Arts for the Aging was founded in 1988 by Ms. Lolo Sarnoff, a sculptor then 72 years old, in response to a request from the National Institutes of Health. The NIH had asked her to conduct workshops for seniors with Alzheimer’s disease. Ms. Sarnoff agreed and soon observed that art in every form was beneficial to the mood of most seniors. Reports by nurses showed less agitation and aggressive behavior in patients, and these moods continued even after the patients left her workshops.

Now in its 23^rd year, Arts for the Aging it is recognized by the National Endowment for the Arts as a pioneering arts program for older adults, and a model for excellence in life-long learning and creative aging. Infusing the latest field research and evaluation into its work, AFTA remains true to the founder’s innovative vision, giving seniors – especially those with dementia, including Alzheimer’s disease – a sense of healing, self-worth and independence.

Arts for the Aging offers older adults specially designed, best-practice programs to promote health improvement and life enhancement through the arts.  Free outreach workshops are provided to small groups of older adults who are vulnerable and who are living with impairments such as dementia. Workshops take place at underserved adult care centers in communities where local residents strive to age in place. Visual, performing, literary, multidisciplinary and intergenerational arts programs are led by trained, professional teaching artists. The one-hour sessions are self-contained; they hold the interest of those with brain degeneration by exposing them to new artists and new media each week. Groups are immersed in painting, poetry, live instrumental music and more. In 2010, AFTA served over 500 older adults through these programs.

The National Endowment for the Arts’ recent Creativity and Aging Study (http://www.nea.gov/resources/accessibility/CnA-Rep4-30-06.pdf) demonstrated that regular participation in professionally-led programs can minimize age-related physical and cognitive impairments, and contribute to better physical, intellectual and emotional health.  In 2010, Arts for the Aging’s offerings focused on achieving positive outcomes for Alzheimer’s and dementia sufferers. Throughout those workshops, 85% of attendees actively participated – impressive considering that three quarters suffered from memory-related ailments, a third were wheelchair bound and others suffered from various debilitating afflictions. One indicator of the severity of participants’ collective memory is that just 40% recall previous Arts for the Aging visits.

Yet post-workshop, an average of 90% show appreciation to the teaching artists, thereby demonstrating seniors’ connection to the artists, their engagement and their  positive attitudes. This bonding is essential to the emotional health of adults who age in place since they may not interact with other people on a regular basis.  Other 2010 outcomes:

• 72% interacted with others, a sign of the social bonds our workshops form.
• 52% shared memories or stories, a practice we encourage continually, given the prevalence of memory-related afflictions in our workshops.
• 75% left the workshops smiling.

Learn more about Arts for the Aging at www.AFTAarts.org.

• Diabetes: adults with blood pressure above 135/80 should be screened for type 2 diabetes, even when there are no symptoms of the disease
• Aneurysm: ultrasound screening to detect abdominal aortic aneurysm for men 65-75 who have ever smoked
• Osteoporosis: Especially for women 65 and older.

To establish this list, the federal government relies on an advisory body, the U.S. Preventive Services Task Force. Not surprisingly, the Task Force also identifies a number of tests that are not recommended. Reasons include lack of sufficient power to detect the disease and too many false positives (the test says you have the disease when you don’t). Among them:

• Alzheimer’s disease
• Hormone-replacement therapy
• Prostate cancer for men over 75
• Testicular cancer.

The Task Force’s Web site,  www.uspreventiveservicestaskforce.org contains an extensive list of recommendations based on the merits of preventive measures, including screening tests, counseling, immunizations, and preventive medications.

While The Patient Protection and Affordable Care Act (also known as Health Reform) will likely see certain changes before it is fully implemented, it is also likely that these preventive measures will continue to be included. You may wish to ask your doctor if the tests are not offered during a routine physical exam.

5 Ways to Stay Safe and Healthy this Winter

1. Stay hydrated.

Dry air and cold winds can really take it out of you, especially the elderly. Just because it’s not hot doesn’t mean it’s not dry. The onset of Seasonal Affective Disorder (SAD), depression, and forgetfulness can be minimized by maintaining the right equilibrium. Lots of fluids (not just water) and lots of colors. If you eat a colorful diet you are sure to get a lot of complimentary nutrients.

