November 2005  

   Welcome to the November 2005 Edition of Issues in Aging.

   Family Caregiving

         
 
 

Ethical Caregiving in America

President’s Council on Bioethics (September 28, 2005)

Taking Care: Ethical Caregiving in Our Aging Society is a 309-page report that addresses the ethical challenges of caregiving in a rapidly aging society.  The report devotes special attention to the care of people with dementia, and its authors provide a humanly rich account of caregiving dilemmas – social, familial, and personal.  Additionally, it offers important ethical guidelines for the care of persons who can no longer care for themselves. The report is available at http://www.bioethics.gov/reports/taking_care.

  
     

Consumer Direction and Family Caregiving
Family Caregiver Alliance/National Center on Caregiving

(October 2005)

This national study examined the role of consumer direction in publicly funded family caregiver support services as well as home- and community-based service programs with a family caregiving component, including Medicaid waivers. The study focused on the range, scope, and payment systems of consumer-directed options that states offer to family caregivers, and the perception among state administrators of the importance of consumer-directed options in long-term care. For more information, visit http://www.hcbs.org/files/79/3926/

ConsumerDirection&FamilyCaregivingNWEB.pdf.

 
       
     

Training Eases Caregivers’ Burden and Aids Care Receivers Stroke: Journal of the American Heart Association (September 2005)

A study followed 232 stroke survivors who were discharged from a stroke rehabilitation care center with moderate disabilities. Half of their family caregivers received customary support from the rehab center, including information on stroke and its consequences; involvement with staff as discharge plans were made; help with setting rehabilitation goals; encouragement to watch nursing care to learn how to assist; and advice on services and benefits available after discharge. The other half of caregivers received formal training on preventing and treating common stroke-related problems and individualized hands-on training in nursing skills, such as physical lifting and helping with communication.  The treatment group of the study received formal training in communicating, helping, and preventing stroke-related problems. Training contributed to a decreased sense of burden and anxiety for caregivers, as well as a better quality of life for stroke survivors. For more information, visit http://www.americanheart.org/presenter.jhtml?identifier=3033396.

 
       
     

The Effect of Kinship and Ethnicity on Caregiving

American Journal of Geriatric Psychiatry (September 2005)

Researchers sought to determine the effect of kinship status (daughters versus wives) and ethnicity (Hispanic/Latino versus Caucasian) on self-efficacy to perform tasks relevant to caregiving. In a sample of family caregivers for persons with memory problems, researchers collected data from 238 female caregivers.  Ethnic and kin relationship groups were compared on measures of caregiver self-efficacy. Hispanics/Latinos reported higher self-efficacy on two of three self-efficacy scales. The research team concluded that these caregivers might relate to cultural values about caregiving and/or ethnic differences in appraisal. Wives, however, may be more at risk for low self-efficacy, which may relate to greater role frustration and distress. This study highlighted the heterogeneity among family caregivers in their experiences of caregiving.

 
         
     

Census Report on Disability and Families

U.S. Census Bureau (July 2005)

According to the new U.S. Census report Disability and American Families: 2000, nearly 21 million families, representing 29 percent of all families, have a member with at least one of five disabilities. The report presents estimates of disability prevalence in American families using measures available from Census 2000.  It discusses the economic well-being of families with members with a disability and examines differences across demographic groups and geographical regions. To read the 20-page report, visit http://www.census.gov/prod/2005pubs/censr-23.pdf.

 
         
     

Value of Unpaid Activities by Older Americans

The Urban Institute (September 27, 2005)

Using data from the national 2002 Health and Retirement Study, researchers assigned hourly “wages” to various tasks and work performed by older Americans. The report concludes that the value of unpaid activities ranged from $97.6 billion to $201 billion in 2002, depending on three levels of cost assumptions. Using a moderate-cost assumption, the value was estimated at about $160 billion, with 61 percent of this value attributable to family caregiving. To review the report, log on to

http://www.urban.org/UploadedPDF/311227_older_americans.pdf.

