AGING

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Comments by Professor Leonard Haylick in "How and Why We Die":

1. Weight increases till about age 55 and then tends to lessen after that, probably due to loss of lean tissue, muscle mass, water and bone. Bone loss is greater in women. Total body fat remains constant, it just redistributes itself as more muscle tone is lost.

2. Being lean is not an indication in living longer. Probably having your weight about in the middle range for your age is the best.

3. Men are 1.12 to 7.0 times more likely to die of heart attacks, strokes, cancer, respiratory diseases, accidents, liver cirrhosis, suicide, homicide and AIDS (is there anything left?). The exceptions are death caused by cancer affecting the female organs, complications of pregnancy or childbirth and some relatively minor diseases.

4. While muscle tone is lost as one gets older, apparently the heart does NOT weaken.

5. Who lives the longest? Those that have the best medical care, nutrition and information.

And here is an interesting perspective. Dr. Haylick says that, "suppose that, in their 60's, humans are at the greatest risk for what ever disease you wish to propose. Once you are in your 70's though, because of your exceptional fitness, you have survived and passed through the bottleneck of the 60's, your likelihood of dying is reduced. Also, "......the Gomex equation guides life insurance premiums and says that from the age of 30 onward, the likelihood of dying doubles every seven years. But recently, it was found the equation does not hold at extreme old age."

KEEPING SHARP: (US News, 1995) In order to stay sharp in your elder years, do the things now that can help

• Seek Variety. The more you experience, the more knowledge you have to draw upon. But they should be things you enjoy doing- if not, the experiences can dull the mind
• Be flexible. If you are willing to do new things in a new way, your mind expands and explores. Doing things the same old way with an avoidance to anything new, and your brain will die before you do.
• Find peace. People who are constantly pessimistic, depressed, anxious, angry or discontented are susceptible to earlier and larger losses of brainpower.

IN CHILDHOOD

• Eat right. They say breast feeding fosters healthy brains. Obviously, lack of nutrition can permanently affect both mental and physical abilities
• Get stimulated. Connections between brain cells grow by as much as 25% in stimulating environments. Further, they drop as much in bland environs
• Stay in school. Education boosts ability and competency in all areas that can be retained and even increased upon in old age.

YOUNG ADULTHOOD

• Make many friends. Those that had more social outlets scored higher on cognitive tests and are better adapted to new situations (probably due to the increased support group).
• Find a mentor. Using an older person's advice can get you going in the right direction must faster and without all the mistakes. Why reinvent the wheel?
• Marry someone smarter than you. They say that over time your abilities will tend to match the other. Take adult courses, but don't cram. Lifelong learning will result in fascinating discoveries about life and living as well as overall knowledge

MIDDLE AGE

• Develop Expertise. High levels of thought prime the brain and often used knowledge is the best remembered.
• Save more. If you are handling your finances properly, you might/should have more opportunity to treat yourself to mind expanding experiences.
• Achieve you major life goals now. If you go into retirement fulfilled, it's thought to bring peace of mind you need for the next 20 years.
• Enjoy the activity. The brain thrives on challenges and new experiences. But don't be lulled into stress by trying too many or the wrong things.
• Avoid burnout. Personally speaking, this is devastating. Your physical body can return to normalcy fairly quickly- you brain does NOT. It may take months and months of recovery before you can again see the forest for the trees. It happened to me in my early years quite a bit. I learned. Take a lesson from me and slow it down so you can see life while you are living it. You can either smell the flowers from above or look at the roots from six feet under.
  

AFTER AGE 65

• Seek new experiences. Just because you're over 65 does not limit you need to continue growing and doing new things. Your mind can keep on growing. If you settle for the dull and routine, so will your brain.
• Engage the world. Do things that will help your community and the world. Being involved in activities that make a difference can give you a major sense of satisfaction.
• Continue exercising. Just because you got older doesn't mean your body stopped. Take a daily walk as a minimum. Consider doing more, health permitting of course, such as biking hiking, weight training.
• Stay under control. Don't let the problems of life, the world, finances overwhelm you. Admittedly, pain and suffering all come into our lives, but a properly trained and functioning mind can work very well even under harsh conditions. If you think you are hopeless enough times, you soon will be.
  

THE ONE PERCENT RULE: Gerontologists have different theories about why the body ages, but it's generally agreed that a loss of efficiency comes about as some cells wear out or actually die and do not replace themselves. It's sometimes called the one percent role- that most organ systems seem to lose roughly 1% of their functioning each year starting at age 30.

GETTING OLDER & BETTER

(SF Chronicle 12/94) Some decline due to aging is inevitable. But at most, only 15% over 65 are classified by gerontologists as frail. The rest, about 26 million, retain their cognitive and creative abilities. In fact, Dr. Lydia Bronte says "there often is a huge growth spurt sometimes after 50. Another Dr. noted that as people get older, they get more and more different from each other. Differences that emerge frequently include a previously undisclosed talent or ability.

Researchers believe that certain factors- such as having more time, reviewing life, losing self consciousness- facilitate creativity. Within the context of less self consciousness is the onset of a new boldness and willingness to take risk. One of the myths about old age is that people become more cautious and conservative as they get older. But older people have less fear of being criticized. They are less fearful of doing something creative for the first. time. As one senior said, "I don't mind if people think I'm crazy, doing what I'm do at this age. I think that people who aren't eccentric are apt to be boring".And new developments- like the extension of the life span, feminism, the aging of baby boomers- encourage it further.

Another recently published longitudinal study indicates that mental acuity and the propensity to create do not diminish inevitably with age. A lot of the decline thought to be normal in the aging process can be slowed or delayed. A doctor noted that the old saying," use it or lose it" is absolutely true.

OLD DRUNKS: (Brigid Schulte) Mentioned year ago, the major reason the elderly fall down is due to drinking. It is estimated that there are 3 million older alcoholics. Perhaps as many as 20% of the elderly have some problem with alcohol. More older people are hospitalized for alcohol than for heart problems. Nearly one-fourth of all those hospitalized over age 60 are diagnosed with alcoholism, with treatment costs as high as $60 billion. 25% of Medicare's costs go to pay for substance abuse among the elderly. And alcohol is the drug of choice. Doctors often misdiagnose the shaking hands, confusion and memory loss of elderly alcoholics as old age.

About 25% of patients diagnosed with dementia, many of whom are mistaken as Alzheimer's sufferers, are actually impaired by alcohol

Most older alcoholics fiercely deny they have a problem. Many live reclusive lives, calling the liquor store for the next delivery, and are nearly impossible to reach.

Families, many of whom live miles away, are often silent. Raised to respect their elders, they either leave them to their "hobby," ignore the problem, don't want to air embarrassing dirty family laundry, or are unable to confront it.

Those who do confront it find, usually after a lengthy search, that only a handful of treatment centers care for the elderly, that treatment costs can run into the tens of thousands of dollars and that Medicare has cut the inpatient treatment it covers from 28 days to five.

The federal government, too, ignores the problem, focusing instead on youths. Research on the elderly gets 2% of the addictions budget; only one of the 14 federally funded addiction research centers is dedicated to studying the elderly.

Older alcoholics have traditionally been divided into two groups: those who've had a problem all their lives, and those who begin to drink to excess only after retirement or the death of a spouse or out of depression.

But the problem is greater still since few elderly- estimated at 10%- ever get treatment. Further, 80% of those who do get treatment will relapse, either once, or for good, within one year.

MEMORY MYTHS: (Dr. Barry Gordon)

• Forgetfulness is a sign of aging. Nope. If we didn't have the ability to forget, we'd all go crazy. We must remember some "stuff" but be willing and able to discard miscellaneous trivia.
• You lose 10,000 brain cells every day and you'll run out. True, you do lose some brain cells, but as one gets older, the brain, absent Alzheimers or senile dementia, just makes new paths to think and work. That's why many elderly people maintain their skills
• The more memory problems bother you, the worse the problem. Nope again. The more severe your worries about your memory, the LESS likely that you have a problem.
• To tell if your memory is poor, simply compare it to others. Not a good idea due to the vast and varied difference between people. Some remember names better, others don't etc.
• Those who think they have Alzheimers, probably do. Probably not. If one has Alzheimers, they have lost/are losing their ability to think and remember. It's their friends and relatives who note the difference. Unfortunately, Alzheimer's patients have lucid periods where they recognize something is very wrong.

