenever possible, use products with polyunsaturated and monounsaturated fats. “Better fats” include vegetable oils that are plant-based, such as soybean, corn, canola, olive, safflower, and sunflower oils. Oils are just fats that are liquid at room temperature, like the vegetable oils used in cooking.
You can also find polyunsaturated fat in nuts, seeds, and fish. Walnuts, flaxseed and salmon are examples of foods with polyunsaturated fat. The target is to limit total fats to no more than 35% of your daily calories. For instance, if you eat and drink 2,000 calories daily, no more than 700 of your calories should be from fats.
As for “bad fats,” you should limit the amount of saturated fats and trans fats you consume. Both of these fats can put you at greater risk for heart disease. You can read the “Nutrition Facts” label on most packaged food to see the amount and types of fat contained in a single serving.
The Nutrition Label also will list the number of calories from fat in a serving of packaged foods. For example, a quarter cup serving of whole almonds contains 15 grams of fat, including 1 gram of saturated fat. On the Nutrition Label is a “% of Daily Value” column, which is based on a 2,000 calorie per day diet. This diet recommends a daily intake of less than 65 grams of fat, of which less than 20 grams should be from saturated fat. The label says one-quarter cup of almonds has 1 gram of saturated fat, which is 5% of the 20 grams of saturated fat recommended daily. One tablespoon of olive oil has 2 grams of saturated fat, twice the saturated fat found in one tablespoon of canola oil. One cup of whole milk has 5 grams of saturated fat.
The Food & Drug Administration is currently updating the Nutrition Facts label. The “calories from fat” listing will no longer be found on the label. "We know that the type of fat is more important than the total amount of fat," an FDA spokesman said. “Total, saturated and trans fat will still be required.” For people with cardiovascular issues, foods lower in saturated fats, trans fats, cholesterol and sodium are best.
Saturated fats are found in red meat, milk products including butter, and palm and coconut oils. Common sources of saturated fat in meals include regular cheese, pizza, grain-based desserts like cookies, cakes, and donuts, and dairy desserts, such as ice cream. Guidelines suggest consuming less than 10% of calories from saturated fats.
It's best to eat a mix of nutrient-dense foods every day. Nutrient-dense foods are foods that have a lot of nutrients but relatively few calories. Choose foods that contain vitamins, minerals, complex carbohydrates, lean protein, and healthy fats. At the same time, try to avoid "empty calories" — foods and drinks that are high in calories but provide few or no nutrients.
Whatever your age, you can start making positive lifestyle changes today. Eating well can help you stay healthy and independent — and look and feel good — in the years to come.
For more tips about healthy eating as you get older, go to the NIH SeniorHealth website:
About the Author
Diana DiGiorgi is the Executive Director of Old Colony Elder Services (OCES). OCES serves 20 towns in Plymouth County as well as Avon, Easton and Stoughton. OCES offers a number of programs to serve seniors, individuals with disabilities, their families and caregivers. For information call (508) 584-1561 or visitwww.oldcolonyelderservices.org
- April 2015: Dealing with Hearing Loss
What should I do if I think I have hearing loss?
If you think your hearing is growing weaker, the first step is to admit it. Then, schedule an appointment with your family doctor to discuss your choices. Hearing problems that go untreated can get worse. Hearing loss is very common; 36 million Americans report some level of hearing impairment. The incidence of hearing loss grows as we age; almost half of seniors age 75 or older have a hearing impairment. Men are more likely to experience hearing loss than women.
Some people may not admit they have trouble hearing. Feeling embarrassed about not understanding what’s being said, older people who can't hear well may become depressed or withdrawn. These people may appear to be confused, unresponsive, or uncooperative—but it’s because they don't hear well. People with hearing loss may find it hard to talk with friends and family, have trouble understanding a doctor's advice, have trouble responding to warnings, or have trouble hearing doorbells and alarms.
There are a number of different kinds of hearing loss. Your doctor can help identify the type of loss you have. Hearing aids may be one treatment, but special training, certain medicines, and surgery are other options that can help people with hearing problems.
There are many factors that can cause hearing loss—aging, disease, long-term exposure to loud noise, and heredity. Hearing involves not only the ear's ability to detect sounds, but also the brain's ability to interpret those sounds. It can range from a mild loss, where you miss certain high-pitched sounds, such as the voices of women and children, to a total loss of hearing. Permanent damage can result from damage to your inner ear or auditory nerve. But a build-up of ear wax, fluid, or a punctured eardrum can prevent sound waves from reaching your inner ear. Medical treatment or surgery can restore this kind of hearing loss.
Sudden hearing loss, or sudden deafness, can happen all at once or over a period of up to 3 days. It should be considered a medical emergency, and you should visit a doctor immediately. But there is also a common form of hearing loss that comes on slowly as a person ages. It can be due to changes in your inner ear, auditory nerve, middle ear, or outer ear. In addition to the causes noted above, head injury, infection, illness, certain prescription drugs, or circulation problems like high blood pressure, can lead to gradual hearing loss.
Another common symptom in elders is Tinnitus—a ringing, roaring, clicking, hissing, or buzzing sound that comes and goes, in one or both ears, loud or soft. Tinnitus is not a disease. It can come with any type of hearing loss—like a side effect of medications, or something as basic as a piece of earwax blocking the ear canal. Your doctor may refer you to an ENT (ear, nose and throat doctor) who will come up with a treatment plan. You may also be referred to an audiologist, who will test your ability to hear sounds of different pitch and loudness. The tests are painless. An audiologist can help you determine if you need a hearing aid, and help you choose the right one.
There are a number of different types of hearing aids to treat different kinds of hearing loss. There are devices worn behind the ear, inside the outer ear, or in the ear canal. Which hearing aid is right for you depends on the kind of hearing loss you have and your own preferences. Wearing two hearing aids may help balance sounds, improve your understanding of words in noisy situations, and make it easier to locate the source of sounds. Some hearing aids may have a telecoil, a small magnetic coil that makes it easier to hear conversations over the telephone.
