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.

Can’t find your car keys? Forget what’s on your grocery list? Can’t remember the name of the personal trainer you liked at the gym? You’re not alone. Everyone forgets things occasionally. Still, memory loss is nothing to take lightly. You can do simple things every day to improve your memory — starting today!

No. 1: Stay mentally active

Just as physical activity helps keep your body in shape, mentally stimulating activities help keep your brain in shape — and memory loss at bay. Do crossword puzzles. Read a section of the newspaper that you normally skip. Take alternate routes when driving. Learn to play a musical instrument. Volunteer at a local school or community organization.

No. 2: Socialize regularly

Social interaction helps ward off depression and stress, both of which can contribute to memory loss. Look for opportunities to get together with loved ones, friends and others — especially if you live alone. When you’re invited to share a meal or attend an event, go!

No. 3: Get organized

You’re more likely to forget things if your home is cluttered and your notes are in disarray. Jot down tasks, appointments and other events in a special notebook or calendar. You might even repeat each entry out loud as you write it down to help cement it in your memory. Keep to-do lists current, and check off items you’ve completed. Set aside a certain place for your wallet, keys and other essentials.

No. 4: Focus

Limit distractions, and don’t try to do too many things at once. If you focus on the information that you’re trying to remember, you’ll be more likely to recall it later. It might also help to connect what you’re trying to remember to a favorite song or another familiar concept.

No. 5: Eat a healthy diet

A heart-healthy diet is as good for your brain as it is for your heart. Focus on fruits, vegetables and whole grains. Choose low-fat protein sources, such as lean meat, skinless poultry and fish. What you drink counts, too. Not enough water or too much alcohol can lead to confusion and memory loss.

No. 6: Include physical activity in your daily routine

Physical activity increases blood flow to your whole body, including your brain — which may help keep your memory sharp. Aim for at least 30 minutes of aerobic activity a day. If you don’t have time for a full workout, squeeze in a few 10-minute walks throughout the day.

No. 7: Manage chronic conditions

Follow your doctor’s treatment recommendations for any chronic conditions, such as thyroid problems, high blood pressure and depression. The better you take care of yourself, the better your memory is likely to be.

When to seek help for memory loss

If you’re worried about memory loss — especially if memory loss affects your ability to complete your usual daily activities — consult your doctor. He or she will likely do a physical exam, as well as check your memory and problem-solving skills. Sometimes other tests are needed as well. Treatment will depend on what’s contributing to the memory loss.

This article (http://www.mayoclinic.com/health/memory-loss/HA00001) was posted on the Mayo Clinic Web site by Mayo Clinic staff. It is reproduced here in its entirety.

Can’t find your car keys? Forget what’s on your grocery list? Can’t remember the name of the personal trainer you liked at the gym? You’re not alone. Everyone forgets things occasionally. Still, memory loss is nothing to take lightly. You can do simple things every day to improve your memory — starting today!

No. 1: Stay mentally active

Just as physical activity helps keep your body in shape, mentally stimulating activities help keep your brain in shape — and memory loss at bay. Do crossword puzzles. Read a section of the newspaper that you normally skip. Take alternate routes when driving. Learn to play a musical instrument. Volunteer at a local school or community organization.

No. 2: Socialize regularly

Social interaction helps ward off depression and stress, both of which can contribute to memory loss. Look for opportunities to get together with loved ones, friends and others — especially if you live alone. When you’re invited to share a meal or attend an event, go!

No. 3: Get organized

You’re more likely to forget things if your home is cluttered and your notes are in disarray. Jot down tasks, appointments and other events in a special notebook or calendar. You might even repeat each entry out loud as you write it down to help cement it in your memory. Keep to-do lists current, and check off items you’ve completed. Set aside a certain place for your wallet, keys and other essentials.

