How much sleep do Seniors need?

Categories:Elderly Care

Many seniors deal with a number of health problems related to aging — one in particular is not getting enough healthy sleep. It’s not the advancing of age per se that keeps seniors from a good night’s rest, but various sleep disorders or sleep disturbances that often come with age. As we get older, our sleep patterns change and, for starters, seniors do not spend as much time in deep sleep as younger people do.

Common symptoms of sleep disorders are:

  • Having trouble falling asleep
  • Waking up very early in the morning
  • Inability to tell night from day
  • Frequent waking in the night

What’s Keeping You Awake at Night?

Many seniors have problems sleeping because of health conditions — as well as their associated symptoms and medications. Some common senior health issues that can prevent you from getting healthy sleep include:

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  • Side effects of prescription medications
  • Chronic pain, often from health conditions like arthritis
  • Depression
  • Alcohol consumption
  • Not getting enough exercise
  • Snoring
  • Alzheimer’s disease or a neurological problem
  • Caffeine consumption
  • Frequent urination during the night

Biological Issues That Can Cause Sleep Problems

 

It’s also possible that biological changes in seniors contribute to sleep disorders. One theory is that seniors produce and release less of the hormone melatonin that helps people sleep.

 

Another problem is a shifting circadian rhythm, which synchronizes various functions of the body, including sleep. This shift makes older people more tired earlier in the evening, so they go to bed earlier and get up a lot earlier, too.

Many seniors also have problems with insomnia, which is often linked to an underlying medical or psychological problem. Not getting healthy sleep can impact a senior’s overall health and wellness, and even impair cognitive functioning.

Tips to Help You Fall Asleep

Seniors don’t need as much sleep as younger people do, no more than seven to eight hours of sleep. But that sleep often comes broken up throughout the day rather than in one big stretch at night.

Here are some suggestions to battle sleep disorders and get a full night of restful, healthy sleep:

  • Get treatment for any medical problems. If you’re experiencing depression, painful arthritis, or bladder problems that force you to get up and go to the bathroom frequently at night, seek medical attention to get these conditions under control.
  • Don’t just lie in bed. Try to go to sleep at bedtime, but if you’re still awake after 20 minutes, get out of bed. Do something quiet and relaxing — read, listen to music, or take a hot shower or bath.
  • Make lifestyle changes. Adjustments may include eliminating caffeine and not eating a huge meal or a big snack before bedtime. It’s also important for you to exercise each day — make it early in the day rather than in the late afternoon or evening, and definitely not before bedtime.
  • Get into a good sleep routine. Set a regular time to wake up each morning and go to bed each night to retrain your body for healthy sleep. Try skipping afternoon naps. And other than intimacy, think of your bedroom as just a place for sleeping and rest.

Don’t accept fatigue and poor sleep as part of getting older. Try these tips for healthy sleep, and talk to your doctor if you still can’t find a way to sleep through the night.

8 things you need to know about Long Term Care Insurance

Categories:Elderly Care

Many of us don’t think about long-term care (LTC) until elderly parents need it or we come face-to-face with our own medical crisis. Myths about long-term care are legion, including “My spouse will take care of me” or

“I’m too young to think about it.” Here are eight things you need to know.

LTC costs more in some parts of the country than others. The median cost of long-term care in New York State, for example, was $116,000 per year for a private room and $73,000 for a semi-private room in 2010, but only $52,000 a year in Louisiana. Would you send your loved one to a less expensive area? Not if you want them to live longer. People whose family, friends and relatives visit them in a long-term care facility live longer and maintain better health than those who have no visitors.

Women are more likely to end up in a nursing home than men. Here’s why: 2 out of 3 people 85 and older are women. Women over 65 are more likely to be living alone. Women are more likely than men to get Alzheimer’s disease, and they are more likely to suffer a debilitating stroke. And to make matters worse, many elderly women have no Social Security benefits.

LTC isn’t only for the elderly. The need for LTC can arise at any age. In fact, more than 40 percent of people who need it are under 65. Michael J. Fox was only 30 when he noticed a twitch in his finger that was later diagnosed as Parkinson’s. Christopher Reeve was 43 when he had his tragic accident that left him a quadriplegic.

Health insurance and Medicare don’t pay for LTC. Many people mistakenly believe that if they have private health insurance or Medicare through the federal- and state-funded plan they’re entitled to after age 65, they’ll be covered if they have to spend an extended time in the hospital or move to an assisted living facility or nursing home. The only insurance that pays for LTC is long-term health insurance. The younger and healthier you are when you buy it, the cheaper it is.

Medicaid may pay for LTC—or it may not. Let’s say that to qualify for Medicaid’s LTC coverage, you gave away your assets to your adult kids or bought annuities believing they would protect your assets or attempted to hide some of your income. All of these classic “mistakes” can result in little or no LTC coverage. So can applying for Medicaid too soon, assuming a living trust will protect your assets or taking advice from a Medicaid worker. Please consult a qualified, experienced elder law attorney before entering the Medicaid maze.

It’s not well-advertised, but the VA might have you covered. This is one of the best-kept secrets in long-term care. If you or your spouse, living or deceased, served during a qualifying wartime period and got a discharge other than dishonorable from one of the military services, you may be eligible for a monthly cash benefit from the Veterans Administration that generously covers a wide spectrum of long-term care services.

Long-term care facilities have “lotsa gotchas” in their contracts. Did you know that you can get kicked out of your long-term care facility if you were to land in the hospital for a few weeks—unless you were smart enough to have a “bed reservation benefit” in the contract? It’s imperative that you ask a certified geriatric care manager to find gotchas like these in the contract before you sign.