2. Arrange Transportation.

If this winter is anything like the last one, seniors living at home independently could become home-bound seniors with few options for getting out to doctors’ appointments, buying groceries, or getting other transportation needs met. Transportation for seniors, the infirm, or disabled is always challenging. When winter winds blow, snow falls, and ice melts and refreezes overnight, transporting the elderly and those with special needs becomes a monumental task. Plan ahead for holiday transportation for seniors this Christmas and Hanukkah. Many transportation services charge a premium for travel on holidays. So, make arrangements with family members, or look into ‘neighbors helping neighbors‘ programs.

3. Socialize.

Visit the elderly in assisted living or bring your companion animal for a visit to a nursing home. Write letters to old friends. Connect with support groups through Meetup.com, Facebook, or local hospitals and senior centers. Many ‘senior villages’ organize social evenings in addition to assisting elderly neighbors as they age in place.

4. Exercise.

Don’t over do it, but get your heart rate up a bit. Our muscles tend to quiver when we’re cold to help keep us warm. The elderly and those with reduced muscle mass have fewer muscle cells to quiver, create friction, and warm their body. All the more reason to get the blood flowing at a reasonable rate (always consult a physician to determine the level of exercise appropriate for your condition).

5. Sleep.

Sleep gives your spine a chance to decompress and relieve stress on your nervous system. It gives the immune system a leg up and helps restore mental and emotional balance. What more can be said. As my friend Jason Wiesinger in the nutrition sciences program at Penn State once said to me, “When you sleep your body heals itself!”

Related articles

• How To Cope With Winter Blues (thewordworm.wordpress.com)

Accessible Design for people with vision loss may get a little boost from the Americans With Disabilities Act (ADA), enacted in 1990, which expanded opportunities for persons with disabilities by prohibiting discrimination and requiring reasonable accommodations in employment and job opportunities, public accommodations and services, government services, and telecommunications services.

As Sheila Solomon Klass said in a recent Washington Post article, “There is much to be noticed when one barely sees.” Ms. Klass suffers from Age-Related Macular Degeneration and Glaucoma. When light fades, so does her ability to see. At dusk the contrast of the street signs, the stairs of the New York subway, and street numbers fade away completely.

My father-in-law, now 82, has said for years that he always knows when he gets to the Friendship Heights Metro station on the boarder of Maryland and the District of Columbia, “because it’s so dark and I can’t see the station sign, I know that I am at Friendship Heights.”

Issues like these need to be addressed by our public officials. As we note in our article Universal Design Enhances Home Care for Seniors, communities and municipalities must implement strategies to engage the elderly and people with disabilities with the physical environment. Many intersections now have crosswalk signals that display the seconds remaining to cross. In Montgomery County many signals at busy intersections in Bethesda, Friendship Heights, Rockville, and Silver Spring emit different sounds indicating walk or don’t walk. Voice prompted ATMs, Detectible Warning Surfaces, screen readers, and more help seniors and others function within their communities. Innovations like these, along with the cut curbs my mother fought for in the late ‘60s while working for Easter Seals, slowly transform the idea of Universal Design into the reality of Equality of Design.

Care for You’s CEO and Executive Director were pleased to attend the August 30^th ceremony at the U.S. Immigration and Naturalization Service to witness Kamaldeen Abubaker take the oath to become a U.S. citizen. A companion with the Company for the past three years, Mr. Abubaker came to the United States from Nigeria in 2001. He is married with three small children.

Mr. Abubaker’s first assignment with Care for You was to staff a retired Air Force (former Army Air Corps) General who suffers from Alzheimer’s disease. Upon being contacted by the bank that manages the General’s trust, the Care for You executive director scheduled an assessment with the family.

The family initially requested an individual to act in the capacity of an “aide de camp,” as this was a term that resonated with the General. The General’s children, a son and two daughters, stated that the General and his wife wanted to remain in their own home as they grew older, and not move into assisted living or a nursing home.

Mr. Abubaker’s initial assignment was for five hours per day to perform a list of duties including:

• Daily shopping with the General for household needs
• Regular lunches at a local restaurant
• Assistance in sorting papers and files in his office to determine what to save, discard, or set aside for his son to review
• Assistance with using the computer for email
• Taking direction from the General and keeping him busy as he was easily bored in retirement
• Working on “projects” per direction from the family.