If your hearing loss is severe, your doctor may suggest a cochlear implant, which is a small electronic device a surgeon places under the skin and behind the ear. The implant picks up sounds, converts them to electrical signals, and sends them past the non-working part of the inner ear and on to the brain. Learning to interpret sounds from the implant takes time and practice.
To learn more about hearing loss, visit the National Institute of Health (NIH) SeniorHealth website:http://nihseniorhealth. gov/hearingloss/hearinglossdefined/01.html.
- March 2015: Understanding The Basics of Bone Health
Is osteoporosis just an old people’s disease?
No. Today we know that steps to improve bone health should start at an early age. Weak bones can affect individuals of all ages. Whether you’re in your 20s, 40s or 70s, it's not too early or too late to make changes in your diet, exercise program and lifestyle to strengthen your bones. It’s true that weaker bones are more common in older people, but certain factors that lead to weaker bones are important at all ages, and even younger people can suffer from broken bones related to osteoporosis.
Most people have never asked their health care provider about their bone mineral density (BMD) level. Something called your T-score reveals whether your bones are weak or strong, and what the chances are for breaking one of them. Brittle bones are not a natural part of aging. According to the U.S. Bone and Joints Initiative, if Americans don't take action, by the year 2020, half of all persons older than age 50 will be at risk for fractures related to osteoporosis and low-bone mass. Osteoporosis affects men and women of all races and ages.
Here are some warning signs of osteoporosis:
- A Broken Bone — A broken bone (fracture) as an adult does not always mean you have osteoporosis, but it could be a warning sign that your bones are weak, especially if the break is from normal activities or during a minor fall.
- Back Pain or Spinal Deformities — Back pain that will not quit could be a sign that you have a spinal fracture. This occurs when bones in your back become so weak that they fracture and collapse.
- Loss of Height — A fractured bone in your spine could collapse onto itself causing you to shrink. Multiple fractures can cause the spine to form a curve causing the disfigurement known as a dowager's hump.
There are two things that you can do to improve your bone health and make your bones stronger —
- Get enough physical daily activity/Exercise
Build into your daily schedule exercise of at least 30 minutes for adults. The best types of exercises for healthy bones are weight-bearing and strength-building activities, like jogging, tennis and walking. These activities force muscles and bones to work against gravity and they put stress on the limbs. Weight-lifting or calisthenics are strength-building exercises which lead to stronger muscles and bones. Tai Chi exercises are good because they can help improve your balance, and decrease your risk of falling. But before starting an exercise program, or if you already have osteoporosis, show your doctor a description of the program. If you have low bone mass, you may need to skip certain exercises to avoid problems, like breaking a bone.
- Take in enough calcium and vitamin D
Calcium is a building block of bone. Men and women over age 50 and postmenopausal women also need a higher intake of calcium. They need about 1,200 to 1,500 mg of calcium daily. Milk and dairy products are high in calcium; as are leafy green vegetables, soybeans and salmon. If you have problems digesting lactose, you can talk to your doctor about taking a calcium supplement. Vitamin D: helps your body absorb calcium from your gastrointestinal tract. It can be synthesized in skin from exposure to the sun, and is found in fortified dairy products, egg yolks, fish (such as salmon, mackerel and tuna), liver or in supplements. Your doctor can recommend an appropriate dosage for you.
A simple, painless BMD test - which takes less than 20 minutes – is a good place to start. If you have low bone mass but no fractures, you and your physician can put together a treatment plan to stop further bone loss and prevent fractures. If you have had one or more fractures due to osteoporosis, your physician or healthcare professional will work with you to prevent further breaks, reduce pain, improve your bone health, keep you active and enhance your quality of life. For more background, go to the U.S. Bone and Joints Initiative,http://www.usbji.org/programs/public-education-programs/fit-to-t/what-youneed-to-know-about-your-bone-health.
- February 2015: The Safety Attitudes of Older Drivers
Are older people concerned about driver safety issues?
Yes. According to new research from the American Automobile Association (AAA) Foundation for Traffic Safety, older drivers are “generally a very safe group of motorists [but] there are some unsafe driving behaviors that still have a high level of acceptance, among seniors.”
86% of Americans, roughly 36 million drivers, ages 65 and older are still driving. One in six drivers on U.S. roads today are 65 years of age or older. 91% of elders in the AAA survey report that they have had no moving violations in the past 2 years, and have not had a car crash during the same period. The AAA Foundation says safe driving attitudes are important among seniors, because they are more likely to have a medical condition or use medications that can affect their driving. Plus, as people age, fragility begins to make crash survival and recovery more difficult.
AAA polled older drivers about a number of driving safety issues. A vast majority of older drivers strongly disapprove of all unsafe driving behaviors included in the survey, but drivers 65-69 are more accepting of some unsafe driving behaviors:
- License Renewals – Over 70% of older drivers support requiring drivers age 75 and older to renew their license in person. More than 70% support requiring drivers age 75 and older to pass a medical screening at renewal. Support for these measures was greatest among drivers age 75+.
- Cell Phone Use – Most older drivers disapprove of texting, emailing or checking/posting on social media while driving. But opinions differed with regard to talking on cell phones. The 70-74 group and 75+ group were significantly more likely than drivers ages 65-69 to disapprove of drivers talking on hand-held phones. The rate of disapproval of talking on hands-free phones while driving was higher amongst the oldest group than the youngest group of elders, 62% vs 54%.
- Seatbelts – Most older drivers say they always wear a seatbelt while driving, but 25% of drivers age 75+ say they have driven without wearing a seatbelt.
- Speeding – A majority of all older drivers support using speed cameras to ticket driving 10 mph over the limit in residential areas and urban areas. Yet 46% of older drivers report having driven 15 mph over the limit on freeways and as many as 48% report having driven 10 mph over the limit on residential streets. The youngest group of elderly drivers is more likely to speed and to find it an acceptable behavior and much less likely to support speed cameras.
- Running a Red Light – In spite of the fact that nearly all older drivers say running a red light is unacceptable, 33% report that they have run a red light in the past month on an occasion when they could have stopped safely.