Running out of money in an LTC facility can cost you your home. If you become impoverished while in a nursing home, your house, your car and even your funeral plot can be taken from you. There are smart and legal ways to protect your assets from being recovered. Again, the best strategy is to find a qualified financial professional who can help you protect your assets.

Why Everything You Think About Aging May Be Wrong

Categories:Elderly Care

Everyone knows that as we age, our minds and bodies decline—and life inevitably becomes less satisfying and enjoyable.

Everyone knows that cognitive decline is inevitable.

Everyone knows that as we get older, we become less productive at work.

Everyone, it seems, is wrong.

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STEPHEN WEBSTER

Contrary to the stereotype of later life as a time of loneliness, depression and decline, a growing body of scientific research shows that, in many ways, life gets better as we get older.

“The story used to be that satisfaction with life went downhill, but the remarkable thing that researchers are finding is that doesn’t seem to be the case,” says Timothy Salthouse, a professor of psychology at the University of Virginia.

In fact, a growing body of evidence indicates that our moods and overall sense of well-being improve with age. Friendships tend to grow more intimate, too, as older adults prioritize what matters most to them, says Karen Fingerman, a professor of human development and family sciences at the University of Texas at Austin.

Other academics have found that knowledge and certain types of intelligence continue to develop in ways that can even offset age-related declines in the brain’s ability to process new information and reason abstractly. Expertise deepens, which can enhance productivity and creativity. Some go so far as to say that wisdom—defined, in part, as the ability to resolve conflicts by seeing problems from multiple perspectives—flourishes.

To be sure, growing older has its share of challenges. Some people don’t age as well as others. And especially at advanced ages, chronic conditions including diabetes, hypertension and dementia become increasingly common and can take a toll on mental, as well as physical, health.

Still, those who fall into the “stereotype of being depressed, cranky, irritable and obsessed with their alimentary canal” constitute “no more than 10% of the older population,” says Paul Costa, a scientist emeritus at the National Institutes of Health, who for more than three decades directed the personality program of the long-running Baltimore Longitudinal Study of Aging. “The other 90% of the population isn’t like that at all,” Dr. Costa says.

Here are six prevalent myths about aging—along with recent research that dispels common misconceptions.

Myth No. 1: Depression Is More Prevalent in Old Age

It’s easy to assume that old age would be a depressing time of life. After all, as health declines and friends and relatives become disabled and die, it can be hard to maintain a positive outlook.

But research indicates that emotional well-being improves until the 70s, when it levels off. Even centenarians “report overall high levels of well-being,” according to a 2014 study by researchers including Laura Carstensen, director of Stanford University’s Center on Longevity, which cites a 2006 study by Christoph Rott, a senior research scientist at Heidelberg University in Germany, among others.

How do researchers measure well-being? From 1993 to 1995, Stanford scientists distributed beepers to 184 adults, ages 18 to 94. For one week, at five randomly selected times each day, the researchers paged participants, who filled out questionnaires asking them to assess—on a scale of one to seven—how much they felt of 19 emotions, including anger, sadness, amusement, boredom and joy. The researchers repeated the same exercise five and 10 years later.

Their conclusion: As the participants aged, their moods—measured by the ratio of positive to negative emotions—steadily improved.

“Contrary to the popular view that youth is the best time of life, the peak of emotional life may not occur until well into the seventh decade,” Prof. Carstensen says.

The study joins others that conclude that older adults focus on positive rather than negative emotions, memories and stimuli. In a 2003 study, for example, Prof. Carstensen found that in contrast to younger adults, older adults presented with an array of happy, sad and angry faces directed their gazes more often toward the happy ones.

Why the focus on the positive? As people age, they tend to prioritize emotional meaning and satisfaction, giving them an incentive to see the good more than the bad, Prof. Carstensen says.

National data back up the findings. According to the National Institute of Mental Health, 5.5% of adults age 50 and over said they experienced a major depressive episode in 2012. For those 26 to 49, the rate was 7.6%, and for ages 18 to 25 it was 8.9%.

While rates of depression in nursing homes tend to be high, Prof. Fingerman says, “In general, when we look at older adults, they tend to be happier, less anxious, less angry and tend to adapt well to their circumstances.”

Myth No. 2: Cognitive Decline Is Inevitable

As we age, our brains undergo structural changes. Certain regions, including the prefrontal cortex, shrink. And the neurons that carry messages become less efficient. As a result, concentration and memory slip and, around age 30, scores on tests of abstract reasoning and novel problem-solving begin to decline.

Like an older computer, an older brain typically takes longer to process and retrieve information from its crowded memory, says Denise Park, a professor of behavioral and brain sciences at the University of Texas at Dallas.

But recent discoveries also indicate that—barring dementia—older adults perform better in the real world than they do on cognitive tests. “Typical laboratory tasks may systematically underestimate the true abilities of older adults,” says Lynn Hasher, a professor of psychology at the University of Toronto and a senior scientist at the Rotman Research Institute.

To test raw intellectual prowess, scientists design experiments that “minimize the influence of past experience” on performance, says Prof. Salthouse in Virginia. The experiments “tell us what people can do in artificial situations,” he says. But in the real world, “most of what we do is based on the knowledge we have acquired.” Because knowledge and experience increase with age, older adults who are tested in familiar situations show few of the deficits that crop up in laboratory tests, he says.

Younger adults may also have advantages in laboratory tests that have nothing to do with their cognitive skills. For example, because professors often recruit students for their experiments, some younger participants may be more comfortable in a lab than older participants, says Prof. Hasher.