STAYING YOUNG: (Gail Sheehy 1998): Gail has written numerous books mostly focusing on aging overall. In her new book, Men's Passages, she reflects on a few issues I have also addressed for years. One of the problems is euphemistically called male menopause-the ages between 45 and 65. Many men experience considerable health problems due to lack of exercise. She suggests that changing lifestyle to incorporate at least a half hour's walk can cut their mortality rate in half compared with their sedentary counterpart's In a recent study by the Cooper Institute for Aerobics Research, it stated "Exercise remains the single most potent anti-aging medication known to humankind."

Additionally, she addresses that a lot of people spend their young and middle years working hard and accumulating assets so that they can be comfortable in old age. However, she states that's almost the last thing that anyone should be almost at any time during life-too comfortable. Keeping an edge keeps you alive.

And is I have repeated over and over again, make sure that you recognize that your brain has to stay active as well. According to a neuroscientist at UC Berkeley, brain cells to tend to shrink as we grow older, but that's primarily due to lack of stimulation and challenge. If you keep staying active, even older brains develop new neural foliage. "There is no significant loss of brain cells- in the healthy brains of people who were living normal, healthy lives- all the way through old age."

OLD- AND GETTING OLDER: (1999) World Population: The global average for life expectancy had increased from 45 to 63 years from the1950's. However, 10% of the population is elderly- over 60 years of age. By 2050, it will increase to 20%.

The majority of people 60 and older, 55%, are women.

Among those 80 or older, 65 percent are women. Japanese women now have a life expectancy of 83, highest in the world. Nine million of the 43 million Americans 60 and older live alone and 80% are women.

Striking differences exist between regions with the elderly: one of five Europeans, for example, is 60 or older, compared to one of 20 Africans. By 2020, 46 percent of women 80 and older will live in Asia.

The American Association for Retired Persons said the Internet has been a boon to the elderly, with 47 percent of all online consumers over 50 and seniors more likely to contact family and others in the cyberspace community, thus reducing any feelings of isolation.

Dr. Anne Murray says that"successful aging" means maintaining three states: (2000)

High mental and physical function Exercise has been shown to improve energy level, lower blood pressure, and decrease the risk of heart disease, late-onset diabetes, and depression — all of which can increase lifespan and help a senior maintain independence.

Active engagement with life Remaining mentally active may decrease the risk or delay the onset of memory loss and dementia such as Alzheimer's disease.

Low risk of disease and disease-related disability Preventive medicine to avoid the onset, or slow the progression of, major illnesses such as heart disease, stroke, diabetes, and cancer is the other essential component of successful aging.

Indicator 14:  Chronic Health Conditions

TABLE 14:  PERCENTAGE OF PERSONS AGE 70 OR OLDER WHO REPORTED HAVING SELECTED CHRONIC CONDITIONS, BY SELECTED CHARACTERISTICS, 1984 AND 1995
	1984	1995		1984	1995
TOTAL			80 TO 84
ARTHRITIS	55.0	58.1	ARTHRITIS	57.3	61.4
DIABETES	9.9	12.0	DIABETES	10.8	11.0
CANCER	12.4	19.4	CANCER	15.2	20.2
STROKE	7.8	8.9	STROKE	9.6	10.4
HYPERTENSION	45.6	45.0	HYPERTENSION	48.6	47.8
HEART DISEASE	16.4	21.4	HEART DISEASE	20.0	23.0
MEN			85 OR OLDER
ARTHRITIS	44.9	49.5	ARTHRITIS	53.3	64.1
DIABETES	9.9	12.9	DIABETES	6.5	8.0
CANCER	13.8	23.4	CANCER	13.1	19.0
STROKE	8.3	10.4	STROKE	10.9	13.2
HYPERTENSION	36.8	40.5	HYPERTENSION	44.4	45.2
HEART DISEASE	18.7	24.7	HEART DISEASE	16.4	25.4
WOMEN			NON-HISPANIC WHITE
ARTHRITIS	61.1	63.8	ARTHRITIS	54.3	57.9
DIABETES	10.0	11.5	DIABETES	8.9	10.9
CANCER	11.6	16.7	CANCER	13.4	21.0
STROKE	7.3	7.9	STROKE	7.5	8.6
HYPERTENSION	50.8	48.0	HYPERTENSION	44.3	44.0
HEART DISEASE	14.9	19.2	HEART DISEASE	17.1	22.0
70 TO 74			NON-HISPANIC BLACK
ARTHRITIS	55.0	54.4	ARTHRITIS	64.6	67.2
DIABETES	10.8	13.4	DIABETES	17.0	20.4
CANCER	11.1	18.5	CANCER	4.6	9.1
STROKE	6.0	7.1	STROKE	10.8	12.2
HYPERTENSION	44.8	43.7	HYPERTENSION	59.3	58.7
HEART DISEASE	15.6	18.9	HEART DISEASE	11.5	18.5
75 TO 79			HISPANIC
ARTHRITIS	54.1	58.3	ARTHRITIS	50.6	50.2
DIABETES	9.7	12.6	DIABETES	17.4	17.4
CANCER	11.9	20.2	CANCER	6.2	10.5
STROKE	7.6	8.7	STROKE	8.3	9.6
HYPERTENSION	45.2	44.9	HYPERTENSION	46.9	42.0
HEART DISEASE	15.2	22.0	HEART DISEASE	13.3	17.0
Note: Hispanics may be of any race. 1984 percentages are age-adjusted to the 1995 population. Reference population: These data refer to the civilian noninstitutional population.| Source: Supplement on Aging and Second Supplement on Aging.

Indicator 16:  Depressive Symptoms

TABLE 16:  PERCENTAGE OF PERSONS AGE 65 OR OLDER WITH SEVERE DEPRESSIVE SYMPTOMS, BY AGE GROUP AND SEX, 1998
	TOTAL	MEN	WOMEN
65 TO 69	15.4	12.1	18.0
70 TO 74	14.3	10.3	17.2
75 TO 79	14.6	10.4	17.4
80 TO 84	20.5	17.1	22.4
85 OR OLDER	22.8	22.5	23.0
Note: Definition of severe depressive symptoms: four or more symptoms out of a list of eight depressive symptoms from an abbreviated version of the Center of Epidemiologic Studies Depression Scale (CES-D) adapted by the Health and Retirement Study. Reference population: These data refer to the civilian noninstitutional population. Source: Health and Retirement Study.

Indicator 18:  Disability

TABLE 18A:  PERCENTAGE OF MEDICARE BENEFICIARIES AGE 65 OR OLDER WHO ARE CHRONICALLY DISABLED, BY LEVEL AND CATEGORY OF DISABILITY, 1982 TO 1994
	1982	1984	1989	1994
TOTAL
LEVEL AND TYPE OF DISABILITY
IADLS ONLY	5.5	5.8	4.7	4.3
1-2 ADLS	6.4	6.5	6.3	5.8
3-4 ADLS	2.8	2.9	3.5	3.2
5-6 ADLS	3.4	3.1	2.8	2.8
INSTITUTIONAL	5.7	5.5	5.5	5.1
TOTAL	23.7	23.7	22.7	21.1
TOTAL MEDICARE POPULATION (IN THOUSANDS)	26,920	28,060	30,870	33,130
MEN
LEVEL AND TYPE OF DISABILITY
IADLS ONLY	5.0	5.0	4.2	3.8
1-2 ADLS	5.1	4.8	4.5	4.3
3-4 ADLS	2.2	2.3	2.8	2.1
5-6 ADLS	3.3	2.9	2.3	2.2
INSTITUTIONAL	3.8	3.4	3.6	3.2
TOTAL	19.5	18.4	17.4	15.5
TOTAL MEDICARE POPULATION (IN THOUSANDS)	10,590	11,050	12,410	13,410
WOMEN
LEVEL AND TYPE OF DISABILITY
IADLS ONLY	5.8	6.4	5.0	4.6
1-2 ADLS	7.2	7.5	7.6	6.8
3-4 ADLS	3.1	3.2	4.0	3.9
5-6 ADLS	3.5	3.2	3.0	3.2
INSTITUTIONAL	6.9	6.9	6.7	6.4
TOTAL	26.5	27.2	26.2	24.9
TOTAL MEDICARE POPULATION (IN THOUSANDS)	16,340	17,010	18,460	19,710
Note: National Long Term Care Survey researchers group tasks of daily living into two categories: activities of daily living (ADLs) such as eating, getting in and out of bed, getting around inside, dressing, bathing, and toileting; and instrumental activities of daily living (IADLs) such as heavy housework, light housework, laundry, preparing meals, shopping for groceries, getting around outside, traveling, managing money, and using a telephone. A person is considered to have an ADL or IADL disability if he or she is unable to perform the activity, uses active help to perform the activity, uses equipment, or requires standby help. A person is considered chronically disabled if he or she has one ADL limitation, one IADL limitation, or is institutionalized, and if any of these conditions has or is expected to last 90 days. Reference population: These data refer to Medicare beneficiaries. Source: National Long Term Care Survey.