- Impaired Driving – Nearly 100% of older drivers disapprove of driving under the influence of alcohol and/or marijuana, as well as drowsy driving. More than 60% of older drivers support lowering the legal limit for blood alcohol content while driving. 87% of drivers over 75 support requiring ignition interlock technology in all new cars to disable the car when a drunk driver tries to start the engine. Drivers ages 75+ were more likely to report drowsy driving, with as many as 29% saying they have driven while drowsy.
AAA concluded, “The older drivers’ own personal driving behavior does not in all cases measure up to the standard to which they would like to hold others. There are some unsafe driving behaviors that still have a high level of acceptance among seniors, which suggests more education is needed.”
For more information on this study please visit AAAFoundation.org.
- January 2015: Are You Ready To Join Medicare?
When do I first sign up for Medicare Parts A&B?
When you’re first eligible at age 65 for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A(Hospital Insurance) and/or Part B (Medical Insurance). This Initial Enrollment Period begins 3 months before you turn 65. For example, if you turn 65 in January of 2015, you can sign up from October 1, 2014 to April 30, 2015. If you join during one of the 3 months before you turn 65, your coverage will begin the first day of the month you turn 65.
Once your Initial Enrollment Period ends, you may have the chance to sign up for Medicare during a Special Enrollment Period. If you’re covered under a group health plan based on current employment, you have a Special Enrollment Period to sign up for Part A and/or Part B at anytime as long as you or your spouse (or family member if you’re disabled) is working, and you’re covered by a group health plan through the employer or union based on your active employment.
You can also sign up for Medicare during the General Enrollment Period, January 1st – March 31st, each year. Your coverage will start July 1. Be aware that you may have to pay a late enrollment penalty for not enrolling in Part B when you were first eligible.
When you sign up, you will get premium-free Medicare Part A if you or your spouse (living, deceased or divorced) paid Medicare taxes during at least 10 years of work. Most people will pay a monthly premium for Medicare Part B. For 2015, the standard monthly premium for Medicare Part B is $104.90, but changes every year. Some people pay a higher premium based on their income or if they don’t enroll when they are first eligible.
There are two typical ways to get your Medicare coverage — Original Medicare or a Medicare Advantage plan(Part C). You can also sign up for Medicare prescription drug coverage (Part D). Each year, you have a chance to make changes to your Medicare Advantage or Medicare prescription drug coverage for the following year. There are 2 separate enrollment periods each year. The Annual Medicare Open Enrollment period is October 15th to December 7th. There is also a Medicare Advantage Disenrollment Period that allows you to drop out of a Medicare Advantage plan and switch back to Original Medicare. This Disenrollment Period runs from January 1st to February 14th.
If you have Original Medicare, you can join a Medicare supplement (Medigap) insurance policy to help pay some of the health care costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. A Medigap policy fills the gaps of Medicare, while a Medicare Advantage plan replaces your Medicare.
When you enroll in both Part A and Part B, Massachusetts offers continuous open enrollment for Medigap plans. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Keep in mind that you may be eligible for Medicare coverage even if you are under 65 years of age. If you have a disability and have been receiving Social Security Disability Insurance (SSDI) for more than 24 months, your Medicare eligibility begins during the month you receive your 25th SSDI check. You do not need to contact anyone. Social Security should automatically mail you your Medicare card three months before you become eligible. People with End Stage Renal Disease or Lou Gehrig’s Disease may also be able to get Medicare coverage.
One of the common mistakes people make about Medicare is signing up too late for Medicare and its parts. And, if you try to sign up too early, Medicare will not accept your application, so it’s important to know when it’s the right time for your situation. If you are aging into Medicare, your initial enrollment period is based on your 65th birthday. To avoid long-term penalties, be sure you know when you have to enroll. If you or your spouse is still working when you turn 65, and your insurance meets certain requirements, it may make sense for you to delay enrollment in Parts A, B, and D.
For free help with all these Medicare decisions, call 1-800-AGE-INFO and select option 3 to be connected to the SHINE (Serving the Health Information Needs of Everyone) program in your area, then make an appointment to meet with a SHINE counselor.
- December 2014: Can I Affect My Brain-Health?
Are there lifestyle decisions that make a brain healthier?
Yes, and tips for a healthier brain do not require you to radically change your daily life.
While the mortality rate for heart disease and cancer are falling—the mortality rate for Alzheimer’s continues to rise and is among the top 10 leading causes of death. By 2050, there may be 16 million Americans with Alzheimer’s, and mild cognitive impairment may affect as many as 25% of the elderly.
A common health concern among older adults is memory loss. According to a recent survey, adults are more than twice as likely to fear losing their mental capacity as losing their physical capacity. In another survey, 9 out of 10 people said they thought they could improve their cognitive fitness. 6 out of 10 said they should have their cognitive functioning checked annually, just like a regular physical checkup. 8 in 10 said they take some time nearly every day to engage in activities designed to improve their cognitive health.
Here are some steps you can take to help your brain health:
- Engage in Physical Exercise—Physical exercise is key to maintaining good blood flow to the brain as well as stimulating new brain cells. It can reduce the risk of heart attack, stroke and diabetes, and protect against risk factors for dementias.
- Eat Brain-Healthy Food—High cholesterol is thought to contribute to stroke and brain cell damage. A low fat, low cholesterol diet is advisable. There is growing evidence that a diet rich in dark vegetables and fruits, which contain antioxidants, may help protect brain cells. HDL (or “good”) cholesterol may help protect brain cells. Use mono- and polyunsaturated fats, such as olive oil. Try baking or grilling food instead of frying. Your brain needs a balance of nutrients, including protein and sugar, to function well. Strive for a well-balanced diet.
- Manage your body weight—One study found that those who were obese in middle age were twice as likely to develop dementia in later life. People with high cholesterol and high blood pressure had six times the risk of dementia.
- Lead A Social Life—Social activity makes physical and mental activity more enjoyable and it can reduce stress levels, helping to maintain healthy connections among brain cells. Leisure activities that combine physical, mental and social activity are the most likely to prevent dementia. Sports, cultural activities, emotional support and close personal relationships together appear to have a protective effect against dementia.