No. 4: Focus

Limit distractions, and don’t try to do too many things at once. If you focus on the information that you’re trying to remember, you’ll be more likely to recall it later. It might also help to connect what you’re trying to remember to a favorite song or another familiar concept.

No. 5: Eat a healthy diet

A heart-healthy diet is as good for your brain as it is for your heart. Focus on fruits, vegetables and whole grains. Choose low-fat protein sources, such as lean meat, skinless poultry and fish. What you drink counts, too. Not enough water or too much alcohol can lead to confusion and memory loss.

No. 6: Include physical activity in your daily routine

Physical activity increases blood flow to your whole body, including your brain — which may help keep your memory sharp. Aim for at least 30 minutes of aerobic activity a day. If you don’t have time for a full workout, squeeze in a few 10-minute walks throughout the day.

No. 7: Manage chronic conditions

Follow your doctor’s treatment recommendations for any chronic conditions, such as thyroid problems, high blood pressure and depression. The better you take care of yourself, the better your memory is likely to be.

When to seek help for memory loss

If you’re worried about memory loss — especially if memory loss affects your ability to complete your usual daily activities — consult your doctor. He or she will likely do a physical exam, as well as check your memory and problem-solving skills. Sometimes other tests are needed as well. Treatment will depend on what’s contributing to the memory loss.

This article (http://www.mayoclinic.com/health/memory-loss/HA00001) was posted on the Mayo Clinic Web site by Mayo Clinic staff. It is reproduced here in its entirety.

In order to be eligible, a homeowner must have:
• A combined household income of less than $64,000;
• Lived in their home for at least six months, or will live in it for the next 12 months; and
• A combined net worth (of everyone in the applicant’s household) of no more than $200,000. This does not include the value of the primary residence or the cash value of any qualified retirement savings or individual retirement accounts.

To apply for the property tax credit program, eligible homeowners must fill out an application form each year.

To get an application form, call the Maryland State Department of Assessments and Taxation (SDAT) at 1-800-944-7403, or download the form and instructions from the SDAT web site at http://www.dat.state.md.us/sdatweb/htc.html. (This announcement was provided by Michael Lachance of the Maryland Department of Aging.)

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.

The Virginia General Assembly set a precedent this year by passing legislation that would override local zoning laws and allow these structures to be placed on a family’s property with orders from the individual’s doctor. Some of these structures are even set up to monitor such things as vital signs and fall-detecting devices.

A local minister, Rev. Kevin Dupin, was inspired by modular hospital rooms during his mission work in Latin America. MEDCottage (www.MedCottage.com), being built in Salem, Va., is expected to retail for between $65,000 and $75,000 with production to begin by early 2011. The company plans to develop a lease arrangement as well.

Other companies producing portable structures with senior relatives in mind include Seattle-based FabCab (http://fabcab.com/), and San Francisco-based Larson Shores (http://www.larsonshoresarch.com/).

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.”

The researchers studied cognitive activities such as reading books, writing for pleasure, doing crossword puzzles, playing cards and playing musical instruments. They also studied physical activities like playing tennis or golf, swimming, bicycling, dancing, walking for exercise and doing housework.

The study was led by the Albert Einstein College of Medicine in New York City, and funded by the National Institute on Aging.  It was later published in the New England Journal of Medicine (New England Journal of Medicine).

Significantly, almost none of the physical activities appeared to offer any protection against dementia. There can be cardiovascular benefits, but the focus of this study was the mind, i.e., are there ways to reduce the risk of being overtaken by some form of dementia. One important finding from the study: the only physical activity to offer protection against dementia was frequent dancing.

In terms of reduced risk of dementia, here is how some of the activities, mental and physical, stacked up:

• Bicycling and swimming – 0% reduced risk
• Playing golf – 0%
• Reading – 35%
• Doing crossword puzzles at least four days per week – 47%
• Dancing frequently – 76% – the greatest risk reduction of any activity studied, cognitive or physical.