 

TABLE 18B:  PERCENTAGE OF PERSONS AGE 70 OR OLDER WHO ARE UNABLE TO PERFORM CERTAIN PHYSICAL FUNCTIONS, BY SEX, 1984 AND 1995
	1984	1995
MEN
WALK	12.9	12.3
CLIMB STAIRS	9.3	8.2
STOOP, CROUCH, OR KNEEL	11.5	9.7
REACH UP	3.4	3.0
ANY ONE OF NINE	22.5	19.6
WOMEN
WALK	20.9	17.8
CLIMB STAIRS	16.0	12.3
STOOP, CROUCH, OR KNEEL	20.2	16.3
REACH UP	5.6	3.9
ANY ONE OF NINE	34.3	28.9
Note: Rates for 1984 are age-adjusted to the 1995 population. The nine physical functioning activities are: walking a quarter mile; walking up ten steps without resting; standing or being on your feet for about two hours; sitting for about two hours; stooping, crouching or kneeling; reaching up over your head; reaching out as if to shake someone’s hand; using your fingers to grasp or handle; lifting or carrying something as heavy as ten pounds. A person is considered disabled if he or she is unable to perform an activity alone and without aids. Reference population: These data refer to the civilian noninstitutional population. Source: Supplement on Aging, Second Supplement on Aging.

Aging well (Washington Post and the  Federal Interagency Forum on Aging ) The study, "Older Americans 2000: Key Indicators of Well-Being", gathered information from over a dozen national sources. Among its findings are: 13 percent of the population is aged 65 or older; the average life expectancy is 76 years; and 11 percent of elderly live in poverty, compared to 35 percent in 1959.

The report also illustrates serious disparities among racial and ethnic groups in various measures of well being, which may have a future impact on government and business.

Mobility problems (Women's Health and Aging Study II 2000):  Up to 50% of persons aged 65 years and older have disability in mobility-related tasks such as walking, climbing steps, transferring, or doing heavy housework.

Income and Assets of the Elderly and Near Elderly (2001) National Bipartisan Commission on the Future of Medicare. Very interesting research article.

Wanna Bet?: (2001) The Administration on Aging has prepared an excellent overview on gambling for older adults who are, perhaps, more vulnerable than other age groups given their greater dependence on fixed incomes and more limited ability to recover from gambling losses.

Aging Americans: Living Longer and Better  (2002)

Aging: (2002) 47% of those 50 to 64 have at least one chronic disease

51% of those between 65 and 74 have at  least one

37% of those over age 75 have at least one

Average life expectancy in 1900 was 47; it's now 77

There are about 4.2 million people in the U.S. over age 85

"HHS Programs and Initiatives for an Aging America"

This Fact Sheet from the U. S. Department of Health and Human Services summarizes various government programs and initiatives for elderly Americans.

The Looming Budgetary Impact of Society's Aging (2002) The Congressional Budget Office has started a new series of issue summaries relating to the federal budget beyond the 10-year focus that legislation requires for CBO's baseline. The latest in this series of nontechnical briefs is "The Looming Budgetary Impact of Society's Aging."

Aging:  (2002) A Dilemma for Parents and Kids WHERE WILL ELDERLY PARENTS LIVE? WHO WILL PAY FOR THEIR CARE? BOSTON-Adult children and their parents are not thinking the same thing when it comes to planning for how parents will be cared for as they get older, or how their care will be financed. Results from the "Long Term Care Partners Survey of American Parents and Adult Children," conducted by Zogby International, show that America's older parents (between the ages of 54 and 84) do not want to move in with their children. A higher percent of adult children, however, feel it is likely their parents will move in with them when they are unable to care for themselves. And both recognize there is a high likelihood adult children will be tapped to help finance their parents' future long term care needs.

Results of the survey showed that parents have a strong desire not to move in with their children should they need care; nearly two-thirds (64%) of parents with children over age 34 stated they would not want to move in with their children in their later years should they need care. Adult children, however, aren't quite so sure. Nearly half (44%) stated they felt their parents would want to move in with them should they need care. And an overwhelming majority (82%) of adult children between the ages of 34 and 65 are prepared to take care of their parents' day-to-day needs if they could not do so themselves.

Additionally, both recognize parents may need financial help with their long term care needs. Nearly one third (32%) of parents believe they'll need financial assistance from their children, while just under half (44%) of adult children expect to help their parents financially. However, children are not advising their parents to purchase long term care insurance (only 23% would consider doing so) and only 12% of parents polled say they have purchased long term care insurance for themselves.

"This study highlights that parents and adult children aren't having conversations about future care needs and/or don't fully understand their options," said Paul Forte, Chief Executive Officer, Long Term Care Partners, LLC. "Parents and children need to talk about these issues before they become crises. Planning before care is needed can help both parties achieve a better outcome in the long run."

Nursing homes are not a popular choice for parents or their children. Almost half (47%) of seniors say it is unlikely they will spend some time in a nursing home or assisted living facility. Adult children agree, with 53% stating their parents will not spend time in a nursing home. Overall, six out of every 10 Americans who reach age 65 will need long term care services. And care can be expensive. According to a 2002 study by the MetLife Mature Market Institute, the average national cost of care in a nursing home is $143 per day for a semi-private room and $168 a day for a private room. Care at home is expensive as well, according to the Institute. The average cost of a home health care aide averages $18 per hour nationally, or $158,000 for round-the-clock care.

"Clearly, children expect to take responsibility for their parents' care and to assume some of their financial obligations," said Forte. "There's a big question, though, as to how they will pay for the care that may be necessary. They ought to be thinking about long term care insurance as a means to help provide more options for them and their parents should care be needed in the future."

Training Improves Cognitive Abilities of Older Adults National Institute on Aging (2003)

Brain Aerobics  (2003)

The State of Aging and Health in America, (2003) produced by the Merck Institute of Aging & Health and released by the Gerontological Society of America, finds that 70 percent of the physical decline Americans experience with aging is due to factors that can be controlled,

Gerontological Society of America warns that the nation is facing a shortage of doctors, nurses, and other health professionals trained to care for aging Americans, a problem that is likely to worsen as the baby boomers reach old age. Already, many health problems of older Americans are misdiagnosed, overlooked, or dismissed as normal aspects of aging, exacerbating illness and driving up the nation's medical bills.

Elderly (Seigel) the number of workers per retiree in the U.S. will plummet from 3.9 today to 2.2 in 2030, in Europe from 2.98 to 1.70, and in Japan from 2.85 to 1.46. Fifty years ago, by comparison, the U.S. had 7 and Japan 10 workers for every retiree.