  
     

Preserving and Sharing Memories

National Alliance for Caregiving (October 27, 2005)

Memories to Treasure is a new program designed to educate family caregivers about caregiving and Alzheimer’s disease and to help them connect with their loved ones by preserving treasured family memories through the art of scrapbooking.  The program includes a website, a brochure for caregivers, and a free scrapbooking starter kit.  Each component offers useful information and tips to help caregivers engage in positive activities with their loved ones. The program was developed by Eisai Inc. and Pfizer Inc., in partnership with the National Alliance for Caregiving and Creating Keepsakes scrapbook magazine. To find out more about this program, log on to www.memoriestotreasure.com.

 

   Long-Term Care

         
 
  Diabetes Quadruples Risk of Falling                 

Journal of Gerontology: Medical Sciences (September 2005)

Diabetic nursing home residents are four times more likely to experience falls than residents who do not have diabetes. Researchers at Columbia University Medical Center and New York-Presbyterian Hospital/The Allen Pavilion followed 139 nursing home residents over a 299-day period. They found that 78 percent of the residents who had diabetes fell within the study period, compared with 30 percent of those who were not diabetic. Results revealed that, along with balance and gait, diabetes is one of the strongest predictors of falling. Researchers said peripheral neuropathy, a condition caused by problems with peripheral nerves that can affect the sensation in diabetics’ feet, might contribute to the high fall rate.

  
      Rising Costs for Nursing Home and Home Care

MetLife Mature Market Institute (October 2005)

The MetLife Market Survey of Nursing Home and Home Care Costs is an annual report that presents the results of a nationwide survey of both nursing home costs and home care costs. In 2005, the average daily rate for a private room in a nursing home is $203, or $74,095 annually; and a semiprivate room is $176, or $64,240 annually. For home care services, the survey found that the average hourly rate for home health aides in 2005 is $19, and for homemakers/companions the rate is $17. For more information, log on to www.maturemarketinstitute.com.

 
         
     

More Immigrants Providing Care

AARP (October 2005)

Immigrants are increasingly taking care of nursing home residents in the U.S. The number of immigrant nurses providing long-term care has nearly quadrupled since 1990, while the number of nursing aides has more than doubled. About 64,000 immigrant nurses were working in nursing homes in 2003, along with 145,000 foreign-born aides. Immigrants now account for more than one-fourth of the nurses and aides in nursing homes in big cities. For more information about the report, visit http://www.aarp.org/ltcforum/asktheexpert.html. A recent conference convened by AARP also addressed the key policy issues and challenges the migration presents in both developed and developing countries. An executive summary of the conference is available at http://www.aarp.org/ltcforum/asktheexpert.html.

 
         

   Reducing Dementia Risk

 
 

Eat More Fish

Archives of Neurology (December 2005)

Eating fish at least once a week is good for the human brain. Researchers at Rush University Medical Center in Chicago measured how well 3,718 people performed when doing simple tests, such as recalling details of a story. The participants, all Chicago residents aged 65 and older, took the tests three times over a six-year period. They also filled out a questionnaire about what they ate, choosing from 139 food options. People who ate one fish meal per week had a 10 percent slower annual decline in thinking, and those who ate two fish meals a week showed a 13 percent slower decline. The researchers looked for, but failed to find, a link between omega-3 fatty acids and protection from brain decline. The research added to the growing evidence that a fish-rich diet helps keep the mind sharp. For more information, visit http://archneur.ama-assn.org/cgi/content/full/62.12.noc50161v1.