- Stay Mentally Active—Engage in mentally stimulating activities. This strengthens brain cells and the connections between them and may even create new nerve cells. Keeping your brain active seems to increase its vitality and may build its reserves of brain cells and connections. Read; write; attend lectures and plays; sign up for courses at your local community college; try gardening. Keep your mind challenged and engaged!
There are some risk factors beyond your control, like genetics and aging. But even people who inherit genes associated with dementia from both parents still may not get the disease. All of the brain-health activities mentioned here work best when done together. A healthy brain lifestyle could delay or prevent the appearance of Alzheimer’s disease.
To learn more about brain health, go to http://www.alz.org/we_can_help_brain_health_maintain_your_brain.asp
- October 2014: Are SNAP Benefits ‘Use it, or lose it’?
Can I lose my SNAP benefits (food stamps) by not using them?
The Massachusetts Department of Transitional Assistance (DTA) has been sending letters to some SNAP recipients telling them they have unused SNAP benefits they may lose. Here’s some information to help you understand these DTA notices and your rights.
Important SNAP rights—
- You have the right to save up your SNAP benefits to do a larger food shop. SNAP helps with immediate food needs and is also a supplemental nutrition assistance program.
- If you have made no food purchases with your EBT card for 6 months in a row, the state can put your benefits off-line, but you have not lost them. If you receive a DTA Off-line Notice, call or write to your DTA worker and request your SNAP benefits be put back on your EBT card. DTA must restore your benefits within 48 hours of your request. If you used your EBT card for food shopping during the past 6 months, your benefits should not be put off-line. You may want to consult an advocate if this happens.
- If you have collected over 12 months of unused benefits on your EBT account, DTA may take some of these away permanently, but must send you a “Notice of Expungement” in advance. DTA should not take away any SNAP benefits if you have less than 12 months worth of benefits on your EBT card. If you think DTA wrongly took away your SNAP benefits, ask a DTA Supervisor or Office Manager to review this decision. You can also ask for a fair hearing and Legal Services may be able to help with a fair hearing. For information on local Legal Services, go to http://www.masslegalservices.org/findlegalaid or call the Legal Services office nearest you.
Saving up SNAP benefits is not fraud. You have done nothing wrong! It’s possible that unused SNAP benefits is a signal that a recipient needs help with food shopping.
Here are some tips to help you—
- To check the amount of SNAP on your EBT card, call the EBT Customer Service number on the back of your EBT card, 1- 800-997-2555.
- If you lose your EBT card, call your DTA worker or visit the nearest DTA office to report a lost card and get a new EBT card.
- If you cannot remember your Personal Identification Number (PIN), call the EBT Customer Service phone number to re-PIN your EBT card at any time.
- If you need a ride to a grocery store, your city or town clerk can give you the number of your Council on Aging (COA), which may provide a free or reduced fee van services to grocery stores, doctor appointments and other trips. You can also reach your local Aging Services Access Point (ASAP) by calling 1-800-Age-Info, then press 1.
- If you need someone to go shopping for you, anyone in your household can use your EBT card to food shop—even if they are not named on your card. Family members often help SNAP recipients with food shopping. You can ask a neighbor or friend to become your authorized representative, and get a second EBT card for your account. If you choose, you have the right to allow your authorized representative to manage your SNAP benefits completely. There is a special Authorized Representative DTA form that must be filled out.
- If you want help from a homemaker or a personal care attendant (PCA) with food shopping, cooking or other personal care, you can call an ASAP at 1-800-Age-Info, then press 1.
- If you have at least $35/month in unreimbursed health care expenses, you can get an income deduction which may increase your housing deduction and raise your SNAP benefit. Your DTA office can explain how these deductions work.
Information for this column was provided by the Mass Law Reform Institute, www.mlri.org.
- September 2014: Can Antibiotics Do More Harm Than Good?
Is it bad for me to take antibiotics I don’t need?
Yes. If you take an antibiotic you don’t need:
- You are vulnerable to the drug’s side effects, but none of its benefits. Older people may have more side effects from medications, and these side effects can cause multiple problems – health outcomes you want to avoid. Side effects can include: fever, rash, diarrhea, nausea, vomiting, headache, and nerve damage.
- You expose yourself to potential drug interactions that are unnecessary - medications could become less effective or cause new symptoms when taken with other medications.
- You increase your risk of developing a resistant infection in the future.
Antibiotics are drugs that fight infections caused by bacteria. Although antibiotics have many beneficial effects, their use has created the problem of antibiotic resistance, the ability of bacteria to resist the effects of an antibiotic. When resistance occurs, bacteria change, survive, and multiply, causing more harm and possibly making you sicker. Fighting resistance requires stronger drugs and more health care, likely with a longer recovery time. Resistance issues are causing a crisis that the Director of the Centers for Disease Control warns is a “threat to health. If we don’t act now, our medicine cabinet will be empty and we won’t have the antibiotics we need to save lives.”
As many as half of all the antibiotics prescribed are not needed or are not prescribed appropriately. One common situation is when a urinary tract infection (UTI) is suspected. UTI is caused by bacteria in any part of your urinary system including the urethra, bladder, ureters and kidneys. With a UTI, you may or may not have a fever. You may also experience other symptoms, including:
- a burning feeling, discomfort or pain with urination;
- pain in the lower abdomen or back;
- increase in urination frequency (needing to “go” more often than usual);
- repeated strong urges to urinate;
- blood in the urine.
A urine culture test may show bacteria, but that doesn’t mean you have a UTI. It’s necessary to find both bacteria in the urine and the presence of specific symptoms listed above. Bacteria can and do live naturally in the bladder without causing pain or symptoms. In the past, when a urine specimen tested positive for bacteria, people thought it should be treated with antibiotics, even when specific symptoms were not present. Now, the American Geriatric Society recommends to doctors that they should not prescribe antibiotics for these harmless bacteria unless specific symptoms are present. For more background, go to http://www.macoalition.org/uti-elderly-tools.