“Profile of Older Americans: 2002,” by the Administration on Aging

LTC: The 2003 Aging Vulnerability Index: An Assessment of the Capacity of Twelve Developed Countries to Meet the Aging Challenge," Center for Strategic and International Studies [CSIS]and Watson Wyatt Worldwide,

Washington, D.C., March 2003. Today, there are 30 pension-eligible elders in the developed world for every 100 working-age adults. By the year 2040, there will be 70. In Italy, Japan, and Spain, the fastest-aging countries, there will be 100. In other words, there will be as many retirees as workers. This rising old-age dependency ratio will translate into a sharply rising cost rate for pay-as-you-go retirement programs - and a heavy burden on the budget, on the economy, and on working-age adults in any country that does not take serious steps to prepare.

"The CSIS Aging Vulnerability Index assesses the 'vulnerability' of the developed countries to rising old-age dependency costs. In this first edition, the Index covers twelve countries - Australia, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Spain, Sweden, the United Kingdom, and the United States. In future editions, the Index may be expanded to include the rest of the developed world - or, data allowing, selected developing countries.

"The Index gives each country an overall ranking and score. The scores show that the twelve countries fall into three clear groups - a low, a medium, and a high vulnerability group.

"Low Vulnerability Group

"In the 2003 Index, the low vulnerability group includes Australia (1), the United Kingdom (2), and the United States (3). These English-speaking countries win the first three places thanks to their favorable demographics, their relatively inexpensive public benefit systems, and their well-developed private alternatives. The group does face some real challenges. The UK, for example, is finding it difficult to keep costs down without hurting elder living standards, while the United States must grapple with runaway health care spending. Still, all of these countries are in relatively good shape. Australia, in particular, is implementing a far-sighted strategy of mandatory private pension coverage that promises excellent results on all fronts.

"Medium Vulnerability Group

"There are six medium vulnerability countries: Canada (4), the English-speaking straggler; Sweden (5) and Germany (7), two continental European countries that have recently enacted major benefit reforms; Japan (6), which ranks much higher in the Index than its massive age wave might indicate; and the Netherlands (8) and Belgium (9), two countries with generous and unreformed benefit systems. All of the medium vulnerability countries, including Canada, face more serious demographic challenges than the low vulnerability countries. And despite recent reforms, all, including Sweden and Germany, face heavier old-age dependency burdens.

"High Vulnerability Group

"The high vulnerability group includes three major continental European countries that all face a daunting fiscal and economic future: France (10), Italy (11), and Spain (12). Their poor scores can be attributed, in varying degrees, to severe demographics, lavish benefit formulas, early retirement, and heavy elder dependence on pay-as-you-go public support. It is unclear whether they can change course without economic and social turmoil. Italy has scheduled big reductions in future pension benefits, but only after grandfathering nearly everyone old enough to vote. France and Spain have yet to initiate major reforms of elder benefit programs.

"The Index is compiled from indicators in four basic categories, each dealing with a crucial dimension of the challenge:

o Public-burden indicators, which track the sheer magnitude of the public spending burden in each country

o Fiscal-room indicators, which track each country's ability to accommodate the growth in old-age benefits via higher taxes, cuts in other spending, or public borrowing

o Benefit-dependence indicators, which track how dependent the elderly are on public benefits and thus how politically difficult it may be to reduce their generosity

o Elder-affluence indicators, which track the relative affluence of the old versus the young - another trend that could critically affect the future politics of benefit reform

"The projections underlying the Index are based on a 'historical trends' scenario, a no-wishful-thinking baseline that assumes a continuation of established demographic and economic trends. According to the projections, public benefits to the elderly will reach an average of 25 percent of GDP in the developed countries by 2040, double today's level. In Japan, they will reach 27 percent of GDP; in France, they will reach 29 percent; and in Italy and Spain, they will exceed 30 percent. This growth will throw into question the sustainability of today's retirement systems - and indeed, society's very ability to provide a decent standard of living for the old without overburdening the young.

"Aging Vulnerability Index 2003 Edition

"Rankings from Least to Most Vulnerable

Low Vulnerability

1. AUSTRALIA

2. UNITED KINGDOM

3. UNITED STATES

Medium Vulnerability

4. CANADA

5. SWEDEN

6. JAPAN

7. GERMANY

8. NETHERLANDS

9. BELGIUM

High Vulnerability

10. FRANCE

11. ITALY

12. SPAIN" (p. iii)

"Number 3: United States

"Of all the developed countries, the United States faces the most favorable demographic future. With the highest fertility rate and one of the highest immigration rates, it will be far and away the youngest of the twelve Index countries by 2040. Given this demographic advantage, together with a modest Social Security benefit formula, a relatively high rate of elder employment, and a well-developed private pension system, the United States could easily have ranked number one in the Index. But it did not, mostly due to the high projected growth in government health care benefits. The United States ranks third on the benefit-level and net-transfer indicators, but fifth on the benefit-growth indicator, lower than two of Europe's biggest welfare states, Sweden and Germany. Also, unlike Australia or the UK, the United States has no overall policy in place to expand its private pension coverage in the future. The growing relative affluence of US elders, however, augurs well for possible cost-cutting reforms down the road."

An Aging, Fatter Population Drives Demand for New Medical Devices (2003) The use of implantable devices to treat heart disease, orthopedic complaints and other conditions is growing steadily because of advancing technology, increasing demand from an ageing and overweight population, and greater acceptance of implantation as an alternative or a complement to medication. With an estimated 35 million Americans suffering from conditions that can be treated by the devices, the potential for growth is huge, as a recent conference sponsored by Wharton’s Emerging Technologies Management Research program pointed out.

But therein lies the problem. It is going to cost a LOT more money. And LTC costs will increase as well.

Aging: (2003) The UN has made the latest population figures, from “World Population Prospects: The 2002 Revision” available on-line as an interactive database. It provides population estimates from 1950 to 2050, and includes a wide variety of aging-related data.

Cognitive decline: (2003) The process of aging does include a normal degree of forgetfulness, due in part to reduced hormone production, changes in neurons (specialized brain cells) and decreased speed in the brain's processing of information. However, researchers see promising indications that they soon may discover ways to avoid cognitive aging and maintain cognitive vitality

Of all people over the age of 85, 40 to 50 percent suffer from Alzheimer's, a non-treatable disease. Severe dementia affects 1.8 million Americans. Mild to moderate cognitive impairment, which falls somewhere between age-associated memory loss and early dementia, is experienced by 1 to 5 million

Most cognitive complaints registered by older adults are not caused by dementia. These cognitive problems, usually preventable or treatable, include symptoms of depression, poor health habits or minor strokes.

Complaints of forgetfulness are often one symptom of depression. Clinical depression affects 1 to 5 percent of older adults with 80 percent of those seeking treatments responding successfully.

Poor health habits represent 20 percent of memory complaints, which include poor diet, lack of physical activity and misuse of medications and alcohol.

Dementia:  (2003) Participation in leisure activities such as reading, playing board games, playing musical instruments or dancing is associated with a reduced risk of dementia, even after adjusting for base-line cognitive status and excluding subjects with possible preclinical dementia, Dr. Joe Verghese with the Einstein Aging Study at Albert Einstein College of Medicine reported in this week’s New England Journal of Medicine. Controlled trials are needed to assess the protective effect of cognitive leisure activities on the risk of dementia. It had been unclear whether increased participation in leisure activities lowers the risk of dementia or participation in leisure activities declines during the preclinical phase of dementia.

Verghese and other researchers studied 469 community-dwelling subjects older than 75 years of age who did not have dementia at base line. They derived cognitive-activity and physical-activity scales and measured activity-days per week. Cox proportional-hazards analysis was used to evaluate the risk of dementia according to the base-line level of participation in leisure activities, with adjustment for age, sex, educational level, presence or absence of chronic medical illnesses, and base-line cognitive status.

Over five years, dementia developed in 124 subjects (Alzheimer's disease in 61 subjects, vascular dementia in 30, mixed dementia in 25, and other types of dementia in 8). Among leisure activities, reading, playing board games, playing musical instruments, and dancing were associated with a reduced risk of dementia.

The research is in the June 19 New England Journal of Medicine (Vol. 348, No. 25:2508-2516).

