Prime Time: A New Look At Aging

Warning signs of Alzheimer's Disease

Your loved one forgets what a key is used for, can’t tell you the function of a cup, or starts using a toothbrush as a hairbrush. Perhaps there’s a change in mood or behavior, a loss in motivation.
 
These are some warning signs that Alzheimer’s Disease may be under way, said Micheal Pope, executive director of Alzheimer’s Services of East Bay, at a workshop in Walnut Creek’s Jewish Community Center. Unfortunately, the progressive disease is not reversible or curable, but several drugs, including Aracept and memantine can slow the process, especially in the early stages.
 
So, are there steps one can take to avoid or delay its onset? Pope noted that people with higher levels of education are less susceptible, as are those who stay involved and take on new challenges. She described a study of nuns that indicates exercise, a heart-healthy diet, meaningful activities, and socialization reduce the chance of getting the disease or minimizing its impact.
 
“Turn your life into activity,” she declared. She said that experts have moved the guideline of 30 minutes of exercise from three to five days a week, “but I think every day is better.”  Weight-lifting was another suggestion.
 
According to Alzheimer’s Disease Research, the total cost for the care and treatment of the disease in the U.S. has reached $100 billion a year. “Caring for an Alzheimer’s patient at home costs the average family between $18,000 and $36,000 per year,” the agency reported. “Nursing homecare costs even more, averaging $80,000 annually.”

When doctors share technology with patients

Doctors are not famours for being the first users of technology. In fact they have the reputation for being old-fashioned. That's often a good thing--they don't get seduced by the latest fad.

But this story is interesting. This is a list of what the medical profession has to cope with right now:

• Need to reduce healthcare system costs.

• Growing incidence of chronic diseases.

• More empowered and educated patients.

• Changing payor dynamics.

• More information available to consumers, primarily via Internet.

• Patient expectations for living a longer, more active and independent lifestyle.

• Consideration that medical errors and infections might be lower with patients cared for outside the hospital contributing to improved outcomes.

• Demographic changes.

• Greater data transparency and benchmarking among healthcare providers and technologies related to cost and outcomes.

• Advances being made in military medicine making their way back into civilian healthcare technology.

• New technological breakthroughs outside of healthcare making their way into industry.

• Technology formerly focused on acute care moving outside of the hospital.

• Changing nature of medicine and roles—Overworked clinicians pushing responsibility to patients.

• Less-expensive medical equipment available to consumers from Asian manufacturers.

• Interest among providers and payors in improving patient adherence and compliance.

• More cosmetic and elective procedures, self care.

• More options for care outside of hospitals.

• More expendable income among older Americans.

• More interest among manufacturers in anticipating patient needs due to competition.

• Growing demand for healthcare services, spending.

 

"For at least the last decade, there has been a quiet revolution under way in the healthcare field. Most Americans are well aware of the challenges facing the country’s healthcare system—escalating costs, denied tests and treatments, fragmented care, less time available for a patient-physician relationship, medical errors, inefficiencies, and other woes. However, a number of important cultural, technological, and demographic trends are increasingly putting more control into the hands of patients themselves to manage their health. This transformation has an enormous potential to change how medicine is practiced and how the healthcare system as a whole operates.

In many cases, the catalyst for this change has been new technologies that have taken advances made in the realm of professional medical products—i.e., those used by doctors, nurses, and other clinicians—and modified them for use by patients in a consumer environment. Consumers have always had access to medical devices to meet their basic needs, such as first aid kits or thermometers. But in recent years, highly advanced technologies have been increasingly rolled out to consumers themselves.

Some of the best examples of this convergence between professional and consumer devices are automated external defibrillators (AEDs), blood glucose monitors, insulin pumps, home diagnostic kits, and remote patient monitoring systems. Medical technology will follow a path similar to that of computers. Large, complex scientific instruments will ultimately become small, powerful consumer appliances for communication and entertainment. This convergence zone represents one of the greatest opportunities to manufacturers in the medical technology and consumer health markets today."

 

"Patients with chronic diseases and conditions are the top targets for most companies moving into the convergence zone between professional and consumer medical devices, and for good reason. According to the organization Partnership for Solutions, in 2000, more than 125 million Americans had chronic health conditions, such as cardiovascular disease, diabetes, asthma, and Parkinson’s disease, and the care of these patients generated direct costs of $510 billion. This number is expected to grow to 157 million people by 2020 with $1.07 trillion in direct costs. Approximately 80% of all healthcare spending will be on this population."