Non-specific symptoms, such as confusion, a sudden change in behavior, fatigue, or a fall, may be caused by other factors like dehydration, medication side effects, poor sleep, inadequate nutrition, constipation, depression, or pain. It is important to consider these possible causes to prevent missing the real diagnosis.
Here are some questions for you and your loved ones to ask the doctor:
- Why do I need an antibiotic?
- When should I stop taking this medication?
Understanding the risks of using antibiotics when not needed leads to good, safe care. The safest care happens when you partner closely with your medical team to understand and follow the most current advice.
- August 2014: Too Late For Seniors To Stop Smoking?
When you are older, is it ever too late to quit smoking?
No. It’s never too late to stop smoking. An estimated 9% of Americans over age 65 are smokers. The leading cause of preventable death is from smoking— 480,000 people die in the United States from smoking each year.
Most older smokers know that it’s not good for them. They know that quitting would lead to many improvements in their life: they would save money ($21,900 saved over 10 years for a 1 pack-a-day user), cough less, and have better smelling breath, fewer wrinkles, and more energy. They would also lower their risk of heart attack, stroke, bronchitis, and cataracts, among other diseases.
Quitting has benefits at any age and some of the improvements are immediate. Here are the benefits compiled by the Centers for Disease Control and Prevention:
- 20 minutes after quitting your heart rate drops.
- 12 hours after quitting carbon monoxide level in your blood drops to normal.
- 2 weeks to 3 months after quitting your heart attack risk begins to drop, and your lung function
begins to improve.
- 1 to 9 months after quitting your coughing and shortness of breath decrease.
- 1 year after quitting your added risk of coronary heart disease is half that of a smoker’s.
- 5 years after quitting your stroke risk will start decreasing. In 5-15, your stroke risk may be
equivalent to a non-smoker’s.
- 10 years after quitting your lung cancer death rate is about half that of a smoker’s and your risk
of cancers of the mouth, throat, esophagus, bladder, kidney and pancreas decreases.
- 15 years after quitting your risk of coronary heart disease is back to that of a nonsmoker’s.
But older smokers face some real challenges in quitting. You may have tried to quit more than once before and were unsuccessful. If you weren’t able to quit before, you know how hard it can be and you may feel too discouraged to try again. For people who have smoked for many years, quitting may feel like saying goodbye to a friend. Nicotine is very addictive. One of the greatest challenges most smokers face is getting through the withdrawal symptoms in the first couple of weeks.
Many former smokers age 50 and older say their main reason for quitting was for their health or because their doctor told them to stop. But smokers also quit to take back control of their lives or to satisfy a loved one who wants them healthier. Older adults have had lots of experience accomplishing difficult tasks and may be better prepared than when they were younger to take on the challenge to quit smoking. They know quitting is tough and won’t be easy, but may be more willing to work at it and be successful.
The National Cancer Institute has a 44 page booklet titled Clear Horizons: A Quit-Smoking Guide for People 50 and Older*, which explains how to set a Quit Date, and develop a Quit Plan that uses friends and family for support, offers tips to break smoking patterns, resists negative thinking and suggests medications that can help.
There will be challenges along the way, but it can be done and help is available. For more information:
- July 2014: Rheumatoid Arthritis
What are the symptoms of rheumatoid arthritis?
The most common form of arthritis is osteoarthritis, which is a disease in which cartilage in your joints deteriorates. It affects roughly 27 million Americans, and it’s most common in people age 65 and over.
There’s another, less common, form of arthritis that affects more than 1.5 million Americans — rheumatoid arthritis (RA). RA is a disease of unknown cause that makes your immune system attack healthy cells, like the ones that line your joints, resulting in inflammation and pain. Its origin is unknown, but it’s believed RA may be caused by a combination of genetic and infectious agents.
RA can make cartilage wear away and result in bone loss. The inflammation can also affect your skin, heart or lungs. RA is seen most often in your hand, wrist, elbow, knee and ankle joints. There is no cure for RA, and its symptoms can come and go. With treatment, the symptoms may go into remission.
Three out of four people affected by RA are women, and the adult onset of RA happens most often between the ages of 40 and 60. The diagnosis of RA is not always a simple matter, but a blood test can look for proteins found in tissue that has been damage by RA. This is a likely indicator that you have RA. There are several other tests to confirm the presence of RA, and doctors often will take X-rays to look at the extent of joint damage.
For many people, RA first appears as an inflammation in the knuckles, feet and wrists, then progressing to elbows, shoulders, hips and knees. RA can cause feeling of fatigue, loss of appetite, weight loss or a low-grade fever.
Medical treatment for RA focuses on slowing or stopping the progression of the disease. There are medications known as disease-modifying antirheumatic drugs (DMARDs). If your RA doesn’t respond well to DMARDs, doctors may try biologic response modifiers, simply referred to as biologics. Made from genes, or from a living organism such as a virus or protein, biologics interrupt the inflammatory process. Doctors may also use non-steroidal anti-inflammatory drugs (NSAIDs), like aspirin or ibuprofen, to reduce inflammation, and analgesics, like acetaminophen, for pain.
A doctor who specializes in RA is a rheumatologist, who has been trained to diagnose and treat arthritis and other diseases that affect the joints. You may also see an orthopaedist, who specialize in diseases of the bone. You can learn exercises to keep your muscles strong and prevent joint stiffness, and to reduce strain on your joints while doing everyday activities. Because some foods affect inflammation, nutrition could be part of treatment. Including whole grains, fruits and vegetables in your diet may help.
Learn as much as possible about your RA and take an active role in managing your own treatment. Keeping a positive attitude is important. Help your doctor by keeping track of your symptoms, medications, side effects, pain levels, etc. Use your network of family members and friends for emotional support when you’re down – and to share good news. The Arthritis Foundation has an online community with blogs and support groups. Go towww.arthritis.org for more information.
- June 2014: Top 10 Scams Against Seniors
What are the most common scams aimed at seniors?