Older adults who believe negative stereotypes about aging can also unwittingly undermine their own performance on memory tests. In a study published in 2012, scientists at the Yale School of Public Health and the National Institute on Aging reviewed memory tests administered to 395 older participants in the Baltimore Longitudinal Study of Aging, all of whom—at younger ages—had filled out questionnaires assessing their beliefs in negative stereotypes about aging. Over a 38-year period, the decline in memory performance for those ages 60 and over with more negative stereotypes was 30% greater than for those with less negative views, says Becca Levy, an author of the study and an associate professor of psychology at the Yale School of Public Health.

The good news: Recent experiments show that certain activities appear to enhance cognitive function and perhaps slow age-related cognitive declines. In two studies published earlier this year, Prof. Park in Dallas tested the memories of 239 adults ages 60 to 90, about one-half of whom spent about 16 hours a week over three months learning new skills, including how to quilt, use an iPad and take digital photographs.

Compared with peers who performed word puzzles or engaged in social activities and other tasks that required no new skills, those learning new skills “showed greater improvements in memory, with some also showing improvement in processing speed,” says Prof. Park, who believes that older adults who learn challenging new skills tap more diffuse brain circuits and pathways to compensate for age-related deficits.

“Novelty combined with mental challenge is very important,” she says. “Get out of your comfort zone.”

Some scientists also believe older adults can make wiser decisions. In a study published in 2010, scientists asked 247 Midwesterners to read stories about conflicts between individuals and social groups and predict the outcomes. After transcribing their responses, the investigators removed participants’ names and ages and asked students who had received training to rate their responses on the basis of “wisdom”—defined, in part, as the ability to see problems from multiple perspectives and show sensitivity to social relationships. The researchers then asked outside experts—including clergy and professional counselors—to rank a subset of the responses according to their own definitions of wisdom, a process that largely confirmed the accuracy of the students’ ratings.

The average age of those with scores in the top 20% was 65, versus 46 for the remaining 80%, says Igor Grossmann, an assistant professor of psychology at the University of Waterloo in Ontario.

Myth No. 3: Older Workers Are Less Productive

Workers 55 or older make up 22% of the U.S. labor force, up from 12% in 1992. But thanks in part to stereotypes that portray older workers as less adaptable than their younger colleagues, they are widely assumed to be less productive.

In fact, the vast majority of academic studies shows “virtually no relationship between age and job performance,” says Harvey Sterns, director of the Institute for Life-Span Development and Gerontology at the University of Akron.

In jobs that require experience, some studies show that older adults have a performance edge. Economists at the Max Planck Institute for Social Law and Social Policy, a nonprofit research organization in Munich, examined the number and severity of errors 3,800 workers made on a Mercedes-Benz assembly line from 2003 to 2006. The economists determined that over that four-year period, the older workers committed slightly fewer severe errors, while the younger workers’ severe error rates edged up.

“The older workers seemed to know better how to avoid severe errors,” says Matthias Weiss, the academic coordinator at the institute.

Myth No. 4: Loneliness Is More Likely

As people age, their social circles contract. But that doesn’t mean older adults are lonely.

In fact, several academic studies indicate that friendships tend to improve with age.

“Older adults typically report better marriages, more supportive friendships, less conflict with children and siblings and closer ties with members of their social networks than younger adults,” says Prof. Fingerman, co-author of a 2004 study that found older adults have “a higher rate of close ties than younger people” and fewer “problematic relationships that cause them distress.”

That is also the message of research that Prof. Carstensen published this year. The researchers asked 184 people they have followed for more than a decade to put their friends and relatives into three categories: an inner circle, consisting of people they “feel so close [to] that it would be hard to imagine life without them”; a middle circle they feel a little less close to “but who are still very important”; and an outer circle. The researchers also asked the participants every couple of years to rate—on a scale of one to seven—the intensity of the positive and negative emotions they felt for each.

The findings: Until about age 50, most people add to their social networks. After that, they eliminate people they feel less close to and maximize interactions with “close partners who are more emotionally satisfying,” says Prof. Carstensen.

Over time, the participants also assigned their networks more positive ratings. “Their loved ones seem to mean more than ever, and that is protective against loneliness,” says Prof. Carstensen. While this doesn’t mean loneliness isn’t a problem for some older people, she adds, research indicates that, on average, older adults are less lonely than young people.

Myth No. 5: Creativity Declines With Age

Creativity has long been seen as the province of the young. (Think: Lennon and McCartney, Jobs and Wozniak.)

But academic studies that date as far back as the 19th century pinpoint midlife as the time when artists and scholars are most prolific. Dean Keith Simonton, a professor of psychology at the University of California, Davis, says creativity tends to peak earlier in fields such as pure mathematics and theoretical physics, where breakthroughs typically hinge on problem-solving skills that are sharpest in one’s 20s. In fields that require accumulated knowledge, creative peaks typically occur later. Historians and philosophers, for example, “may reach their peak output when they are in their 60s,” he says.

In recent years, an economist has put forth a theory of creative late bloomers. David Galenson, a professor at the University of Chicago, analyzed the ages at which some 300 famous artists, poets and novelists produced their most valuable works. (For the artwork, he used auction prices and the number of times specific works appeared in text books. For literary works, he counted the words devoted to them in scholarly monographs.)

His conclusion: Creative genius clusters into two categories: conceptual artists, who tend to do their best work in their 20s and 30s, and experimental artists, who often need a few more decades to reach full potential. Conceptual artists work from imagination, an area where the young have an advantage because they tend to be more open to radical new ideas, Prof. Galenson says. Experimental artists improve with experience. They take years to perfect their style and knowledge of their subjects.

