September 2005  

   Welcome to the September 2005 Edition of Issues in Aging.

   Long-Term Care

         
 
 

Vaccines Mandated This Year  
Centers for Medicare & Medicaid Services (August 12, 2005)

The decision to mandate flu and pneumonia vaccinations for nursing home residents is a critical element of the quality improvement movement, according to the U.S. government. Nursing homes will have to vaccinate their residents beginning this fall if they want to continue to receive Medicare or Medicaid funding. The goal is to reach a 90 percent vaccination level for residents. One study showed that in 1999, vaccination rates were just 65 percent for flu and 38 percent for pneumonia. Residents have the option to refuse the vaccinations. The new rule also will encourage more healthcare workers to become vaccinated. A study showed that last year, just 36 percent of the nursing home workforce was vaccinated. For more information, visit http://www.archives.gov/federal-register.

 
      Assisted Living Booming, Nursing Homes Slumping
Journal of Applied Gerontology (August 2005)

Although the actual number of nursing home beds increased modestly from 1990 to 2002, their proportion to the overall population dropped. The siphoning of residents to assisted living facilities largely explains the proportional decrease. While the total supply of nursing home beds rose seven percent, assisted living beds shot up 97 percent. Long-term care beds of all types increased from 2.3 million to 2.9 million. Residential care and assisted living beds rose from 20.9 to 35.6 per 10,000 people, and nursing home beds fell from 66.7 to 61.4. Proportions of housing supply varied widely by state.

 
       
     

Inexpensive Nutrition Increases Residents’ Weight                  

The Journals of Gerontology: Biological and Medical Sciences

(June 2005)

Care of nursing home residents is often complicated by nutritional problems such as weight loss and worsening protein status. The inability or refusal of a resident to consume enough food often necessitates the use of commercial formulas for nutritional support. The purpose of this study was to determine whether the use of an in-house (high-protein, milk-based) low-cost formula with added minerals and vitamins for nutritional support would be effective in maintaining weight and protein status. One hundred forty-three participants who received this formula were followed for a maximum of six years. Mean weight increased by 12 pounds during the first year and remained stable thereafter. The long-term use of an inexpensive formula increased weight and protein status in most people who participated in the study.

 
       
         

   Vitamins & Supplements

         
 
  Antioxidants Cut Risk of Arthritis                  

American Journal of Clinical Nutrition (August 2005)

Certain carotenoids, compounds commonly found in some fruits and vegetables, appear to help stave off arthritis. Previous studies have suggested that dietary carotenoids, the chemicals responsible for the orange and yellow coloring of fruits and vegetables, can reduce inflammation through antioxidant effects. Researchers followed more than 25,000 subjects to investigate the association between dietary carotenoids and arthritis risk between 1993 and 2001. Eighty-eight subjects developed arthritis during follow-up and they were matched to 176 healthy comparison subjects. Average daily intakes of the certain carotenoids were lower for arthritis patients, compared with healthy subjects.

 
     
Vitamins Don’t Prevent Infections

Journal of the American Dietetic Association (July 2005)

An estimated 10 percent of people in their 70s or older are thought to have a vitamin or mineral deficiency that may lead to poor immunity, which can increase their risk of infection. A study, however, involving 900 persons over 65 years of age indicated that daily supplements of multivitamins and minerals do not prevent respiratory, stomach, skin, and other types of infections. Half were given a multivitamin and mineral supplement and the remainder took a placebo daily. After comparing the number of infections over a year and their quality of life, the researchers found no difference between the two groups.

 
         
     

Supplements and Medical Care

Journal of the American Medical Association (July 2005)

Older persons who use herbal supplements are less satisfied with conventional medicine than non-users and often do not tell their physicians they are combining supplements with prescription drugs. Of 69 older persons surveyed for this study, 35 said they used supplements, including garlic, glucosamine, gingko biloba, and fish oil. Nearly one-fourth of herbal supplement users said their doctor did not know they were taking the supplements. Of 26 who combined supplements with prescription drugs, 23 percent said they were doing so without medical supervision. Supplement users were significantly less likely to be satisfied with medical care, supporting studies that have found alternative medicine users “dissatisfied with conventional medicine due to ineffectiveness of treatments.