The National Council on Aging has created a list of the worst scams targeting seniors:
1. Health Care/Medicare/Health Insurance Fraud — A scammer poses as a Medicare representative, and ask seniors to give out personal information; or they offer phony services at makeshift mobile clinics, then use the personal information to bill Medicare.
2. Counterfeit Medications — An internet scam which offers seniors better prices on specialized medications. The elder pays for something that won’t help their medical condition, and could be an unsafe substance that actually makes conditions worse.
3. Funeral & Cemetery Scams — A complete stranger will call or attend a funeral service, claiming the deceased had an outstanding debt with them, and will ask relatives to pay money to settle the fake debts. Another scam is when a funeral home itself adds unnecessary charges to the bill—like insisting that an expensive casket is needed for a cremation, when an cardboard casket is all that is required.
4. Bogus Anti-Aging Products — Fake botox scams net millions of dollars, as renegade labs sell products containing botulism neurotoxin, one of the most toxic substances known to science. A bad batch can have serious health consequences.
5. Telemarketing Fraud — A con artist tells the senior that he/she has found a large sum of money and is willing to split it if the elder will make a good faith payment by withdrawing funds from his/her bank account. In another ploy, a con artist asks the elder to wire or send money to help the elder’s relative who is in the hospital and needs the money. Phone calls are also used for charity scams, especially after natural disasters, to help charities that don’t exist.
6. Internet Fraud — Seniors are emailed a message to download a fake anti-virus program (at a substantial cost) that opens up whatever information is on the user’s computer to scammers. Or, seniors receive emails asking them to update or verify their personal information. Some receive fake notices from the IRS about a tax refund.
7. Investment Schemes — A number of investment schemes are sent to elders offering complex, financial products that many economists don’t even understand. If seniors have money to invest, they should only work with local advisors they trust and have worked with in the past.
8. Reverse Mortgage Scams — Unsecured reverse mortgages can lead property owners to lose their homes when the perpetrators offer money or a free house somewhere else in exchange for the title to the property.
9. Sweepstakes & Lottery Scams — Seniors are informed that they have won a lottery or sweepstakes of some kind but need to make some sort of payment to unlock the supposed prize. Scammers may send a check that the elder can deposit in their bank account. It will take a few days for the fake check to bounce. In the meantime, the criminals ask the senior to pay fees or taxes on the phony prize.
10. The Grandparent Scam — The elder gets a call saying: “Hi Grandma, do you know who this is?” When the elder guesses the name of the grandchild, the scammer uses that name to ask for money to be wired by MoneyGram or Western Union.
- May 2014: SNAP (Food Stamp) Photo EBT Cards
I am a senior. Do I need a photo on my food stamp card?
A new Massachusetts state law requires that certain Electronic Benefit Transfer (EBT) cardholders have their photo on their card. If you receive Supplemental Nutrition Assistance Program (SNAP, previously known as Food Stamps) or cash benefits, you may get a letter from the state about the new photo EBT card. About half of SNAP households will have a photo EBT card—but a photo is not needed if the head of your household is: age 60 or older; disabled or blind; under age 19; a victim of domestic violence; or if you have a sincere religious objection to a photo.
There are a lot more Massachusetts residents getting SNAP benefits today than ever before. In 2004 a total of 334,939 people in the Commonwealth received SNAP benefits. By December of 2013, there were 876,992 people using SNAP benefits. The program has grown more than 2½ times larger than it was a decade ago.
The impact of the SNAP program on participating families and the state’s economy is significant. The average monthly SNAP benefit last year was $130.92, or $1,571 per year. That means the SNAP program put $1.37 billion into the Massachusetts economy in food purchases.
Keep in mind:
- You can be working and may still qualify for SNAP benefits.
- The state has been making it easier for seniors to get a SNAP card. The application for seniors is only 2 pages—shorter than for other applicants.
- Using SNAP benefits is completely confidential. At the check-out counter, SNAP recipients use a card which works just like a debit card. Your SNAP benefits are kept in a special account for you until you want to use them.
- If you spend more than $35 per month on medical expenses including medications and doctor’s visits, you may qualify for a $155 standard income deduction which could result in a higher monthly SNAP benefit.
Under federal law, every SNAP household member has the right to use the EBT card. Stores cannot refuse to accept the EBT card from household members, such as spouses or older children. This is true even if their name or photo is not on the card. In addition, if you’re unable to get out of the house, any caregiver you authorize can also use your EBT card to food shop for you. Your card has a Personal Identification Number (PIN) that keeps your benefits safe and is your electronic signature. If the proper PIN is used with your card, your caregiver should be able to use the card.
Stores are not allowed to treat SNAP recipients differently from other shoppers. A store clerk cannot ask to see your EBT photo card unless they routinely ask everyone using credit or debit cards to show a photo ID. Stores that accept EBT cards cannot set up “SNAP-only” checkout lines or discriminate against SNAP households. If a member of your household is not allowed to use your EBT card or if you think you are being discriminated against, call your local Legal Services, or go to www.masslegalhelp.org for advice.
To apply for SNAP, call 1-866-950-3663 (FOOD).
- April 2014: Osteoarthritis & Pain Control
Is osteoarthritis a common problem for seniors?
Yes. There are over 100 types of arthritis; Osteoarthritis (OA) is the most common. It affects more than 27 million Americans—more people than diabetes. Arthritis and rheumatic conditions cost the United States economy $128 billion annually. The word arthritis means joint inflammation.
OA is most common in people over age 50, but it can affect younger people who have injured joints. Damage to a joint can cause pressure and stress when the joint moves and inflammation in the joint’s tissues. OA is often associated with aging, but it’s not a normal part of aging; it’s a disease.
OA pain can be managed. Many people will stop moving when they feel the pain, but joints that are not kept active will stiffen and cause more pain. People may think that physical activity will make their OA worse, but just the opposite is true, not moving makes OA worse. Poorly managed pain can lead to depression, loss of sleep and isolation.
The best way to control pain is to stop it from occurring and prevent it from getting worse. To maintain your health:
- Remain physically active, but pace yourself and include rest breaks.