Cognitive Vitality: (2003) A study in the June 19 th issue of the New England Journal of Medicine found that older people who engage in mentally challenging activities, such as reading, doing crossword puzzles, and playing board games can significantly reduce their risk for Alzheimer’s disease and other forms of dementia by almost two-thirds, compared to those who rarely engage in such activities. The study highlights the importance of maintaining cognitive vitality as one ages.

“Evaluating and Treating Older Adult Urinary Incontinence: (2003) A Step-wise Approach for Primary Care Providers,”

The American Geriatrics Society has posted a step-by-step approach for primary care providers to evaluate and treat urinary incontinence (UI) in older adults. The approach was developed by AGS’ Urinary Incontinence Education Initiative Editorial Board, chaired by Dr. Patricia P. Goode. AGS notes that most people with UI, which is not a normal part of aging, do not need to be referred to a specialist.

People with UI have a high incidence of complications such as skin breakdown, urinary tract infections, falls and fractures. These complications are associated with substantial morbidity and mortality. Moreover, UI and its associated complications often contribute to the decision to institutionalize frail elders. UI-related costs total more than $36 billion annually, AGS indicates.

Center on an Aging Society: The Center released a Center for Studying Health System Change: The Center has performed a study of health care costs in 2002, finding that health care spending per privately insured American increased 9.6 percent in 2002, a slight decrease from the rate of growth in 2001 of 10%, but almost four times the growth in the nation’s GDP. A decrease in the growth of prescription drug costs is one reason for the lower spending trend in 2003. In addition, the study found that private health insurance premium trends accelerated in 2003—increasing an average of 15 percent, the largest jump in at least a decade—and continued to outpace underlying health  are spending.

International Longevity Center (ILC 2003): The ILC has produced a new publication “Has Anyone Ever Died of Old Age?” authored by Leonard Hayflick and Harry R. Moody. The publication contains essays by each author that examine the omission of aging as a legal cause of death and the largely unrecognized contribution the aging process plays in mortality. The essays highlight the need to better understand the underlying biology of aging.

Dementia: (2003) Older women taking combination hormone therapy had twice the rate of dementia, including Alzheimer's disease (AD), compared with women who did not take the medication, according to findings from a memory substudy of the Women's Health Initiative (WHI), part of the Women's Health Initiative Memory Study (WHIMS), reported by WHIMS Principal Investigator Sally A. Shumaker, with the Wake Forest University School of Medicine, and colleagues at the 39 sites involved in the study.

Researchers found the heightened risk of developing dementia in a study of women 65 and older taking Prempro, a particular form of estrogen plus progestin hormone therapy. The study also found that the combination therapy did not protect against the development of mild cognitive impairment, or MCI, a form of cognitive decline less severe than dementia. The memory substudy was funded by Wyeth Pharmaceuticals, which manufactures Prempro.

“Because of possible harm in some areas and lack of a demonstrated benefit in others, we have concluded that combination hormone therapy should not be prescribed at this time for older, postmenopausal women to maintain or improve cognitive function,

The risk for dementia among women taking estrogen and progestin was twice that of women taking placebo pills. This represents an increase per year from 22 women per 10,000 at risk of dementia in the placebo group to 45 women per 10,000 in the combination therapy group, an additional 23 cases per 10,000 per year among women taking combination therapy. Sixty-one cases of dementia were diagnosed among the 4,500 women participating in the study; 66 percent of those cases occurred among women on combination therapy while 34 percent occurred in women taking placebo.

Aging: (2003) By 2035 the 70-plus age group will more than double, from about 26 million last year to 57 million

If people reach age 70 in good health, their life expectancy isn't likely to be affected by diseases that run in their family

When people get older, extra pounds are associated with longer life. If someone older is underweight, that can be of concern. Obesity is an entirely different issue.

Has Anyone Ever Died of Old Age? (PDF) LONGEVITY CENTER–USA, Leonard Hayflick, Ph.D., Harry R. Moody, Ph.D.

Answering the Difficult Questions About Aging

Travel Guidelines For People With Dementing Illness, Geri Richards Hall, PhD, ARNP, CNS, FAAN, Department of Neurology, UIHC and Associate Director of Outreach and Policy University of Iowa Center of Aging

Exceptional article and mandatory reading

"Live Long and Prosper: Challenges Ahead for an Aging Population," Thomas Klitgaard (Current Issues in Economics and Finance, February 2002) Over the next thirty years, the percentage of people who are sixty-five and over will grow rapidly while the percentage of people in their working years will decline. This shift in the age distribution of the population will put enormous pressure on social security systems in the United States, Germany, and Japan as the number of workers whose payroll taxes fund each retiree drops sharply.

Is It Time to Take the Keys Away? (Michael Plontz 2003)

Caring for a loved one requires walking a fine line. We want our loved one to maintain as much freedom as possible while staying as safe as possible. One of the difficult decisions to make­, keeping the previously mentioned goals in mind, is whether to let your elderly loved one get behind the wheel of his or her vehicle.

According to a WebMD article entitled “The Car Key Decision,” one in eight drivers in America today are over 65 years old. One in five drivers will be over 65 in 25 years. That makes this issue a big deal.

According to the Insurance Institute for Highway Safety, 12 states now require that older drivers renew their licenses more often than younger drivers. In Illinois, drivers 75 or older must take a road test each time they renew. Also, they must renew every two years starting at age 81, and once a year after 87. A similar bill in California last year brought about the typical politically correct opposition who called the bill “ageist.” Ultimately the references to age were deleted.

One thing remains certain. It is not an easy subject to approach with a loved one, but concern for their safety overrides that. The main concerns for older drivers are cataracts, decreased reaction times, and loss of peripheral vision. There are operations now that can fix these eye problems. Reaction times can also be improved. Computer training sessions on making quick driving decisions can improve reaction times by sometimes 40% or greater. These programs are not yet widely available, but others are. The 55 and Alive class given by AARP helps sharpen seniors’ driving skills.

However, there comes a time when most loved ones must be persuaded to give up their keys. While some give them up easily, most need persuasion by their doctor and you. If more drastic measures need to be taken, social workers, police officers, and the Department of Motor Vehicles may be enlisted to help. By filing a hazardous driver report with the DMV. They will revoke the license, and most people will comply--some with bitterness. This approach may appeal to the loved one’s respect for authority figures.

This is by no means an easy issue or an easy task, but when the safety of your loved one is at stake, all the stops must be pulled out.

Good article. I believe I will be involved with this decision with my friends in Florida in a year or less.

Old?:- older people now make up 12 percent of the nation's workers, up from 10.2 percent in 2000.

Since March 2001, when the last recession began, the percentage of working people in the population of 55- to 64-year-olds has steadily risen, reaching a peak of 60 percent in the spring, or 16.4 million men and women, up from 58.1 percent and 14.5 million workers. While that gain appears to have tapered off this summer, the older workers were still the only age group to improve their lot in the recession and jobless recovery.

the average weekly wage of the 55- to 64-year-olds, adjusted for inflation, reached $673 by the end of last year, up 4.5 percent from the $644 in 2000. That is a faster pace than the wage gains of any other age group, according to the Economic Policy Institute, which analyzed the bureau's wage data. Only the 25- to 34-year-olds, earning $590 in 2002, came close, increasing their average wage by 2.7 percent over the same period.

De-Stigmatizing Urinary Incontinence by Michael Plontz 2003

Ageism: How Healthcare Fails the Elderly (PDF) The Alliance’s report cites serious medical short-comings in medical training, prevention screening and treatment patterns that disadvantage older patients. The report outlines five key dimensions of the ageist bias in which US healthcare fails older Americans:

Healthcare professionals do not receive enough training in geriatrics to properly care for many older patients.

Older patients are less likely than younger people to receive preventative care.

Older patients are less likely to be tested or screened for diseases and other health problems.

Proven medical interventions for older patients are often ignored, leading to inappropriate or incomplete treatment.

Older people are consistently excluded from clinical trials, even though they are the largest users of approved drugs.

International Ageing: Between 2000 and 2020, Japan will experience an increase of 102% in public financing of long-term care. In comparison, the United Kingdom and the U.S. will experience a 20-21% increase.