 
         
       

   Alzheimer's Disease

         
 
 

Bypass Surgery Increases Risk of Alzheimer's Disease              Journal of Alzheimer's Disease (August 2005)

Researchers compared 5,216 persons who underwent coronary artery bypass graft surgery (CABG) and 3,954 persons who had coronary angioplasty. Over the course of five years, 78 patients who had bypass surgery and 41 patients who had angioplasty developed Alzheimer's disease. The coronary bypass patients had a 70 percent increased risk of developing Alzheimer's disease. “Heart bypass surgery represents a traumatic insult to the brain, particularly by reducing oxygen supply to the brain and increasing the stress response,” said Dr. Benjamin Wolozin, the study’s lead author. For more information, visit http://www.j-alz.com.

 
       
     
Different Modes of Weight Loss

American Journal of Clinical Nutrition (August 2005)

Alzheimer’s disease is often accompanied and worsened by malnutrition. A prospective study of 395 patients with Alzheimer’s disease investigated both progressive and severe weight loss. Progressive loss affected a third of subjects with disease severity a risk factor, whereas treatment with cholinesterase inhibitors at baseline decreased this risk. Severe weight loss affected 10 percent of subjects with an intercurrent event, such as hospitalization, acute disease, institutionalization, and change of living arrangements. Researchers concluded that factors for these modes of weight loss should be sought to identify patients who would benefit from a nutritional intervention.

 
       
     

Preventing Hip Fractures
Archives of Internal Medicine (August 2005) 

Women who are vitamin D deficient are at increased risk for hip fracture. A high incidence of fractures, particularly of the hip, represents an important problem in women with Alzheimer’s disease (AD), who are prone to falls and have osteoporosis.  A total of 500 women with AD were randomly assigned to daily treatment with risedronate (medication used to prevent and treat osteoporosis), combined with vitamin D2 and calcium, and followed up with for 18 months. During the study period, bone mineral density in the risedronate group increased and decreased in the control group. Treatment with risedronate and vitamin D2 may be safe and effective in reducing the risk of a hip fracture.

 

   Weight & Weight Reduction

   
 
  Obesity Not a Killer but a Disabler

The Gerontologist (August 2005)

 

Researchers studied more than 7,100 obese Americans aged 70 and over and found they had a life expectancy parallel to that of thinner subjects in the same age group. Obese people, however, were more likely to suffer from physical disability. At age 70, men could expect to live an additional 12.3 years if they were non-obese and 12.4 years if they were obese. Women age 70 could expect to live 15.3 years if they were non-obese and 15.5 years if they were obese. However, there was a difference when it came to ability levels. Non-obese men could expect to live 9.8 active years and 2.5 disabled years beyond the age of 70, while obese men could only expect to live 8.4 active years and 4.0 years with disability. In the same sample, women averaged 10.5 active years and 4.8 disabled years if they were non-obese, and 8.1 active years and 7.4 disabled years if they were obese.

 
   
      Trends in Obesity & Arthritis in Two Generations     

American Journal of Public Health (September 2005)

Researchers examined trends in obesity and arthritis prevalence among the “baby boom” (1946–1965) and “silent” (1926–1945) generations using successive waves of the National Health and Nutrition Examination Survey (1971–2002). Obesity rates increased markedly, beginning earlier in life with each successive birth cohort. When the members of the silent generation were aged 35 to 44 years, 14 percent to 18 percent were obese. At comparable ages, 28 percent to two percent of the youngest baby boomers were obese. Results showed that members of the baby boom generation were more obese and became so at younger ages than their predecessors. Although differences in arthritis prevalence are not yet evident, findings suggested that obesity has contributed to more cases of arthritis in recent years than in previous decades.