People who are creative in older age aren’t anomalies, he says. Mark Twain, Paul Cézanne, Frank Lloyd Wright, Robert Frost and Virginia Woolf are just a few of the artists “who did their greatest work in their 40s, 50s and 60s. These artists rely on wisdom, which increases with age.”

Myth No. 6: More Exercise Is Better

When it comes to improving health and longevity, exercise is key. But a growing number of studies show that more exercise may not always be better.

“You get to a point of diminishing returns,” says James O’Keefe, a professor of medicine at the University of Missouri-Kansas City.

In a study to be published this month, Dr. O’Keefe and co-authors tracked 1,098 joggers and 3,950 non-joggers from 2001 to 2013; all were part of the Copenhagen City Heart Study, under way since 1976. Overall, the runners in the Copenhagen study lived longer than the non-runners: 6.2 years longer for the men, and 5.6 years longer for the women.

But the new study discovered that those who ran more than four hours a week at a fast pace—of 7 miles per hour or more—lost much, if not all, of the longevity benefits.

The group that saw the biggest improvements? Those who jogged from one to 2.4 hours weekly at 5 to 7 mph and took at least two days off from vigorous exercise per week.

Other studies have come to similar conclusions. In research published this year, scientists at institutions including Iowa State University found that the death rate for runners is 30% to 45% below that for non-runners. But the mortality benefits were similar for all runners, even those who ran five to 10 minutes a day at speeds of 6 mph or less. “Fairly modest doses of running provided benefits as great as…a lot of running,” says Russell Pate, an author of the study and professor at the University of South Carolina.

Dr. O’Keefe believes long-term strenuous endurance exercise may cause “overuse injury” to the heart. His recommendation: Stick to a moderate cardiovascular workout of no more than 30 miles a week or 50 to 60 minutes of vigorous exercise a day, and take at least one day off each week. “You don’t need to run a marathon,” he says.

The Best Exercise for Aging Muscles

Categories:Elderly Care

The toll that aging takes on a body extends all the way down to the cellular level. But the damage accrued by cells in older muscles is especially severe, because they do not regenerate easily and they become weaker as their mitochondria, which produce energy, diminish in vigor and number.

study published this month in Cell Metabolism, however, suggests that certain sorts of workouts may undo some of what the years can do to our mitochondria.

Exercise is good for people, as everyone knows. But scientists have surprisingly little understanding of its cellular impacts and how those might vary by activity and the age of the exerciser.

So researchers at the Mayo Clinic in Rochester, Minn., recently conducted an experiment on the cells of 72 healthy but sedentary men and women who were 30 or younger or older than 64. After baseline measures were established for their aerobic fitness, their blood-sugar levels and the gene activity and mitochondrial health in their muscle cells, the volunteers were randomly assigned to a particular exercise regimen.

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Some of them did vigorous weight training several times a week; some did brief interval training three times a week on stationary bicycles (pedaling hard for four minutes, resting for three and then repeating that sequence three more times); some rode stationary bikes at a moderate pace for 30 minutes a few times a week and lifted weights lightly on other days. A fourth group, the control, did not exercise.

After 12 weeks, the lab tests were repeated. In general, everyone experienced improvements in fitness and an ability to regulate blood sugar.

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There were some unsurprising differences: The gains in muscle mass and strength were greater for those who exercised only with weights, while interval training had the strongest influence on endurance.

But more unexpected results were found in the biopsied muscle cells. Among the younger subjects who went through interval training, the activity levels had changed in 274 genes, compared with 170 genes for those who exercised more moderately and 74 for the weight lifters. Among the older cohort, almost 400 genes were working differently now, compared with 33 for the weight lifters and only 19 for the moderate exercisers.

Many of these affected genes, especially in the cells of the interval trainers, are believed to influence the ability of mitochondria to produce energy for muscle cells; the subjects who did the interval workouts showed increases in the number and health of their mitochondria — an impact that was particularly pronounced among the older cyclists.

It seems as if the decline in the cellular health of muscles associated with aging was “corrected” with exercise, especially if it was intense, says Dr. Sreekumaran Nair, a professor of medicine and an endocrinologist at the Mayo Clinic and the study’s senior author. In fact, older people’s cells responded in some ways more robustly to intense exercise than the cells of the young did — suggesting, he says, that it is never too late to benefit from exercise.

To Age Well, Change How You Feel About Aging – WSJ

Categories:Elderly Care

To Age Well, Change How You Feel About Aging – WSJ.

Japanese Automakers Look to Robots to Aid the Elderly

Categories:Elderly Care

TOKYO (Reuters) – Japanese automakers are looking beyond the industry trend to develop self-driving cars and turning their attention to robots to help keep the country’s rapidly graying society on the move.

Toyota Motor Corp said it saw the possibility of becoming a mass producer of robots to help the elderly in a country whose population is ageing faster than the rest of the world as the birthrate decreases.

The country’s changing demographics place its automakers in a unique situation. Along with the issues usually associated with falling populations such as labor shortages and pension squeezes, Japan also faces dwindling domestic demand for cars.

Toyota, the world’s second largest automaker, made its first foray into commercializing rehabilitation robots on Wednesday, launching a rental service for its walk assist system, which helps patients to learn how to walk again after suffering strokes and other conditions.

Toyota’s system follows the release by Honda Motor Co of its own walking assist “robotic legs” in 2015, which was based on technology developed for its ASIMO dancing robot.