- Protect your joints from the stress of daily activities.
- Lose weight to ease pressure on your joints. For every 1 pound of weight lost, the load on the knees is cut by 4 pounds.
- Break up repetitive movements with other tasks that use different joints.
- If you get tired, don’t overdue the exercise.
- Get a good night’s sleep.
- Avoid activities which put high strain on joints, like prolonged standing.
- Use your largest and strongest muscles for tasks—use both arms to carry objects rather than both hands; and, bend at the knees when lifting something from the ground.
Any kind of movement—like walking your dog or working in the garden—will improve the symptoms. People with OA are urged to get at least half an hour of moderate aerobic exercise like walking, swimming or biking, at least 5 days a week. Any amount of activity is good for your joints. Musclestrengthening exercise is also good 2 or 3 times a week.
Your pain may be manageable with over-the-counter pain relievers, anti-inflammatory medications, or prescription pain medications. Sometimes anti-depressants and anti-seizure medications are prescribed because they interrupt pain signals. There are also prescription anti-inflammatory medications in the form of gels and lotions which can be rubbed over sore joints. You should discuss all these pain relievers with your doctor. Be sure to report any side effects or reactions your body has to any medications.
Your doctor may want you to see a specialist, like a physical therapist, who can combine therapy with exercise to reduce pain and improve function. Most people with osteoarthritis will never need joint surgery, but it is an option.
Consider the program, Put Pain in Its Place, developed by the Arthritis Foundation and the National Council on Aging. Go to http://www.arthritis.org/resources/community-programs/educational-programs/put-pain-in-its-place/or call the Arthritis Foundation at 1-800-283-7800 for more information.
- March 2014: Spousal Income & Asset Protections
What are MassHealth “community spouse” protections?
If someone in your family requires nursing facility care, Medicare generally only provides short-term, limited coverage. Medicaid, known in Massachusetts as MassHealth, will pay for care over the longterm. However, you must have limited income and assets to qualify for MassHealth. To be eligible for MassHealth benefits, a nursing home resident may have no more than $2,000 in assets—excluding your house, car, pre-paid burial, and a few other expenses.
MassHealth rules provide special protections for the at-home spouse, also known as the community spouse, of a MassHealth applicant. The intent is to give the community spouse the minimum support needed to continue to live in the community.
If the MassHealth applicant is married, the countable assets of both the community spouse and the institutionalized spouse are totaled as of the day on which the ill spouse enters either a hospital or a long-term care facility and stays for at least 30 days. If a married couple has $100,000 in countable assets, for example, the applicant will be eligible for Medicaid once the couple’s assets have been reduced to a combined figure of $52,000 — $2,000 for the applicant and $50,000 for the community spouse. In general, the community spouse may keep one-half of the couple's total countable assets up to a maximum in 2014 of $117,240. This asset amount is called the Community Spouse Resource Allowance.
There are also protections for income. The community spouse can keep all of her own income, with no limit. If most of the couple’s income is in the name of the institutionalized spouse and the community spouse’s income is not enough to live on, the community spouse is entitled to some or all of the monthly income of the institutionalized spouse. If the community spouse’s own income is below $1,939 per month, he or she is allowed to divert income from the institutionalized spouse to get up to the $1,939. This is known as the Minimum Monthly Maintenance Needs Allowance. It will go up under Federal law on July 1, 2014. If the community spouse needs more than the minimum allowance, she may keep up to the maximum of $2931 per month with approval and by submitting proof of necessity.
Also be aware that the Excess Shelter Allowance may be available if the community spouse’s housing expenses are more than 30% of the minimum monthly maintenance needs allowance (30% of $1,939 = $582). How much income the community spouse is entitled to is calculated for each community spouse according to a formula that includes housing costs—rent, mortgage payments, property taxes, insurance. The income range will fall in between the low of $1,939 and the high of $2,931 a month.
Keep in mind that the income of the community spouse is not counted in determining the MassHealth applicant’s eligibility. Only income in the applicant’s name is counted.
Consider, a married couple has joint income of $4,000 a month — $3,000 of which is in the institutionalized spouse’s name and $1,000 is in the community spouse’s name. MassHealth determines that the community spouse’s minimum monthly maintenance needs allowance, based on housing costs, is $2,500. Because the community spouse’s own income is only $1,000 a month, MassHealth diverts $1,500 monthly of the institutionalized spouse’s income for the community spouse’s support. This lowers what the institutionalized spouse pays the nursing facility.
If one member of a married couple has to go into a nursing facility, the community spouse should consider contacting an elder law attorney about spousal protection laws. To obtain a list of elder law attorneys in Massachusetts, call 617-566-5640, or send an email to email@example.com.
- February 2014: Check Up On Your Benefits
Are you missing out on benefits?
There are more than 2,000 federal, state and private programs that can assist people who are living on limited incomes. Some are better known than others—now you can get help finding these programs in the privacy of your own home with an online program called BenefitsCheckUp®.
BenefitsCheckUp® is sponsored by the National Council on Aging and is a free, online, confidential service that helps identify programs available in your area that can help pay for prescriptions, health care, food, utilities, and more. You can also get help with tax relief, transportation, legal issues, or finding work.
BenefitsCheckUp® empowers seniors, family members, and caregivers by helping to determine what benefits a person may qualify for and how to apply. Individuals are asked a series of questions to identify benefits that may help save money and cover the costs of everyday expenses. After answering the questions, a personalized report is created that describes programs that may be available. Many of the applications for these programs can be filled in online and the completed application can then be printed.
Supplemental Nutrition Assistance Program (SNAP), formerly Food Stamps, helps low-income individuals and families purchase healthy food. Approximately six million seniors across America face the threat of hunger each day. According to the Meals on Wheels Association, 11% of all seniors have experienced a form of food insecurity over the last year. For struggling families, SNAP is making a huge difference in their economic well-being and health. SNAP benefits, if counted as income, lifted 4 million people in the United States above the poverty line in 2012. SNAP is also good for local economies because each $1 in federally funded SNAP benefits generates $1.79 in economic activity. Since 2009, there has been a 36% increase in the number of individuals in Massachusetts getting SNAP benefits—roughly 892,000 people today. But, many seniors and families still are not getting this nutritional assistance.