      Yoga May Help Prevent Weight Gain

Alternative Therapies in Health and Medicine (July/August 2005)

The slow stretches and meditations of yoga don’t burn calories like a run on the treadmill, but a new study suggests it might help people keep weight off in middle age. Researchers collected data from 15,500 persons between the ages of 53 and 57 who were asked about exercise, weight, health, and diet histories. Overweight people in their 50s who regularly practiced yoga lost about five pounds over 10 years, while a group in the same age range gained about 13½ pounds over the same period. Middle-aged people of normal weight generally put on pounds over 10 years, but those who did yoga gained less weight than those who didn’t practice yoga.

 

   Other Items of Interest

         
 
 

Sex and Aging   
AARP The Magazine (July/August, 2005)

AARP conducted a representative national survey of more than 1,600 adults ages 45 and older on the topic of their sex lives. Sixty-six percent of men and 48 percent of women said that satisfying sex is important to their quality of life. Twenty-two percent of men have tried Viagra, Levitra, Cialis, or other treatments to enhance their sexual ability, and a majority of these men say treatments have increased their sexual satisfaction. In terms of important aspects of one's quality of life, good spirits; good health; close ties with friends and family; financial security; spiritual well-being; and a good relationship with a partner were all rated as more important than a fulfilling sexual connection. For more results, see “Sex in America” at www.aarpmagazine.org/relationships.

 
      Opinions Split on Medicare Drug Benefit

Kaiser Family Foundation (August 25, 2005)

The Kaiser Health Poll Report Survey was conducted among a nationally representative sample of 1,205 adults ages 18 and older, including 300 respondents 65 years of age and older. The August poll showed about one in three (32 percent) older adults have a favorable impression of the Medicare drug benefit and an equal number have a negative one. Favorable views are up since April, when about one in five (21 percent) said they had a favorable impression. The survey shows modest progress in reported understanding of the new benefit. Overall, 37 percent of older persons now say they understand the new benefit “very” or “somewhat” well, up from 29 percent in April. Sixty percent say they don’t understand the benefit well or at all. The tracking poll results are available at http://www.kff.org/kaiserpolls/med082505pkg.cfm.

 
       
     

Economic and Policy Implications of Longevity           

Journal of the American Geriatrics Society (September 2005)

A thoughtful essay by noted health policy expert Bruce Vladeck identifies five critical areas about the coming “graying of America.” First, patterns of work life and labor-force participation will change. Second, government expenditures now, financed largely by payroll and federal income taxes, will increase, whereas those financed by state and local property taxes will fall, at least proportionately. Third, the post-World War II pattern of suburbanized, automobile-dependent communities will pose challenges to serving an aging population. Fourth, family caregiving patterns will change. Fifth, the level of disability and dependence of older people will have a major effect on all these and other phenomena.

 
       
     

Global Study on Retirement           

HSBC Bank (August 2005)

The Future of Retirement project, sponsored by London-based HSBC Bank, involved asking 11,453 adults in 10 countries about how they envisioned their futures. The major finding of this study is the overwhelming agreement among those surveyed that they do not want to be judged by their age alone; they also want to be judged by their energy, their attitude, and what they are contributing to the world. In the more developed countries, such as the U.S., Canada, Britain, France, and Hong Kong, people rejected the notion of retiring and "just more of the same." What they wanted were new beginnings with new challenges.  They wanted to be involved, productive, and connected within the new lifestyle. See the report at www.hsbc.com/public/groupsite/retirement_future/en/

_overview_future_of_retirement.jhtml.

 
       
     

Life Guides Available      

The International Longevity Center-USA (August 2005)

The Alliance for Health & the Future developed a series of Life Guides that aim to assist individuals to maintain various aspects of their health throughout life. The Guides provide scientifically-based recommendations in areas that have not yet received a great deal of attention. The first two Life Guides have been completed, one on vision and one on cognitive vitality. The guide on cognitive health presents various ways in which one can protect and promote brain power. The new publications are available at www.healthandfuture.org/ lifeguides.html.