 

“Caring for individuals with chronic health conditions will be the public health challenge of the 21st Century,” according to Gerard Anderson, PhD, at the Johns Hopkins Bloomberg School of Public Health. Much of the increase in these costs is due to advances in medical practices and technology which often turn an acute condition into a chronic one. For example, since 1980 there has been a greater than 40% drop in mortality from coronary heart disease since, but more people are living with deleterious effects of these acute events. The same is true for patients surviving cancer, stroke, premature birth, renal failure, trauma, and other conditions.

 

 

7 areas of research to help seniors

The Center for Technology and Aging was established to advance the diffusion of technologies that help older adults lead healthier lives and maintain independence.

In July they published a paper detailing how they intend to spend some research money:

1) Medication Optimization refers to a wide variety of technologies designed to help manage medication information, dispensing, adherence, and tracking.

2) Remote Patient Monitoring (RPM) includes a wide variety of technologies designed to manage and monitor a range of health conditions. Point-of-care (e.g., home) monitoring devices, such as weight scales, glucometers, and blood pressure monitors, may stand alone to collect and report health data, or they may become part of a fully integrated health data collection, analysis, and reporting system that communicates to multiple nodes of the health system and provides alerts when health conditions decline.

3) Assistive Technologies include a wide range of devices and equipment that help individuals perform a task or prevent injury. Assistive technologies promote independence as they compensate for sensory, physical, and cognitive impairments, and promote safety for vulnerable individuals as they detect and report health hazards.

4) Remote Training and Supervision (RTS) technologies can be used to train and supervise health and long-term care workers, and offer the potential for continuing education and quality assurance. Remote training means the student does not have to be physically located where the teaching is taking place – teaching and learning can be asynchronous or synchronous in time.

5) Disease Management (DM) is a patient-centric, coordinated care process for patients with specific health conditions, particularly chronic conditions and conditions that have a significant self-care component. DM programs include data mining processes to identify high risk patients within a population, use of evidence-based medical practice guidelines to support and treat individual patients, and a coordinated, data-informed system of patient outreach, feedback, and response.

6) Cognitive Fitness and Assessment technologies include thinking games and cognitive challenge regimens. Like physical fitness, the premise of cognitive fitness is that cognitive health can be maintained or improved if individuals exercise their brain. The emphasis with older adults is to prevent or delay Alzheimer’s and related dementias. Many cognitive fitness technologies are computer or Internet based, and include an assessment and tracking component.

7) Social Networking technologies enable the creation of social networks and focus on building communities of interest that help older adults communicate, organize, and share with other older adults and with their care providers. These are already gaining traction among older adults, and could be important both for the functions just described and for peer counseling and education that would complement the Remote Training and Supervision technologies described previously.

They've chosen to dedicate their funding to the first two categories. I find this strange, as these are the two areas that are also receiving the most private sector research funding--wouldn't it make more sense to dedicate their money to research areas that are being more or less ignored? Like, umm the other five on this list?

Senior population growing all over the world

You young folks, if you're average, can expect to live 18.7 more years after celebrating your 65th birthday. That's a seven-year bonus when you compare the gain with folks who reached 65 in 1900.
Here's another positive note. The life expectancy for those who reach 85 is now 92.2 years for women and 91.1 years for men.

Sounds pretty good, but elders in Japan, Canada and France do even better. Maybe it's the sake, the wine, the cool climate.

Worldwide, about 506 million people had topped the 65-year mark as of mid-2008. By 2040, that number will hit 1.3 billion, according to "An Aging World: 2008" study developed by the National Institute on Aging and produced by the U.S. Census Bureau. The proportion of older people will double from 7 percent to 14 percent in that time frame.

"Aging is affecting every country in every part of the world," said Richard Suzman, Ph.D., director of the institute's Behavioral and Social Research Division. In a bit of understatement, he added, "Global aging is changing the social and economic nature of the planet and presenting difficult challenges. . . Within 10 years, for the first time in human history, there will be more people aged 65 and older than children under 5. . . "

The most rapid increases in the number of elders are in developing countries. The fastest growing portion of the total population is the people 80 and up. This segment will increase 233 percent by 2040. China and India have almost one-third of the 65-and-older population, the study determined.
One sidelight: 20 percent of the women in the U.S. in 2006 had no biologic children. "These data raise questions about the provision of care when this cohort reaches advanced ages," the report stated.