“If there’s a way that we can enable more elderly people to stay mobile after they can no longer drive, we have to look beyond just cars and evolve into a maker of robots,” Toshiyuki Isobe, chief officer of Toyota’s Frontier Research Center, told Reuters in an interview on Wednesday.

Speaking to reporters, he added that mass producing robots would be a natural step for the company which evolved from a loom maker in 1905 into an automaker whose mission is to “make practical products which serve a purpose”.

“Be it robots or cars, if there’s a need for mass produced robots, we should do it with gusto,” Isobe said.

GROWING OLD

Japan is graying faster than the rest of the world, with the number of people aged 65 or older accounting for 26.7 percent of the population in 2015, dwarfing the global average of about 8.5 percent.

As a result, demand for care services for elderly people has boomed and a shrinking working population means that fewer able-bodied adults are available to look after them.

Globally, sales of robots for elderly and handicap assistance will total about 37,500 units in 2016-2019, and are expected to increase substantially within the next 20 years, according to the International Federation of Robotics.

At the same time, car sales in Japan have fallen 8.5 percent between 2013-2016, as older drivers stop buying cars while car ownership becomes less of a priority among younger drivers.

Like most major automakers, Toyota is still competing fiercely to develop self-driving cars, committing $1 billion to a robotics and A.I. research center.

Isobe conceded that it took Toyota longer to develop robots than cars, as it stretched the company further beyond its comfort zone. As a result, Toyota’s new walking assist system took more than 10 year to bring to market.

“The biggest challenges have been in determining the needs of the robot market, which is relatively new, and to ensure that our products are safe,” Isobe said.

Still, industry experts said that automakers were well placed to compete with medical technology companies including Switzerland’s Hocoma and robot manufacturers such as ReWalk Robotics of the United States, both of which have developed robotic walking assist systems.

“Cars operate using engines and other components which enable mobility and control,” said Nagayoshi Nakano, research vice president at Gartner Research’s IoT Center of Excellence.

“On top of that, many of them have been partnering with the likes of Google and other companies looking at applying artificial intelligence, which will put them in a strong position to compete in robot services for the elderly.”

 

 

Aging and Isolation- Causes and Impacts

Categories:Elderly Care

January/February 2017 Issue

Aging & Isolation — Causes and Impacts
By Lauren Snedeker, LMSW
Social Work Today
Vol. 17 No. 1 P. 24

Many older adults experience aging as a positive time because they remain active and connected to others, but many other elders become disconnected from family, friends, and community. This article examines the causes and results of isolation and how social workers can help reduce its impact.

Older adults comprise the fastest growing segment of the population, with some 10,000 baby boomers turning 65 every day, a rate the U.S. Census Bureau estimates will continue until the year 2030. By 2020, it is estimated that approximately one in six Americans will be age 65 or older. As people are living longer and the number of older adults in America’s population is increasing, the diversity of their needs and interests is also evolving. Psychologist Abraham Maslow, PhD, proposed that healthy human beings have a specific collection of needs arranged in a way according to function: physiological needs, safety, love and belonging, esteem, and self-actualization. From person to person, this hierarchy can and will shift. Shifts can be caused by age, values, environment, beliefs, and more.

Social workers are clinically trained to evaluate and triage clients’ needs in efforts to provide adequate and efficient support. If some of the most basic needs go unmet, it can cause the entire pyramid to fall. And while the specific needs of the aging population continue to change, connectedness remains a core constant for maintaining an optimal quality of life. Yet too often, older adults experience loneliness and isolation. Understanding the causes of isolation can help position social workers to help mitigate feelings of loneliness and isolation in their clients and contribute to a much-needed societal change.

Potential Causes of Isolation 
A variety of factors can contribute to isolation. An ecological approach is critical in understanding the complex and dynamic relationship between any aged people and their environment. Our bodies naturally experience changes that may cause our capabilities to shift. Aging can, at times, include some form of vision, hearing and/or muscle impairment—factors that can put an individual at greater risk for falls.

In the United States, emergency departments treat an older adult for a fall every 11 seconds (National Council on Aging, 2016). Further, some 27,000 older adults have died as a result of falls, equating to about 74 per day (Centers for Disease Control and Prevention, 2016). Because falls can cause serious injury and sometimes death, older adults may develop a fear of falling and seek to avoid falls. Sometimes the fear can be so pervasive that individuals may no longer wish to leave their home. This can compromise access to food, socializing with family and friends, attending medical appointments, picking up prescriptions, going to work or to volunteer, and other recreational activities that help alleviate stress and promote a positive quality of life. Practitioners must acknowledge this and help older adults address this fear through education and support, and by empowering them to take preventive measures, such as utilizing slip-proof footwear, and installing grab bars or other adaptive equipment in the home.

One’s personal capabilities and physical status are not the only limiting factors contributing to isolation of the aging. Environment can also play a big role. Many community settings are not aging friendly. The vast majority of older adults prefer to age in place. In order to achieve this goal, every community—rural and metropolitan—will need to adapt. As reported by Partners for Livable Communities (2007), design that makes it difficult to walk may contribute to older adults’ isolation and therefore may negatively impact quality of life. Additionally, a lack of affordable and accessible housing may force older adults to transition to facility-based care. Following are some additional settings and causes of isolation.

Geography and Accessibility 
Rural or nonmetropolitan areas in the United States have been found to have a higher amount of older adult residents in comparison with more metropolitan areas. Twenty percent of older adults in America live in nonmetro areas (Hartman & Weierbach, 2013). Research has shown that rural areas have higher incidences of poverty and less access to community resources, such as activity centers, grocery stores, pharmacies, and town halls. For older adults in rural areas, lack of access to these services is often the greatest challenge faced. Without them, it is difficult to continue to live independently and meaningfully. Lack of transportation or professionals to staff such sites as activities or senior centers can contribute to this challenge. But regardless of whether isolation is imposed by one’s environment or chosen by the individual, its effects are of significant concern for the growing aging population and are in need of more attention.