  
       
     
Exercise in Middle Age Has Lasting Benefits

The Lancet Neurology (November 2005)

Physical activity may help maintain cognitive function and decrease dementia risk. Findings thus far, however, remain controversial, so this study investigated the association between leisure-time physical activity at midlife and the subsequent development of dementia and Alzheimer’s disease. Participants were randomly selected from the survivors of a population-based cohort previously surveyed in 1972, 1977, 1982, or 1987. A total of 1449 people aged 65 to 79 years participated in the re-examination in 1998 (average follow-up: 21 years). Results showed that working out at least twice a week lowered the odds of developing Alzheimer’s disease or other forms of dementia by 60 percent. The biggest impact was seen in people who had a genetic susceptibility to dementia. The researchers found no link between the amount of exercise and the degree of reduced risk.

 
       
     

Benefit of High Folate Intake

Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association (July 2005)

 

A study published in this journal’s premier issue linked a diet high in folate to a reduced risk of Alzheimer’s disease. Participants included 579 older adult volunteers from the Baltimore Longitudinal Study of Aging who completed dietary diaries and recorded supplement intake for a seven-day period.  After an average follow-up of 9.3 years, the disease developed in 57 participants. Higher intake of folate, vitamin E, and vitamin B6 were associated individually with a decreased risk of the disease, after adjusting for age, gender, education, and caloric intake. When these vitamins were analyzed together, only total intake of folate at or above the U.S. Food and Drug Administration’s Recommended Daily Allowance of 400 micrograms per day was associated with a 55 percent decreased risk of Alzheimer’s disease.

 

   Pros & Cons of Drugs
   
 
  Statins Drop Cholesterol Levels

Journal of the American Medical Association (October 12, 2005)

Statin drugs have contributed to the drop in average cholesterol levels among older Americans. Researchers from the Centers for Disease Control and Prevention reported that average total cholesterol levels for men and women aged 20 to 74 dropped from 222 milligrams per deciliter of blood to 203 between 1960 and 2002. The drop is mostly due to a decline among those aged 50 and older. Among Americans aged 60 to 74, average levels fell 12 percent among men and 15 percent among women. Below 200 is considered desirable with regard to average risk for heart disease. Statins such as Lipitor, Pravachol, and Zocor are commonly prescribed to lower dangerously high levels of low-density cholesterol in the blood, the cholesterol known to clog and damage arteries, leading to heart disease.

 
   
      Statins Cut Bone Risk in Men   

Archives of Internal Medicine (September 26, 2005)

Statin drugs used to lower cholesterol levels also cut the risk of bone fractures. In a two-and-one-half-year survey of 83,000 mostly male military veterans, the 28,000 who took statin drugs had a 36 percent lower risk of fracturing bones compared with those not taking statins or those taking other types of cholesterol-lowering drugs. The findings backed up previous research that showed statins lowered bone fracture risk in women, who, as they grow older, are more susceptible than men to developing brittle bones.

      Drugs Increase Risk of Death   

Journal of the American Medical Association (October 19, 2005)

Drugs known as atypical antipsychotic medications are widely used to treat delusions, aggression, and agitation in persons with Alzheimer’s disease and other related dementias. Researchers pooled results from 15 previously published studies. Among the more than 5,100 persons with dementia, more than half of the participants were more likely to die within 12 weeks of starting atypical antipsychotics compared with peers who took placebos. There were 118 deaths among the drug users versus 40 in the placebo group, or 3.5 percent compared with 2.3 percent, respectively. The results reinforce the need for new warning labels on the medications, which may be sold under brand names such as Seroquel, Risperdal, Abilify, and Zyprexa. The drugs are approved for treating schizophrenia and bipolar disease but not dementia.

 

   Other Items of Interest

         
 
 

Characteristics of Physical Activity Programs   
The Gerontologist (October 2005)

Little is known about the supply and use of physical activity programs for older adults in the U.S.  Seven academic centers in diverse geographic areas surveyed physical fitness centers for older adults. Of the 2,110 targeted centers, three-quarters responded. Aerobic programs were offered by 73 percent, flexibility by 47 percent, and strength training by 26 percent. Commercial gyms or YMCAs, senior centers, park or recreation centers, and senior-housing communities offered 90 percent of available programs. Facilities reported 69,634 individuals as current weekly program participants, equaling six percent of the total older-adult population in the seven selected areas, ranging from three percent in Pittsburgh to 28 percent in Colorado. Based on conservative estimates of demand, the number of physical activity programs would have to increase substantially to meet the needs of older adults. The data also indicate the need to develop more strength-training programs and to engage a higher percentage of older adults in these programs.