The study’s authors suggested that the dancers are more resistant to the effects of dementia as a result of having greater cognitive reserve and increased complexity of neuronal synapses. Like education, participation in some leisure activities lowers the risk of dementia by improving cognitive reserve. We need to keep as many of those paths active as we can while also generating new paths to maintain the complexity of our neuronal synapses.

Other study results corroborate the Albert Einstein College of Medicine study, or identify additional benefits experienced by participating individuals. For example, Science Daily (http://www.sciencedaily.com/releases/2010/04/100416144617.htm) reported, “Two recent studies conducted by University of Missouri researchers found that participation in dance-based therapy can improve balance and gait in older adults. Improved functionality among seniors can decrease their risk of falling and reduce costly injuries.”

Several organizations around the country are engaging older adults in a variety of cultural and arts experiences. Arts for the Aging (AFTA) (www.aftaarts.org), is a local organization doing just that: their main goal being to improve health and wellness in older adults. Pairing teaching artists with senior centers throughout the greater Washington, D.C. area, they bring artistic programming including art, music, story-telling, and yes, dance to over a thousand elderly, most of whom are already dementia or Alzheimer’s disease sufferers.

Elderly people who care for a spouse who has dementia are at increased risk of developing dementia themselves, a study finds. The stress of attending to a mentally incapacitated spouse may somehow contribute to the added risk, scientists report in the May Journal of the American Geriatrics Society*.

Previous studies have shown that chronic stress leads to increased levels of the hormone cortisol in the body, which can suppress immunity, says study coauthor Peter Rabins, a psychiatrist at Johns Hopkins School of Medicine in Baltimore who teamed with researchers at Utah State University in Logan to do this study. “It’s long been thought that this might have adverse outcomes psychologically and physiologically.”

Taking care of a spouse with dementia takes a toll in other ways as well, Rabins says. “Caregivers often complain that they lose their friends,” he says, because they don’t have time to socialize. But the biological mechanisms that might link these challenges to heightened dementia risk remain unclear.

In the new study, the researchers assessed the mental status of 1,221 Utah couples who had agreed to be part of a community-wide health study that started in 1995. The men averaged age 76 and the women 73 at that point, and 95 percent had been married for more than 20 years. Researchers tracked these couples’ mental status with up to four exams over the next decade with a median follow-up of 3.3 years. No participants in this analysis had dementia at the start.

During the follow-up years, 229 people found themselves caring for a spouse with dementia. The caregivers were six times more likely to develop dementia themselves compared with people whose spouses did not develop dementia. The researchers accounted for differences between the couples in age, education, socioeconomic status and the presence of variants in the APOE gene that can increase risk of Alzheimer’s disease.

While this is the first study to look at actual dementia risk in spousal caregivers, other research has documented an array of physical and mental problems associated with caregiving. These include depression, sleep problems, less exercise and unhealthy diet, says Peter Vitaliano, a psychologist at the University of Washington School of Medicine in Seattle, writing in the same issue of the Journal of the American Geriatrics Society. All these conditions may be risk factors for dementia, he notes.

In the new study, the authors point out that some of the increased risk of dementia in caregivers may be due to shared environment. The couples had been married on average for 49 years upon enrollment in the study. But what those shared environmental risk factors might be remains unknown.

One other possible contributor to this dementia risk could be the tendency of people who are prone to distress or mental illness to find and marry one another, Rabins says.

Bruce McEwen, a neuroscientist at Rockefeller University in New York City, says that in the future researchers might do well to investigate whether caregiver spouses who have less social support — or who are just more isolated — might be at the most risk.

By Nathan Seppa

(This article was published in Science News, June 19, 2010, Vol. 177 #13, http://www.sciencenews.org/view/generic/id/59316/title/Caring_for_a_spouse_with_dementia_leaves_caregiver_at_risk.)

Previously published, related articles on the Care for You Web site include: “Caring for the Caregiver,” and “Don’t Forget to Remember.”