The U.S. Census Bureau notes that baby boomers (those born between 1946 and 1964) will start turning 65 next year. The 65-and-up U.S. population in 2040 is projected to be twice as large as in 2000, growing from 35 million to 71.5 million and representing nearly 20 percent of the total U.S. population.

Now if the bureau could just let Congress know about this development and its possible impact on Social Security, Medicare and a few other programs.

Watch your step

Just found this:

More than 1.8 million older adults are treated annually in emergency departments for injuries from falls, 433,000 are admitted to hospitals and 16,000 die because of their injuries, according to the CDC. Every year, about a third of Americans 65 and older fall, and about a third of those who lose their footing require medical treatment.

Rocky Miller, a 60-year-old Plano resident has launched a business, Slip Doctors, that will treat floors with a chemical that he says will make them more resistant to slips, slides and falls.

After years of selling motorcycles, the 60-year-old Plano resident has launched a business, Slip Doctors, that will treat floors with a chemical that he says will make them more resistant to slips, slides and falls.

"Simply put, my partners and I sell friction," he said. "In a country where the older population will double over the next 25 years, we think that's something that will be in demand for a long time."

The Addison-based business hopes to set itself apart from competitors, Miller said, by using a high-tech robot that scoots across the floor of a home or senior-living community and identifies slick spots.

Slip Doctors joins an industry springing up from people's concern over falling. Entrepreneurs and big corporations are creating products and services to stem a problem that threatens to worsen as boomers age.

"The good news is that we can reduce the risk of falling. It doesn't have to be an inevitable part of growing old," said Lynn Beattie, vice president of injury prevention at the National Council on Aging.

Aside from promoting longer lives and greater independence, the new efforts to prevent falls may help control health care costs as the oldest boomers qualify for Medicare in about a year, she said.

More than $19 billion is spent annually on treating seniors who fall. Without better prevention, that cost is projected to escalate to $43.8 billion a year by 2020, and Medicare will pay for most of it.

Chances are you'll need assistance

The odds of your house burning down are pretty small. It happens to just .08 percent of U.S. citizens. Chances of being involved in an auto accident during your lifetime are .4 percent. The risk factor of being hospitalized for an illness or accident rises to 12 percent. The biggest bugaboo? Sixty percent of us will someday need assistance in our daily living.
 
As he jotted these statistics on a flip chart, Randy Watson, CLU, BCE, noted that most of us buy insurance for the house, the car, and the hospital, but we shy away from long-term-care insurance because of the cost.
 
“The average cost for daily living assistance is $70,000 a year,” said Watson, a trim, dark-haired man who started his lecture with the promise he wouldn’t try to sell us anything.

“So what can you do?” he asked.
 
Number One, the choice of most Americans, is to do nothing. A variant on that is to spend down until one becomes eligible for Medi-Cal. As a sidelight, Watson described a little-known Veterans Administration benefit under Title 38 of the United States code that provides an Aid and Attendance Pension up to $1,949 per month for veterans who qualify and need some type of human intervention.
 
Option Two, long-term-care insurance, is regarded as too expensive, but seniors should “price it out,” he said. Number Three is the “reserve parachute” of a reverse mortgage, a step that doesn’t suit everyone, and should be used as a last resort, he said.
 
Number Four is called asset-based long-term-care insurance, and involves the conversion of an asset, such as a CD, into long-term-care coverage worth a much larger amount with possible tax advantages. “You still have control of your investment, and you’re covered whether you need assistance at home or in a nursing home,” he said.
 
Watson said his father, who worked in the financial services industry for 40 years, taught him, “Never spend more than you make,” an aphorism that the U.S. forgot, and he offered figures to prove it. He also suggested shifting a conventional IRA to a multi-generation IRA. When you die, the children would be prevented from accidentally receiving a lump-sum, and thus avoid paying taxes on the total amount at a much higher rate.

“Either you give it to the government or you give it to your kids,” said Watson who has earned the designation of charter life underwriter and is a board certified estate planner. Additionally, Watson serves on the board of advisors for the Institute of Business and Finance.

For more information, contact him at [email protected] or phone 866-973-1088.
 

How long will you live?