 
      Inspiration Needed to Get Moving

Journal of General Internal Medicine (October 2005)

A study shows the negative power of self-fulfilling prophecies: older adults with the lowest expectations for aging – that is, for what one can do at an advanced age – were the most likely to lead sedentary lifestyles. Study participants were 636 adults aged 65 or older recruited from 14 Los Angeles-area older adult centers. Those persons with the lowest expectations were more than twice as likely to report having engaged in less than 30 minutes of moderate to vigorous activity during the previous week compared with those with higher age expectations. Lead researcher Catherine Sarkisian commented, “We know that the number-one way we can improve the health of older adults is to increase physical activity – it’s more powerful than common expensive medications. We might be able to help more seniors exercise if we can change what they believe.”

  
       
     

Rethinking the Role of Older Workers

AARP Public Policy Institute (October 2005)

Older worker employment and retirement trends in the European Union (EU), Japan, and the U.S. are examined in this Issue Brief. It presents the EU and Japan’s responses to the aging of their populations and the soaring costs of pensions. It also includes an analysis of their goals and initiatives to foster older worker employment. In Japan, work life extension is encouraged by increasing the pensionable age and providing subsidies for employers to hire and retain older workers. In Europe, efforts to prolong work life include removing incentives to retire early, reforming pension policies to reward later retirement, providing work that is more flexible, and retirement options. To learn more, log on to http://www.aarp.org/research/socialsecurity/

reform/ib77_workers.html.

 

  
     

Risks of Obesity Surgery

Journal of the American Medical Association (October 19, 2005)

Patients 65 and older have a substantially higher rate of death and re-hospitalization resulting from surgical procedures used to treat obesity. One study found that the death rate one year after a surgical procedure to treat obesity was 11.1 percent for persons aged 65 or older compared with 3.9 percent for younger patients. In another study, gastric bypass surgery resulted in increased hospital use after surgery. But death rates were lower when compared with the first study. While the studies demonstrate certain patient populations are more vulnerable to adverse outcomes, experts caution that the results should encourage improvement in obesity surgery and not the exclusion of certain patient groups.

  
       
     

Diabetes Information for Helping Older Adults

The American Society on Aging (October 2005)

Created in collaboration with the Centers for Disease Control and Prevention and the National Diabetes Education Program for professionals serving older adults, Diabetes Prevention and Management: Small Steps With Big Rewards contains information, tools, and resources to meet the challenge of preventing and managing diabetes in older adults. Topics include national guidelines for diabetes management; weight loss; nutrition and physical activity for people with diabetes; and empowering individuals to make healthful choices and communicate better with their health care providers. This free resource is available at http://www.asaging.org/cdc/module7/home.cfm.

 
     

 

Free Falls Newsletter

The National Council on Aging (September 2005)

One in three community-dwelling persons over the age of 65 falls each year, and this number increases to one in two by the age of 80. The Falls Free Coalition is a group of national organizations and state coalitions working to reduce the growing number of falls and fall-related injuries among older adults. The Falls Free e-newsletter highlights recent activities among Coalition members as well as the latest research on falls prevention. The latest editions are posted at www.healthyagingprograms.org. The National Council on the Aging, the Archstone Foundation, and the Home Safety Council also released Falls Free: Promoting a National Falls Prevention Action Plan, which addresses the challenges and barriers related to a national falls prevention initiative and outlines key strategies and action steps to help reduce fall dangers for older adults. For more information, visit http://www.healthyagingprograms.org/content.asp?sectionid=98