Could you use the assistance of SNAP? You can find out if you qualify through BenefitsCheckUp®. You may also find information and learn how to apply by visiting www.mass.gov/snap or calling 1-866-950-3663 (FOOD).
To try BenefitsCheckUp®, go to www.benefitscheckup.org.
You can now also find out if you are making the most of your money through EconomicCheckUp®, www.economiccheckup.org, also sponsored by the National Council on Aging. Discover how to cut spending, reduce your debt, find work, and use your home equity. To speak to an Information Specialist personally about any of these programs in Massachusetts, call 1-800-AGE-INFO and select option 1. Specialists are available Monday through Friday during normal business hours.
- January 2014: Beginning To Talk About The End
Any tips for having a discussion about End-Of-Life Care?
Most people feel uncomfortable talking about dying or what kind of care they would like at the end of their life. A new group, The Conversation Project, believes that the time to talk about end-of-life care is at the kitchen table, not in the intensive care unit. “Too many people are dying in a way they wouldn’t choose,” The Conversation Project states, “and too many of their loved ones are left feeling bereaved, guilty, and uncertain.” The Conversation Project wants to make sure that an individual’s wishes and preferences are talked about and respected.
According to a survey conducted in California, 60% of people say that making sure their family is not burdened by tough end-of-life decisions is extremely important, yet 56% have not told their family about their end-of-life wishes. The same survey revealed that less than one in four people had put their wishes in writing. One federal survey found that 70% of people would prefer to die at home, yet 70% die in hospitals or nursing facilities.
The Conversation Project began in 2010 when a group of medical professionals, clergy, and members of the media began sharing stories of good deaths and bad deaths within their own circle. The group then began a grassroots public campaign hoping to initiate a change in our culture. “To make it easier to initiate conversations about dying, and to encourage people to talk now and as often as necessary so that their wishes are known when the time comes” is the goal of The Conversation Project.
For people not sure how to begin this discussion with loved ones, The Project has published Your Conversation Starter Kit, designed to help you get your thoughts organized. The Starter Kit asks questions like: How long do you want to receive medical care? How involved do you want your loved ones to be? Do you think that your loved ones know what you want, or do you think they have no idea?
The Kit also suggests dialogue to break the ice and begin the discussion regarding end-of-life care. You might try, “I need to think about the future. Will you help me?” Another approach might be, “Even though I’m ok right now, I’m worried about what might happen to me and I want to be prepared.” The Kit also suggests you talk about how actively you want to be involved in decision-making about your care, and who you would like to have as your health care proxy? Do you want (or not want) aggressive treatment—resuscitation, feeding tube, etc?
According to The Conversation Project, you don’t need to guide the conversation. Just let it happen. Every attempt at a conversation is valuable; these conversations are meant to help you and your loved ones live and die in a way that you choose.
Every family has stories to tell about how some loved one died—after a long illness, or perhaps suddenly. We talk about good deaths and bad deaths, but in many of these situations, it is not clear how and where the loved one wanted to die, and what specific instructions they would have wanted the family to use as a guide.
To learn more about The Conversation Project, and to print out a copy of Your Conversation Starter Kit, go towww.theconversationproject.org, and be sure to print out the document titled “How to Talk to Your Doctor”.
- November 2014: Seniors & The Flu — Do I Need A Shot?
Do I really need to get a flu shot this season?
Nine out of ten flu-related deaths occur in people age 65 and over. Six out of ten people hospitalized for flu-related problems are older adults. Last year, 215,000 seniors were hospitalized from the flu. The flu is especially dangerous for people with chronic conditions, like heart or pulmonary disease, or diabetes. It’s harder for seniors to fight disease, because the immune system weakens with age.
Influenza is easy to catch — it’s passed from person to person through coughing, sneezing, or contact with fluids from an infected person’s mouth or nose. Protect yourself by taking preventive measures like washing your hands often, staying away from people who are sick, and encouraging others to cover their coughs. Get vaccinated annually; it is still the best way to prevent the flu. As a bonus, getting a flu shot helps protect your family and everyone around you. Anyone who is around someone with a chronic condition should get a flu shot; grandparents who care for grandchildren should get vaccinated too. Do it for yourself and do it for others!
There is a flu vaccine made specifically for people age 65 and older that improves the body’s production of antibody against the flu. This higher-dose vaccine contains four times the antigen compared with the traditional, standard-dose vaccine. Antibodies help your immune system protect you against infection when exposed to the virus. Most people have minimal or no side effects after receiving the higher-dose vaccine. The most common side effects include swelling or redness at the injection site, muscle aches, fatigue, headache, or fever. The higher-dose shot for seniors is available through your doctor, your workplace clinic, local pharmacies, or other flu shot clinics. Medicare Part B covers the full cost of one flu shot per flu season. You pay nothing for the shot, so be sure to ask in advance if your doctor, clinic or other health care provider accepts Medicare.
Your doctor can explain who should not get a flu shot. Anyone with a severe allergic reaction (e.g., anaphylaxis) to any vaccine component, including eggs, egg products, or to a previous dose of any flu vaccine, should not get a shot. Anyone who has experienced Guillain-Barré syndrome (severe muscle weakness) after a previous flu shot should not be vaccinated. If you notice any other problems or symptoms after vaccination, contact your health care professional immediately.
The flu season usually peaks in January or February, but can continue well into the spring. It takes approximately two weeks following a flu shot to be considered immune. Even if you can’t get a flu shot early in the season, it is still recommended that you get a shot into the winter months and beyond.
Remember to get a flu shot every year.
The flu viruses usually change from season to season and protection from the vaccine decreases over time. A new vaccine is produced each year to protect against the strains that are expected to cause disease. Keep in mind that the flu shot does not contain the live virus; you cannot get the flu from the shot.