Here’s one of the quizzes that reveal, if you’re an average belle or bloke, how long you will remain in your living, breathing form. The total is based on the assumption you’ll avoid being hit by a truck or a meteorite.
 
Start with the number 72.
 
Personal facts:
If you’re a male, subtract 3. If female, add 4.
If you live in an urban area with more than 2 million people, subtract 2.
If you live in a town under 10,000 or on a farm, add 2.
If any grandparent lived to 85, add 2.
If all four grandparents lived to 80, add 6.
If either parent died of a stroke or heart attack before 50, subtract 4.
If any parent or sibling under 50 had cancer, a heart condition, or has had diabetes since childhood, subtract 3.
If you earn more than $75,000 a year, subtract 2.
If you finished college, add 1. If you have an advanced degree, add 2.
If you are over 65 and still working, add 3.
If you live with a spouse or friend, add 5. If not, subtract 1 for each decade alone since age 25.
 
Lifestyle status:
If you work behind a desk, subtract 3. If your work requires physical labor, add 3.
If you exercise strenuously five times a week for at least 30 minutes, add 4. If two or three times a week, add 2.
If you sleep more than ten hours per night, subtract 4.
Are you tense, aggressive, easily angered? Subtract 2.
Are you happy? Add 1. Unhappy? Subtract 2.
Have you had a speeding ticket in the last year? Subtract 1.
Smoke more than two packs a day? Subtract 8. One to two packs? Subtract 6. One half to one? Subtract 3.
Do you drink the equivalent of 1½ oz. of liquor a day? Subtract 1.
Overweight by 50 or more lbs.? Subtract 8; 30-50 lbs.? Subtract 4; 10-30 lbs.? Subtract 2.
A man over 50 who gets annual check-ups? Add 2.
A woman who sees a gynecologist yearly? Add 2
 
Age adjustment:
If you are between 30 and 40, add 2. Between 40 and 50, add 3. Between 50 and 70, add 4. Over 70, add 5.
 
 

The tech view of life extension

Following on from Ted's post... although I believe I would greatly enjoy sleeping between two virgins, there is a lot of work going on regarding life extension. If I were in reasonably good health, I do believe I would be pleased to keep on truckin' as long as I could.

Life expectancy has risen from 47 years of age in 1900 to just about 80 now. That's quite a feat, and there seems to be no sign of it stopping--we apparently are adding 3 years of life expectancy every decade.

The beginning work was all about removing causes of death for the young, and basic hygiene did a lot of the work in that area. The invention of antibiotics was another big help in getting us to that three score and ten. 

But now, we are focusing more on getting from 70, to 80, to 90 and on to 100. I personally think that someone born today who takes decent care of her/himself and avoids traffic accidents has a pretty good shot at reaching 100.

So what will get us there? First, each other--but after that, a lot of technology. It seems pretty clear that within the next 10 years we will be using cloned organs from our own cells for transplants. No waiting lists, no tissue rejection. How about getting a younger version of your own heart just because your current model is wearing out?

Our ability to look inside the human body and brain is improving dramatically every year. This will mean earlier and better diagnoses of diseases that currently carry us off because they are not caught in time.

We are not yet close to understanding cancer, but as Churchill might have said, we only need to understand how to kill it, and we're making progress on this front. Nanotechnology can deliver such silver bullets as are available right to a tumor cell, and nanotechnology will be heavily involved in the silver bullets themselves. But what I want to see is nanobots cleaning our bloodstreams, scouring hardened arteries, eliminating free radicals, etc. 

Traffic and the other causes of fatal accidents will continue to become less lethal, due to better communications technology and more and better safety features in the rest of the physical world.

Lots more technology that will help us. Regarding the above, I'm pretty certain that, even if I don't benefit from any or all of them, I will live to see them introduced--if I can avoid playing in traffic.

Guys don't get it on life extension

For about 3,660 years, give or take a decade or two, sporadic attempts of prolonging life have taken place. For virtually all of those years, it’s been a case of males who have been attempting to stretch their years, along with some other things.

Somewhere between 1600 to 1800 B.C., presumably on the advice of their physicians, older Egyptian fellows began dining on the internal organs of young animals, hoping this would renew their aging parts. In India, the Hindu physician Sushruta concocted more than 700 meds, include soma, a mind-altering plant that perked up older brains, or at least helped the fellows accept their faltering thinking ability.