There may be an assumption that metropolitan areas, which offer public transportation, are more supportive to older adults However, what many do not realize is that the physical problems that can make driving difficult for older individuals can also make using public transportation difficult. For example, individuals with physical disabilities may have trouble crossing wide streets to reach bus stops, or may have difficulty climbing the high stairs of a bus or train. Or, perhaps, an individual has always driven but now has to rely on public transit and needs assistance with navigating the route or timetable. Customer service may not always be willing or able to respond to those needs (Burkhardt, McGavok, & Nelson, 2002).

There are pros and cons to rural and metropolitan areas. Despite the challenges transit systems may face in terms of functionality for an aging population, they nonetheless outnumber what is available in rural areas. It is no surprise that rural residents endure longer travel times to get to the closest shopping areas and other resources. For people who no longer are able to drive and have no nearby family, the chances of isolation and the many health outcomes it brings can increase. In 2013, the National Rural Health Association produced a policy brief stating concerns of rural elder health. Within the brief, Firestine (2011) states that according to the Department of Transportation Bureau of Statistics, “between 2005 and 2010, 3.5 million rural residents lost access to scheduled intercity transportation, increasing the percent of rural residents without access to intercity transportation from seven to 11 percent.” Not only does the lack of transportation for rural older adults impact their ability to connect with family and friends, it also impacts their ability to get food and medicine and to see medical providers. Budget cuts are often the reason public programs, such as transportation for elders, get cut, and such cuts make this vulnerable population even more so.

Fortunately, the recent reauthorization of the Older Americans Act has helped restore financial security to vital programs and services, including transportation, meals on wheels and nutrition, in-home services, legal programs, and caregiver support. One in five older adults currently receives services from Older Americans Act programs, which help them maintain their independence.

Further, research describes how threats of security, including elder abuse, have caused many older adults to stay home instead of venturing out for an activity. Unfortunately, as Gusmano and Rodwin (2010) indicated in their research, it has historically taken crisis to understand the significant lack of attention older adults receive in relation to public safety and security. Furthermore, while many may presume a city would offer more access to services, it may, in fact, contribute to greater isolation of the aging due to congestion, pollution, crime rates, and unaffordable housing.

Security, transportation, accessibility, and functionality of a neighborhood all serve to contribute to the isolation of older adults. While there are efforts being made to make communities more aging friendly, considerable progress must be made to meet the needs of this growing population.

Stigma and Stereotypes
Stigma also contributes to both voluntary and involuntary isolation of the aging population. Many people make assumptions about the aging and focus on aging stereotypes of what an individual can’t do, without knowing an individual’s capabilities. Statements such as, “You’re too old for that,” are uttered so often that perhaps they are perpetuating a self-fulfilling prophecy. Ageism long has been present in society and is a form of discrimination. It is important not only to do away with these stereotypes but also to avoid paternalistic tendencies. Older adults are not children and should not be treated as such. Social workers have an opportunity to promote the integrity of America’s older adult population so that they feel confident in today’s society and continue to lead purposeful lives.

Milestone Events
Retirement for many older adults can symbolize a significant life transition. People may have different attitudes toward this new stage of life based on their circumstances. Some look forward to traveling and exploring other activities, some may be wondering what they will do to occupy their time, and still others may be forced to retire due to age. Retirement may impose pressure to develop a new plan—perhaps one that is different from what the person originally envisioned. When working with any aged person, it is important to acknowledge that often one’s profession is a crucial part of his or her identity. Retirement can sometimes be a shock to one’s sense of self, as it may bring feelings of losing one’s identity. Undoubtedly, retirement can cause a decrease in the amount of social contact individual experiences throughout the day. Many friendships or close relationships with former colleagues can be difficult to maintain after leaving the workplace and not seeing one another each day. Retirement not only impacts social connectedness but also can cause a shift in income and social role (Kaplan & Berkman, 2016). For some, retirement can be symbolic of an end. Even the word “retire” is defined as withdrawing from work at a certain age. While this process can represent a positive change, it deserves exploration and acknowledgment in clinical work with older adults in order to understand the intricacies of this population and its needs.

As people are living longer, they are now available to experience milestone events and, specifically, a new chapter of life that previous generations had not. AARP reports that 45% of people older than 65 are divorced, separated, or widowed. It is certainly possible for individuals who are living longer to outlive their children, spouses, and other members of their family and for relationships and status to change. Additionally, as societal norms continue to ebb and flow, it is possible for individuals to live longer as childless and spouseless by choice or not. In fact, research being conducted by Maria T. Carney, MD, chief of geriatrics and palliative medicine at Northwell Health in New York, suggests that nearly one-quarter of Americans older than age 65 may become physically or socially isolated and lack someone, like a family member, to care for them, according to a 2015 article in ScienceDaily. Because of this, it is and will be possible for an older adult to live longer than members of his or her support team, and to live longer acting as their sole support system.

The likelihood of living alone increases with age. According to the Institute on Aging (2010), nearly one-third of older adults in America lives alone, outside of a nursing home or hospital. This number is projected to rise in line with the growing efforts of aging in place programs and initiatives. Living alone does not necessarily equate to feeling lonely or being isolated; however, it can increase the odds. As Carney suggests, because so much of caregiving and support at this time is from family, people without such support may be particularly vulnerable, and it is important to recognize this and learn about what can help.