Aging and decision making: A comparison between neurologically healthy elderly and young individuals  ( Kovalchik, Stephanie; Camerer, Colin F.; Grether, David M.; Plott, Charles R.; Allman, John M. 2004)

Abstract: We report the results of experiments on economic decisions with two populations, one of healthy elderly individuals (average age 82) and one of younger students (average age 20). We examine confidence, decisions under uncertainty, differences between willingness to pay and willingness to accept and the theory of mind (strategic thinking). Our findings indicate that the older adults decision behavior is similar to that of young adults, contrary to the notion that economic decision making is impaired with age. Choices over lotteries do not reflect the age differences previously reported in the psychology and biology literature. Moreover, some of the demonstrated decision behaviors suggest that the elderly individuals are less biased than the younger individuals.(1)There is a greater prevalence of overconfident behavior in the younger population. (2) Our results show no significant support for a theory of an endowment effect in either population. (3) Both populations perform similarly on the beauty contest task, although there is a modest indication of a higher incidence of confused behavior by the older

Exercise the brain: (2004) If you hit the weights at the gym with iron regularity, your arms may get to look a little more impressive. The right kind of training, it now appears, can do much the same for the brain.

In a study conducted by Dr. Arne May and colleagues at the University of Regensburg in Germany, people who spent three months learning to juggle showed enlargement of certain areas in the cerebral cortex, the thin sheet of nerve cells on the brain's surface where most higher thought processes seem to be handled. They were then asked to quit juggling completely, and three months later the enlarged areas of the cortex had started to shrink.

National Institute of Health Senior Health  A web site for older adults. NIHSeniorHealth makes aging-related health information easily accessable for older people as well as their family and friends. The site features authoritative and up-to-date health information from Institutes and Centers at NIH. In addition, the American Geriatrics Society provides expert and independent review of some of the material found on this web site.

Alliance for Aging Research: The Alliance has released the winter issue of its webzine “Living Longer and Loving It!” This issue includes a discussion of the hype and the reality surrounding anti-aging efforts, the importance of geriatrics education and training, a profile of the 82 year old captain of a senior hockey team called the Geri-Hatricks, and other interesting issues.

Living and dying:  (2004) It is estimated that in 2001, 72 million of the 6.1 billion inhabitants of the world are 80 years or older (United Nations, 2001). The population of the oldest-old (e.g. those 80 years and older) constitutes therefore 1.2 per cent of the world’s population but, although it is a small fraction of the whole, it is the fastest growing segment of the population. Thus, whereas the world population is expected to increase by about 50 per cent and to reach 9.3 billion by 2050, the number of people aged 80 years or older is expected to increase more than five-fold, to reach 379 million in 2050 (Figure 1). Most of the growth of the oldest-old population will occur in the developing world where their numbers are expected to increase almost eight-fold, from 34 million in 2001 to 266 million in 2050. In the more developed countries, the number of oldest-old will likely triple, passing from 38 million to 113 million. By 2050, therefore, the majority of the oldest-old will be living in the less developed regions of the world. Furthermore, because life expectancy continues to increase, not only are an increasing number of people surviving to very old ages but also deaths to the oldest-old are accounting for an increasing proportion of all deaths. Thus, at the global level, 18 out of every 100 deaths expected in 2000-2005 will be to persons aged 80 years or older (i.e., 10 million out of the expected 55 million deaths). In the more developed regions, the proportion of deaths to persons aged 80 or over is expected to be much higher¾ 42 per cent¾and those proportions are expected to keep on rising.

HAS ANYONE EVER DIED OF OLD AGE?, International Longevity Center, Leonard Hayflick and Harry R. Moody,

Prospective study of type 2 diabetes and cognitive decline in women aged 70-81 years, Giancarlo Logroscino, Jae Hee Kang, Francine Grodstein

Hearing Problems in Loved Ones

Assisted suicide:  Richard Huxtable, lecturer in medical law and ethics, Centre for Ethics in Medicine, University of Bristol, Bristol BS2 8BH

Diabetes, Exercise and Caregiving

The Center for Retirement Research at Boston College: (2004) The Center has just released a new Just the Facts entitled “Why Are So Many Older Women Poor?” The report documents that 18 percent of non-married older women fell below the poverty line in 2000, and another 10 percent were near poor (i.e.below 125% of the poverty threshold. Moreover, older non-married woman are a large segment of the population. The report highlights two key reasons for why these older single women are poor. First, the retirement income system is based on lifetime earnings and women have lower earnings for a variety of reasons (such as wage inequalities and less time in the workforce due to child raising). Second, women live longer than men and when the husband dies their income usually declines (i.e. Social Security benefits are reduced and private pension income is reduced or ends entirely). The report also projects that without significant changes in the retirement income system and/or in work and savings behavior, their economic position could become even more precarious in the future.

OLD  (AARP 2004) older Americans often feel overwhelmed when confronted with tasks such as choosing a health care provider or selecting investments for a retirement account or sorting through telephone service options.

Older Americans spend an average of $38,787 a year, with nearly a third going to housing, the study found. Other major categories include 13 percent for food, 7 percent for health care, 19 percent for transportation, 10 percent for insurance and pensions, and the rest for other purposes, such as entertainment, alcohol and tobacco, and personal care products.

Why Are So Many Older Women Poor? (Alicia H. Munnell 2004) The economic status of older Americans has improved dramatically since 1960. Today, the poverty rate for those 65 and over is about the same as for those aged 18-64. But substantial pockets of poverty remain, especially among older non-married women. This brief will focus on why older women are particularly vulnerable. It also reviews the outlook for the future, when the graying of the population will place increasing pressure on resources available for the elderly.

Of all the factors associated with poverty in old age, the most critical is to be a woman without a husband. 18 percent of non-married women fell below the poverty line in 2000. Another 10 percent of older single women were classified as “near poor,” which means that they had an income of less than 125 percent of the poverty threshold. Thus, 28percent of single older women are either poor or near poor — a clearly vulnerable group as the nation grays.

Non-married women in 2000 accounted for about 30 percent of all house-holds aged 65-69 and more than 60 percent of households aged 85 and over.

Mixing Muscle and Maturity

As You Age...A Guide to Aging, Medicines, and Alcohol Substance Abuse and Mental Health Services Administration

Does Aerobic Exercise Slow Progression of Atherosclerosis? American College of Physicians

Tips for a Healthy Life for Men Centers for Disease Control and Prevention, Office of Women's Health (Notice it was written by a woman)

De-Stigmatizing Urinary Incontinence, by Michael Plontz

Too often caregivers feel that their loved one’s incontinence is a natural result of aging, dementia, medication or disability. They may not seek help because they assume that nothing can be done. But that might not be entirely true. Let’s learn about this too-little-talked-about condition.

First of all, we need a basic anatomy lesson. The urinary system contains a urethra, a bladder, two ureters, and two kidneys. A circular muscle called the sphincter can play a role in incontinence, but it is not an official part of the urinary system. The kidneys remove waste from the blood and turn it into urine. The muscular ureter tubes move the urine from the kidneys to the bladder. The balloon-like bladder stores the urine until it’s released through the urethra. If any part of this system malfunctions, incontinence could occur.

More often than not, incontinence in women occurs because of problems with muscles that aid in holding or releasing urine. While urinating, bladder wall muscles contract, forcing urine from the bladder into the urethra. While this is happening, sphincter muscles surrounding the urethra relax, letting urine pass from the body. If bladder muscles suddenly contract or muscles surrounding the urethra suddenly relax, incontinence will occur.

Many things can cause incontinence—some temporary, some not. The temporary causes may include constipation, medication side effects, urinary tract infections, and vaginal irritation or infection. Causes that aren’t temporary could include a weak bladder, weak urethral sphincter muscles, weak pelvic floor muscles due to pregnancy and childbirth, overactive bladder muscles, nerve disorders, immobility, a blocked urethra(sometimes because of an enlarged prostate), or a hormonal imbalance(especially in menopausal women). As you might be able to deduce from that list, twice as many women experience incontinence as men.