Mr. Abubaker quickly gained the General’s and family’s trust, and strong relationships were formed.

Much has happened over the past three years. The General’s wife has died. After two brief stays in assisted living facilities, the family realized the General was extremely unhappy and determined to have him spend his remaining years in his own space. Care for You was requested to increase staffing to 24/7; Mr. Abubaker is lead companion on the team. And we are pleased to have Mr. Abubaker on our team.

Paying for the law

Many seniors have expressed concern that the expanded coverage to many uninsured Americans will come at the expense of reduced Medicare services. However, according to the non-partisan Congressional Budget Office (CBO), this is not the case.

CBO has estimated that the new law will save Medicare about $400 billion over the next 10 years. A reasonable person might ask: How can this be accomplished without reducing services?

For starters, the CBO projects that about half the savings will be achieved by reducing the rate of growth in payments to hospitals, nursing homes and home health agencies. (For many of these providers, the slowed growth in payments will be offset by profits from the newly insured.)

And, as mentioned in an earlier article, the CBO anticipates that significant savings will come through the gradual reduction of the Medicaid Advantage “premium”. By reducing the MA “overpayment” over a period of about six years until it reaches parity with traditional Medicare, the CBO estimates the government will achieve about a 30% savings. (This overpayment was initially offered to insurers to entice Medicare enrollees to select the HMO option.)

Note though, that while Medicare Advantage plans must continue to offer the same benefits as traditional fee-for-service Medicare, certain additional benefits could be curtailed, or individual premiums could be increased. Medicare Advantage enrollees should review their premium and coverage prior to open enrollment in November to determine if their insurer has increased premiums or limited benefits in any way.

The CBO anticipates additional savings through reducing fraud and waste, and from program efficiencies (10%).

Certainly, reducing the number of uninsured Americans is a laudable goal. Paying for the new law through reductions in insurer overpayments, fraud and waste – to the extent they can be achieved – is also key. But remember, projections are based on assumptions. Whether the CBO’s assumptions will be born out through actual experience remains to be seen.

Prescription Drug Coverage

Congress passed the Medicare prescription drug plan (Part D) earlier in the decade. The plan now covers the cost of prescription drugs up to $2,830 in a given year. The insured is responsible for paying for all prescription drugs until total costs reach $6,440, at which point the government will pay 100%. This gap in coverage is known as the donut hole. But starting in 2010, people whose drug expenses reach the $2,830 threshold will receive a $250 check from Medicare. Starting in 2011, when a person reaches the threshold, Medicare will pay for half of all brand-name drugs up to the higher limit, at which point the full amount will be covered. This donut hole will be completely eliminated by 2020.

For example, 38% of respondents stated they were “not at all satisfied” with the accuracy and reliability of information they had received about the new law. Only 7% said they were “very satisfied.”

Mr. Firman used the town hall meeting to announce the launch of NCOA’s response to this information void: the “Straight Talk for Seniors on Health Reform” campaign, and a series of fact sheets that describe key features of the Act and changes to Medicare.

Although the Act is not targeted toward seniors specifically, seniors are a major focus as the Federal government spends hundreds of billions annually for Medicare. Per the Congressional Budget Office, in 2008, the latest year for which numbers are available, total spending for health care was about $2.2 trillion. Federal spending for Medicare that year was 22% of the total, or about $484 billion⁴.

Still, many have heard that the law is being paid for, at least in part, through cuts to Medicare. There are important caveats to this assumption. First, when Medicare Advantage, the HMO-like program, was introduced earlier in the decade, the government gave insurers additional money as an incentive to bring people into a managed care program and away from fee-for-service. In 2009, this amounted to about $1,100 more per enrollee than they pay for traditional Medicare. Starting in 2012, reductions in this MA premium will commence and continue over six years.

Given that the government will be taking away the financial incentive for MA enrollment, many plans will face a decision of whether to raise their premiums or reduce services. Note however, MA plans must continue to offer at least the same benefits that are guaranteed to everyone on Medicare. So, although there will be premium increases or cuts in certain areas, this will slow the rate of growth of Medicare spending, not the growth itself.