Potential Impacts of Isolation 
Isolation of the aging population can be a result of a variety of complex factors. In addition to understanding why this may happen, it is also important to understand that this an emerging public health issue.

A study of social isolation and loneliness experienced by adults aged 52 and older found that both factors led to a higher risk of mortality (Steptoe, Shankar, Demakakos, & Wardle, 2013). This could be a result of limited contact, feeling uncared for or forgotten, or having little to no available resources. In 2009, research from the National Social Life, Health and Aging Project found that regardless of the facts related to an older adult’s status of isolation, those who felt lonely and isolated were more likely to report having poor physical and mental health (Cornwell & Waite, 2009). In addition to emotional health, brain health and wellness are vital parts of successful aging, and a lack of social engagement and activity has been linked to poor cognitive performance (Cacioppo & Hawkley, 2009).

Many perceive that the challenges that impact the lives of young adults do not impact those of the older adults. For example, alcohol and drug misuse is often overlooked in this population; however, the signs are clear. Depression, a condition that can contribute to young adults’ misuse of substances, is also a factor for many older adults. According to the National Council on Alcoholism and Drug Dependence, Inc. (2015), widowers older than age 75 have the highest rate of alcoholism in the United States. Just as younger adults may turn to alcohol and drugs as a method for coping, so may older adults and, too often, they are the individuals who are underscreened, overlooked, and misdiagnosed.

Without a more robust workforce to address and incorporate new interventions to help reduce incidences of isolation, more of America’s population will be vulnerable to the potentially compromised quality of life that isolation brings.

What Can We Do?
Society can no longer afford to treat the aging population as invisible. Population health is a significant determinant of success and because individuals are living longer, the health of older adults is finally becoming a factor. Unfortunately, the lack of professionals working with the aging as well as being educated about their needs is another issue that must be addressed.

NASW estimates that up to 70,000 geriatric social workers will be needed to help address the needs of the growing aging population (Pace, 2014). According to the American Geriatrics Society’s “Projected Future Need for Geriatricians,” there were only 7,029 certified geriatricians practicing throughout the United States in 2009—roughly one-half the number currently needed.

An increase in aging education is also warranted in other disciplines. For example, per a 2008 report from the Institute of Medicine, fewer than one-half of pharmacy schools in the United States offer a course in geriatrics despite the fact that per capita prescription drug use by people 65 and older is triple that of younger individuals.

The aging population’s growth is an opportunity not only for more social workers, nurses, and medical providers to offer their clinical services but also for individuals in different professions and from all over the country to come forward and contribute to a positive and healthy societal change. It is an opportunity to address an emerging public health issue and to ensure that all individuals feel valued and connected at every stage of their lives.

— Lauren Snedeker, LMSW, is with the Alzheimer’s Foundation of America. 

References
Burkhardt, J. E., McGavock, A. T., Nelson, C. A., & Mitchell, C. B. G. (2002). Improving public transit options for older persons. Federal Transit Administration, Transit Cooperative Research Program, Report 82. Retrieved from http://onlinepubs.trb.org/onlinepubs/tcrp/tcrp_rpt_82v2a.pdf.

Cacioppo, J. T., & Hawkley, L. C. (2009). Perceived social isolation and cognition. Trends in Cognitive Sciences, 13(10), 447-454.

Centers for Disease Control and Prevention. (2016). Older adults fall prevention. Retrieved from http://www.cdc.gov/media/dpk/healthy-living/injury-falls-older-adults/older-adult-falls.html.

Cornwell, E. Y. & Waite, L. J. (2009). Social disconnectedness, perceived isolation, and health among older adults. Journal of Health and Social Behavior, 50(1), 31-48.

Firestine, T. ( 2011). The U.S. rural population and scheduled intercity transportation in 2010: A five-year decline in transportation access. Retrieved from https://www.rita.dot.gov/bts/sites/rita.dot.gov.bts/files/publications/
scheduled_intercity_transportation_and_the_us_rural_population/2010/pdf/entire.pdf
.

Gusmano, M. K., & Rodwin, V. G. (2010). Urban aging, social isolation and emergency preparedness. Global Ageing, 6(2), 39-50.

Hartman, R. M., & Weierbach, F. M. (2013). National Rural Health Association policy brief: Elder health in rural America. Retrieved from https://www.ruralhealthweb.org/getattachment/Advocate/Policy-Documents/
ElderHealthinRuralAmericaFeb2013.pdf.aspx?lang=en-US
.

Institute on Aging (2010). Information on senior citizens living in America. Retrieved from http://www.ioaging.org/aging-in-america.

Kaplan, D. B., & Berkman, B. J. (2016). Effects of Life Transitions on the Elderly.
Retrieved from http://www.merckmanuals.com/home/older-people’s-health-issues/
social-issues-affecting-older-people/effects-of-life-transitions-on-older-people
.

National Council on Aging. 2016. Falls prevention: Fact sheet. Retrieved from https://www.ncoa.org/news/resources-for-reporters/get-the-facts/falls-prevention-facts/.

National Council on Alcoholism and Drug Dependence, Inc. (2015). Alcohol, drug dependence and seniors. Retrieved from https://www.ncadd.org/about-addiction/seniors/alcohol-drug-dependence-and-seniors.

Pace, P. P. (2014). Need for geriatric social work grows. Retrieved from http://www.socialworkers.org/pubs/news/2014/02/geriatric-social-work.asp.

Partners for Livable Communities & The National Association of Area Agencies on Aging. (2007). A blueprint for action: Developing a livable community for all ages. Retrieved from http://livable.org/storage/documents/reports/AIP/blueprint4actionsinglepages.pdf.