The Chinese developed a potent elixir with tiny pieces of gold in it.  Around the first century B.C, they believed everlasting life would be gained by using gold utensils. The gold had to be transmuted from mercury, which, unfortunately, poisoned the patient. 

In the 1400s, injections came into vogue. Men who could afford it opted for blood. Pope Innocent VIII, interested in living longer, lined up transfusions from younger fellows. Unfortunately, one or more of them had the wrong blood type, and the pope died within a few hours of the injections.

Greeks and Romans believed the breath of virgins would invigorate older guys. Then a Dutch physician topped them with his tonic in the eighteenth century. Dr. Hermann Boerhaave prescribed that an older man should sleep between two virgins to regain his vigor and prowess. Makes you wonder about the scope of pharmacy services in those days.

Serge Voronoff put a new twist on the practice of injecting testicle extract into older men. The Russian surgeon began grafting the testicles of monkeys on the men. Some grafts failed because of immunologic rejection. Another problem: many of the monkeys had syphilis. Despite these drawbacks, other practitioners adopted the grafts technique throughout the 1920s and ‘30s until people finally wised up.

Maybe it’s time for research on why women outlive men.
 

Diabetes and Alzheimers

Wow. I'm doing a bit of work for a new client on healthcare devices and stumbled across some information that really surprises me. There are similarities between Alzheimer's disease and what happens in a failing pancreas that produces diabetes.

Equally surprising, there seems to be a link between the two--people with diabetes seem to be more likely to develop Alzheimers. This story from the July 16 issue of the New York Times seems to sum up the story:

"Several new studies suggest that diabetes increases the risk of Alzheimer’s disease, adding to a store of evidence that links the disorders. The studies involve only Type 2 diabetes, the most common kind, which is usually related to obesity.

The connection raises an ominous prospect: that increases in diabetes, a major concern in the United States and worldwide, may worsen the rising toll from Alzheimer’s. The findings also add dementia to the cloud of threats that already hang over people with diabetes, including heart disease, strokes, kidney failure, blindness and amputations.

But some of the studies also hint that measures to prevent or control diabetes may lower the dementia risk, and that certain diabetes drugs should be tested to find whether they can help Alzheimer’s patients, even those without diabetes. Current treatments for Alzheimer’s can provide only a modest improvement in symptoms and cannot stop the progression of the disease."

For me, despite all the talk, money and attention devoted to cancer and to Alzheimers, diabetes has always seemed to be the 'disease of our age.' Especially Type II diabetes. Diabetes is a reflection of our lifestyle--and no, I'm not talking about lazy diet choices and watching too much TV, although they are certainly factors. What I mean is that our work has become sedentary, our transportation has become sedentary, our hobbies have become sedentary, and our diet is still based on what humans needed to maintain body weight when they consumed 4-6,000 calories a day. We now burn fractionally more calories than someone in a coma...

More from the Times article: "Alzheimer’s affects 1 in 10 people over age 65, and nearly half of people over 85. About 4.5 million Americans have it, and taking care of them costs $100 billion a year, according to the association. The number of patients is expected to grow, possibly reaching 11.3 million to 16 million by 2050, the association said.

But those projections do not include a possible increase from diabetes.

“Alzheimer’s is going to swamp the health care system,” said Dr. John C. Morris, a neurology professor at Washington University in St. Louis and an adviser to the Alzheimer’s Association.

Not everyone with diabetes gets Alzheimer’s, and not all Alzheimer’s patients are diabetic. But in the past decade, several large studies have found that compared with healthy people of the same age and sex, those with Type 2 diabetes are twice as likely to develop Alzheimer’s. The reason is not known, but researchers initially suspected that cardiovascular problems caused by diabetes might contribute to dementia by blocking blood flow to the brain or causing strokes.

More recently, though, scientists have begun to think that the diseases are connected in other ways as well. In both, destructive deposits of amyloid, a type of protein, build up: in the brain in Alzheimer’s, in the pancreas in Type 2 diabetes.

People with Type 2 often have a condition called insulin resistance, in which their cells cannot properly use insulin, the hormone needed to help glucose leave the blood and enter cells that need it. To compensate, the pancreas makes extra insulin, which can reach high levels in the blood. Too much insulin may lead to inflammation, which can contribute to damage in the brain."

The good news is, that since diet and exercise can help ward off Type II diabetes, it also can help prevent dementia.

So get on out there.