There are several types of incontinence: stress incontinence, functional incontinence, overflow incontinence, and urge incontinence. If your loved one has a combination of two or more types, they are said to have mixed incontinence. Another type, transient incontinence, is the temporary type, triggered by the temporary causes in the previous paragraph. Let’s explore the different types in more detail.

Stress Incontinence

The stress here is physical not emotional. Stress incontinence is the most common form of incontinence in women. It is normally the result of the pelvic floor muscles stretching after childbirth, certain surgeries or weight gain. The neck of the bladder drops due to this stretching and the neck may open when any pressure in the abdomen on the bladder causes leakage. The leakage is worse during a woman’s menstrual period and during menopause. That’s because the decrease of estrogen leads to lower muscular pressure around the urethra. Pressure on the bladder while laughing, sneezing, coughing, lifting, running, or getting out of a bed or chair may cause leaking.

Functional Incontinence

With this type of incontinence the person has normal bladder control but, due to a physically limiting disorder, they are unable to reach a toilet in time. For instance, someone in a wheelchair might be blocked from getting to a toilet on time or someone with Alzheimer’s may not think well enough to plan a trip to the bathroom. This is a big problem in many nursing homes.

Overflow Incontinence

Here the bladder is always full, so small amounts of urine leak out. It feels as though your bladder is never completely empty or you may feel the need to empty it and you can’t. Small amounts of urine are often lost during the day and night, frequent trips to the bathroom may produce only a small amount of urine leaving the feeling that the bladder is still partly full, and a long time spent on the toilet may produce a weak, dribbling stream of urine.

The causes of overflow incontinence can be loss of normal bladder control in a person with diabetes, obstruction of the urethra due to an enlarged prostate gland, or tumors and urinary stones that may also block the urethra. This is a serious condition that requires immediate medical attention. If left untreated, it can cause urine to flow backwards from the bladder to the kidney that raises the risk of kidney infection and even permanent damage. This type of incontinence is rare in women.

Urge Incontinence

Urge incontinence is an overpowering urge to urinate followed by leakage of a large amount of urine. The muscles that help control the bladder spasm which can be scary, because it happens too quickly to get to a bathroom. Some medical professionals might describe such a bladder as “unstable,” “spastic,” or “overactive.” Also, this condition is sometimes called reflex incontinence.

If you have urge incontinence, you may leak urine when you drink even a small amount of liquid or even when you hear or touch running water. Usually you go to the bathroom very often and you may even wet the bed. It’s best to drink very little after 6pm.

Urge incontinence is often caused by nerve damage, alcohol consumption, bladder infection, or some medications. It is common in menopausal women, people with diabetes, multiple sclerosis, dementia, Parkinson’s disease, and those who have suffered strokes. Others have chronic pelvic tension in the muscles surrounding the urethra due to sexual abuse, or vaginal or urinary infections, and they don’t pick up on weak signals that their bladder is full. Some people have bladders that contract spontaneously, without warning causing loss of urine.

Maintain Muscle and Increase Physical Activity  (2004) Weight loss due to cancer is different than weight loss from dieting and exercise. People with cancer lose weight, and therefore muscle, without intending to for two major reasons: They burn too many calories or they eat too little food. Or both.

Depression in the Elderly is Often Under Diagnosed, By Jennifer B. Buckley It has been estimated that 15% of older Americans experience depression at some point in their elderly years. In nursing homes, around 20% of residents are depressed, and it is also common with elderly people living with a serious medical condition like cancer or heart disease.

Normal Aging or Dementia?, by Sherri Issa Good article- read all of it. (2004)

In the early stages of dementia, distinguishing dementia from normal aging can challenge families and friends. Initially dementia can be fairly innocuous as most people compensate for minor mental slip-ups with notes, reminders, and "rational-lies".

Since social skills are generally the last to go, short visits with someone who has early dementia may not reveal anything wrong. She may look as she always did, chat about old times, and socialize as usual. Caregivers, who don't want to believe that something might be wrong, often dismiss inappropriate appearance, changes in behavior, and memory lapses without realizing it.

the following include common signs and symptoms of beginning dementia:

Short-term memory loss - important details of recent events are forgotten frequently and permanently.

Self neglect - personal hygiene is neglected, such as mouth care, brushing hair, or wearing the same or soiled clothing.

Erratic emotional responses - the person becomes more anxious, restless, or tearful.

Speech difficulty - one word is confused for another; finding the right word is more difficult.

Impaired abstract thinking- counting and balancing the checkbook becomes increasingly challenging, the person may pay bills twice or forget to pay some bills; a lifetime golfer may have more difficulty choosing the appropriate club.

Poor judgment- the person makes unsafe or unusual decisions, he may not remember to make sure traffic is clear before driving or walking across the street.

Bureau of the Census, "National Population Projections--Annual Projections of the Resident Population by Age, Sex, Race, and Hispanic Origin: Lowest, Middle, Highest Series and Zero International Migration Series, 1999 to 2100," middle-series data,

Alcohol drinking in middle age and subsequent risk of mild cognitive impairment and dementia in old age: a prospective population based study (Tiia Anttila, Eeva-Liisa Helkala, Matti Viitanen, Ingemar Kareholt, Laura Fratiglioni, Bengt Winblad, Hilkka Soininen, Jaakko Tuomilehto, Aulikki Nissinen, Miia Kivipelto)

Normal Aging or Dementia?

Neurology: Dementia

Temporal relation between depression and cognitive impairment in old age: prospective population based study

David J Vinkers, Jacobijn Gussekloo, Max L Stek, Rudi G J Westendorp, Roos C van der Mast

Chronic Disease: Chronic diseases account for seven of the 10 leading causes of death in the United States, including the three leading causes of preventable death (tobacco use, improper diet and physical inactivity, and alcohol use). In addition, 70% of health-care costs in the United States are for chronic diseases. Seven of every 10 U.S. residents who die each year (>1.7 million persons) do so as a result of a chronic disease. Chronic diseases affect the quality of life of 90 million U.S. residents (1), and the cost of medical care for persons with these diseases accounts for 70% of total medical care expenditures

Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. Adopting healthy behaviors (e.g., eating nutritious foods, being physically active, and avoiding tobacco use) can prevent or control the effects of these diseases. In addition, quality of life is enhanced when chronic diseases are detected and treated early. Regular screening can reduce morbidity and mortality from cancers of the breast, cervix, colon, and rectum. Clinical preventive services can prevent the debilitating complications of diabetes and cardiovascular disease.

the Council of State and Territorial Epidemiologists has released these revised indicators for chronic disease surveillance. Of the 92 indicators, 24 are for cancer; 15, cardiovascular disease; 11, diabetes; 7, alcohol; 5 each, nutrition and tobacco; 3 each, oral health, physical activity, and renal disease; and 2 each, asthma, osteoporosis, and immunizations. The remaining 10 indicators cover such overarching conditions as poverty, education, life expectancy, and health insurance.

Positron Emission Tomography (FDG) and Other Neuroimaging Devices for Suspected Dementia

Managing comorbidities in patients at the end of life, Chronic conditions require careful management in patients who develop a life limiting illness. Doctors need to consider both the physical and psychological effects of treatment

Activities For People With Dementia

Disease management: people with chronic diseases account for more than two-thirds of the nation's $1.6 trillion medical bill, a figure that is expected to grow as baby boomers age. The aim of disease management, whether through the family doctor or a health-plan service, is to educate patients about their disease and help them manage its symptoms, such as controlling blood sugar in diabetics to stave off blindness, kidney failure and amputations.

The percentage of employer-sponsored health plans offering disease-management programs grew to 58% last year from 41% the year before.

Typically, chronically ill patients are monitored over the phone via nurse call centers, which work with information provided by labs, doctors and pharmacies. Disease-management programs are now expanding to include depression, cancer, kidney disease, obesity and lower-back pain.

There is plenty of evidence to show that taking better care of chronically ill patients can improve the quality of life, slow the progression of disease and reduce hospitalizations.

Geriatric Medicine: Long term care

Living on cruise ships is cost effective for elderly people, Janice Hopkins Tanne

Drugs and mortality: (2005) As of 2003, 8.2% of people in the United States over the age of 12 report having used an illicit drug within the past month, and 15% reported use within the past year. While 46% of the population reported illicit drug use at least once in their lifetime, the rate for people ages 35-43 is significantly higher, about 50% higher than the mean.