Steptoe, A., Shankar, A., Demakakos, P., & Wardle, J. (2013). Social isolation, loneliness, and all-cause mortality in older men and women. Proceedings of the National Academy of Sciences of the United States of America,110(15), 5797-5801.

 

Dementia on the Downslide

Categories:Elderly Care

Dementia on the Downslide, Especially Among People With More Education

In a hopeful sign for the health of the nation’s brains, the percentage of American older adults with dementia is dropping, a new study finds.

The downward trend has emerged despite something else the study shows: a rising tide of three factors that are thought to raise dementia risk by interfering with brain blood flow, namely diabetes, high blood pressure, and obesity.

Those with the most years of education had the lowest chances of developing dementia, according to the findings published in JAMA Internal Medicine by a team from the University of Michigan (U-M). This may help explain the larger trend, because today’s elders are more likely to have at least a high school diploma than those in the same age range a decade ago.

With the largest generation in American history now entering the prime years for dementia onset, the new results add to a growing number of recent studies in the United States and other countries that suggest a downward trend in dementia prevalence. These findings may help policy-makers and economic forecasters adjust their predictions for the total impact of Alzheimer’s disease and other conditions.

“Our results, based on in-depth interviews with seniors and their caregivers, add to a growing body of evidence that this decline in dementia risk is a real phenomenon, and that the expected future growth in the burden of dementia may not be as extensive as once thought,” says lead author Kenneth Langa, MD, PhD, a professor in the U-M Medical School, Institute for Social Research, and School of Public Health, and a research investigator at the VA Ann Arbor Healthcare System.

“A change in the overall dementia forecast can have a major economic impact,” he adds. “But it does nothing to lessen the impact that each case has on patients and caregivers. This is still going to be a top priority issue for families, and for health policy, now and in the coming decades.”

Nearly Three-Point Drop
Langa and colleagues used data and cognitive test results from the Institute for Social Research’s long-term Health and Retirement Study to evaluate trends from 2000–2012 among a nationally representative sample of more than 21,000 people aged 65 or older.

In all, 11.6% of those interviewed in 2000 met the criteria for dementia, while in 2012, only 8.8% did. Over that time, the average number of years of education an elder had rose by nearly an entire year, from 12 to 13.

“It does seem that the investments this country made in education after the Second World War are paying off now in better brain health among older adults,” says David R. Weir, PhD, senior author of the paper and director of the Health and Retirement Study. “But the number of older adults is growing so rapidly that the overall burden of dementia is still going up.”

Even as these new results come out, the Health and Retirement Study team is in the middle of another large study of dementia in the United States that will help refine the techniques for better understanding who has dementia in the American population, and allow them to be used in other countries around the world where Health and Retirement Study “sister studies” are also collecting data.

Langa, the Sturgis Professor of Internal Medicine and a member of the U-M Institute for Healthcare Policy and Innovation, notes that the differences in dementia risk according to education level mark an important health disparity now, and likely into the future.

“More baby boomers have completed some higher education than any previous generation, but the trend toward more education appears to be leveling off in the United States. And there are clear disparities in educational attainment according to wealth and ethnicity,” he says. “These differences in education and wealth may actually be creating disparities in brain health and, by extension, the likelihood of being able to work and be independent in our older years.”

Years of formal education were the only marker tracked among the study participants. But, Langa says, it is likely that the other ways that people challenge and use their brains throughout life, e.g., reading, social interactions, what occupation they have, and how long they work, may also have an impact on dementia risk in later life.

All of these pursuits can help build up a person’s “cognitive reserve” of brain pathways that can survive the assault of the physical factors that lead to dementia.

Next Steps
Researchers hope to learn much more about the cognitive reserve concept with new funding from recent federal initiatives that aim to increase dementia-related research and discovery.

Continued focus on reducing cardiovascular risk—through increased physical activity and controlling hypertension and diabetes in younger and middle-aged people—may also help reduce future dementia rates.

Growing evidence has shown that dementia in older adults is usually due to multiple causes, including Alzheimer’s disease, which is characterized by a buildup of abnormal proteins in the brain, as well as vascular dementia, which results from brain tissue not receiving enough blood due to blockages and leaks in the brain’s blood vessels.

For those who do develop dementia, Langa notes, the challenge for Americans going forward will be to address the need for long term care at home and in institutions, in the face of smaller families with fewer members to act as caregivers.

Even if the slide in dementia incidence continues, the baby boomer generation’s sheer size will mean challenges for those who fund care or provide it.

— Source: University of Michigan Health System

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Behavioral Therapy Helps More Than Certain Drugs For Dementia Patients

Behavioral Therapy Helps More Than Certain Drugs For Dementia Patients

-By Ina Jaffe, NPR

“When we think of Alzheimer’s disease or other dementias, we think of the loss of memory or the inability to recognize familiar faces, places, and things. But for caregivers, the bigger challenge often is coping with the other behaviors common in dementia: wandering, sleeplessness and anxiety or aggression.”

Music and Art in Memory Care for Dementia Patients

Music and Art in Memory Care for Dementia Patients

-From Today’s Geriatric Medicine by Caroline Edasis, MAAT

“…With no identified cure and no medications available that can permanently halt disease progression, there are limited treatment options. Finding ways to alleviate the day-to-day struggles of dementia is critically important, and focusing solely on providing physical care is not enough. Person-centered care approaches improve quality of life through creative interventions that allow individuals to connect with personal meaning, express feelings and experiences, and feel connected to others in the present moment.”