In fact, starting in 2011, Medicare will pay bonuses to primary care physicians, e.g., general practitioners, internists, to encourage more to accept Medicare patients.

In upcoming articles, we’ll cover other features of the new law.

¹The National Council on Aging can be found at: www.NCOA.org.
²PPACA, Public Law 111-148
³Harris Interactive can be found at: www.harrisinteractive.com.
⁴The Long-Term Budget Outlook, June 2010, P. 27, http://www.cbo.gov/ftpdocs/115xx/doc11579/06-30-LTBO.pdf.

“Simple techniques exist to screen for memory problems, but many doctors don’t routinely use them. Increasingly, however, efforts are being made to diagnose patients’ cognitive impairment earlier.

“To examine the cost-effectiveness of screening and earlier diagnosis, researchers from the Department of Veterans Affairs in the Midwest conducted a standard memory screen on over 8,000 patients aged 70 and older. More than a quarter failed the two-minute screen and were referred for further evaluation. Of the 700 veterans who were more extensively evaluated, nearly all were found to have significant cognitive impairment.

“In clinics that were trained to recognize dementia, the researchers found, the average cost of all medical care for those patients identified with dementia dropped $1,700 in the year after diagnosis from the year before, according to Riley McCarten, medical director of the geriatric research education and clinical center at the Minneapolis Veterans Affairs Medical Center, who presented the research. The savings didn’t reflect the cost of the evaluation, which averaged $800, Dr. McCarten said.

“The cost savings are probably due to reduced hospitalizations and visits to urgent-care centers because families no longer bring their loved ones to these facilities as frequently as when they didn’t understand what was going on, according to Dr. McCarten. The reduced costs may also be related to having a caregiver step in to help the patient better manage chronic health conditions, he said.

“Patients often aren’t diagnosed until later stages, when day-to-day functioning is affected. As they try to manage on their own, many fail to take medications for such chronic conditions as diabetes, or experience falls and accidents leading to costly hospitalizations.

“The results of the large study were presented at the International Conference on Alzheimer’s Disease in Honolulu. It is the biggest study so far to examine the reduction of costs by identifying cognitive dysfunction early, according to William Thies, chief medical and scientific officer for the Alzheimer’s Association. He said the data show the program is “clearly cost-effective.”

“But it isn’t yet clear whether these “really important” findings would apply to patients who aren’t part of the Veterans Affairs system, or who go to clinics without specialty training in Alzheimer’s disease, according to Howard Fillit, executive director of the Alzheimer’s Drug Discovery Foundation, who wasn’t involved in the study.”

A study, “The Impact of Professionally Conducted Cultural Programs on the Physical Health, Mental Health, and Social Functioning of Older Adults,” complete with its outcomes, was published in The Gerontologist, Vol. 46, No. 6, 2006. Gene D. Cohen, MD, PhD, was the lead investigator on this study.

The intent of the study was to measure the impact, if any, of professionally conducted community-based cultural programs on the physical and mental health, and social activities of individuals aged 65 and older. The study was conducted in three geographic locations throughout the country, including greater Washington, DC.

The study solicited participants through mailed requests to be part of a study “to assess the general state of health and mental health as well as involvement in overall group activities of older adults living in the community. The notice for the intervention group differed only in that it sought singers for a chorale; no singing experience was required..”

Findings on the physical health side of the study included several that were statistically significant:

Self-Rating of Overall health: Over the course of the study, the intervention groups’ assessments of their health increased while the comparison groups’ decreased.

Number of Doctor Visits During the Past 12 Months: Both the intervention and comparison groups’ number of visits increased, but he comparison groups’ visits increased by more.

Number of Over-the-Counter Medications: Again, both groups’ OTC medications increased, but the comparison groups’ increase was greater.

Instances of Falls During the Past 12 Months: On this measure, the intervention groups’ numbers declined, but the comparison groups’ numbers increased.

The study also found that the intervention group, “reported a trend toward increased activities 12 month post-baseline, whereas the comparison group reported a decline during this same time period.” These differences are especially interesting in that the mean age of the participants was nearly 80 – greater than life expectancy.