According to NSDUH statistics, the use of illicit drugs has declined by 50% since 1979. About 60 million people who used drugs when they were younger, especially people who now are over age 35, no longer use them. About one-third of drug abuse is cocaine and misuse of prescription drugs.

Alcohol, a legal substance, is used by more than 50% of the population. The NSDUH found that 22.6% of the population had participated in binge drinking, defined as five or more drinks on one occasion, within the past 30 days, and 6.8% were heavy drinkers, defined as five or more drinks on a single occasion at least five days within the past 30 days. People aged 18-25 were most likely to be binge drinkers and heavy drinkers.

The same study found that 29.8% of people surveyed had used tobacco within the past month. That figure includes 25.4% who smoke cigarettes; 90% of chronic pulmonary disease is related to cigarette smoking.

Tobacco use is the leading cause of death in the United States with about 435,000 deaths annually resulting from it. Alcohol use/abuse causes about 101,000 deaths annually; reactions to and abuse of prescription medications, 32,000 deaths annually; illicit drug use, 19,000 deaths annually; NSAIDS and drugs like aspirin, about 7,600 deaths annually; and marijuana, zero deaths annually.

Drug use is not confined primarily to lower socioeconomic groups. “It’s really pervasive in our society and permeates all levels of our society,” Dr. Henricks said. Almost 75% of drug users are employed.

The highest rates of current illicit drug use are among workers of employers that have fewer than 50 employees. Drug and alcohol users are more likely to be young males, with relatively low education and income levels. The food industry, construction, and transportation and material moving occupations have particularly high rates of illicit drug use and alcohol abuse.

Commonly used illicit drugs are cocaine, heroin, and methamphetamine. Cocaine is so highly addictive that after trying the drug once, a user cannot predict or control his or her future use. More than 5.5 million people in the U.S. have used cocaine in the past year, and 2.3 million of them have used it within the past month. Cocaine can be administered by smoking, intravenously, or through a mucosal membrane. Many users, probably 30% to 60%, combine cocaine with alcohol, which greatly increases the risk.

The risk of acute myocardial infarction (MI) is 24 times higher than normal in the first 60 minutes of cocaine use,

Half of the MIs occur in persons with no evidence of atherosclerosis. Warm weather increases cocaine’s mortality risk; cocaine-related mortality is 33% higher in the summer months.

Heroin has about 600,000 addicts in the United States. Lower purity forms are injected, while higher purity forms can be snorted or smoked. Heroin-related causes of death include hepatitis B and C, HIV, cardiac deaths from malignant dysrhythmias, overdose, and interplay of firearms.

About 5 million persons in the U.S. have tried methamphetamine, and about 6% of adults and juveniles arrested test positive for it. The drug’s medical risks are similar to cocaine. It is widely available, especially in the West, Southwest, and Midwest.

An estimated 14.6 million persons in the U.S. smoke marijuana, and about 5 million use it frequently (at least 51 days a year). It accounts for 77% of current illicit drug use. About 57% of these people use no other illicit drugs.

Medication abuse and misuse also increase mortality risk. Painkillers, psychotherapeutic drugs, and anabolic steroids are the kinds of drugs most likely to be abused intentionally. Older patients who see multiple physicians for different conditions and have many prescriptions may combine drugs inappropriately but unintentionally.

drug abuse has decreased overall since the late 1970s, but rates of lifetime illicit drug use remains significantly higher in baby boomers. This use is increasingly serious from a mortality viewpoint as the group matures into what he termed “their coronary years.”

Elderly: (NY Times 2005) Census figures show that 6.5 million older Americans need daily assistance and that the number of Americans 85 and older is expected to quadruple in 45 years.

Independent-living communities offered basic services like housekeeping, meals in dining rooms, social activities, transportation and security. Assisted-living communities went further, providing help with daily activities like bathing, dressing and getting around, along with 24-hour oversight. Once the medical needs of residents reached a certain point, they would have to move to a nursing home. Continuing-care communities cover the spectrum at one site - from independent-living to nursing home services.

In the past, residents of a continuing-care community had one long-term contract, requiring a sizable entry fee and monthly maintenance payments. But in recent years, wide ranges of arrangements have evolved. There are more types of housing as well as new ways to pay for it, including some plans in which nearly all the down payment is returned upon departure.

When examining the options, consumers should first consider the services they need - both now and in the future - and how much they can spend

Costs vary greatly, depending on the facility, the services and the region. Classic Residence by Hyatt, for example, operates 17 facilities in the United States. At its independent-living sites, the monthly fee for a studio apartment in Reno, Nev., starts at $1,900, while a one-bedroom in Teaneck, N.J., starts at $3,800. For its continuing-care communities, the entrance fee in Lantana, Fla., starts at $103,400 for a one-bedroom, one-bath apartment, with an additional $1,733 monthly fee, while in Palo Alto, Calif., units start at $569,400 for a one-bedroom, one-bath unit with an additional monthly fee of $3,105. The entrance fee there can go up to $4.2 million, and a monthly fee of $7,430, for a three-bedroom, three-and-a-half-bath unit with a den.

Specialists on housing for the elderly say that assisted-living facilities do not always make clear the rules for discharging a resident. In addition, some states do not regulate assisted-living facilities.

AGING IN AMERICA 2004 LINK:  Merch Institute of Aging and Health (pdf- 48 pages) “In the United States, 20% of all Americans, or about 70 million people, will have passed their 65th birthday by 2030. Aging in the 21st century, however, is more than just a matter of numbers. The average 75-year-old has three chronic conditions and uses five prescription drugs. Older adults also have unique challenges and different medical needs than younger adults. Consequently, it is not enough to be aware of the demographic imperative; we must also be prepared for it. This report presents information and recommendations on what policy makers, practicing physicians and patients can and must do to ensure not just longer lives but better lives for Americans. It presents specific calls to action to help promote good health, prevent chronic disease and postpone disability for older adults. Most of all, this report forces us to realize that we must face our demographic challenge with sustained attention and significant action.”

OLD: (2005) The Census Bureau predicts that 26 states will double their populations of people older than 65 by 2030, when the oldest members of the baby boom generation hit their 80s. Florida, Pennsylvania, Vermont, Wyoming, North Dakota, Delaware, New Mexico, Montana, Maine and West Virginia will have fewer children than elderly. Only the District of Columbia will grow younger (most politicians are babies anyway). The growth in the 65-and-older population will be about 3½ times the growth of the nation as a whole.

More than one in four residents will be 65 and older in six states by 2030: Florida, Wyoming, Maine, New Mexico, Montana and North Dakota.

In 2000, 24% of Maine's residents were younger than 18, and 14% were 65 and older. By 2030, the numbers will flip: 18% will be school-age, and 27% will be elderly.

The projections, the first the Census Bureau has done for states in eight years, are based on immigration and migration patterns and rates of births and deaths. If the trends continue until 2030:

• The South and West will gain more influence at the expense of the Midwest and Northeast. The share of Americans living in those regions will increase from 58% in 2000 to 65% in 2030. The share in the Midwest and Northeast will decline from 42% to 35%.

• Michigan and New Jersey will be bumped off the list of the 10 most populous states by North Carolina and Arizona.

• California, Texas and Florida each will gain more than 12 million residents and together will account for 46% of the nation's growth. Such growth will pressure natural resources and public works.

Obesity in middle age and future risk of dementia: a 27 year longitudinal population based study, Rachel A Whitmer, Erica P Gunderson, Elizabeth Barrett-Connor, Charles P Quesenberry, Jr, Kristine Yaffe

Lifetime intellectual function and satisfaction with life in old age: longitudinal cohort study,

Elderly drivers: (2005) Elderly men have 6 years where they are unable to drive; elderly women have 9.

Old: (2006) According to the U.S. Census Bureau, every 8 seconds an American turns 50

· There are now more Americans over 65 than there are teenagers, for the first time in history

· Among those age 65 and older approximately 55 percent are women and 45 percent are men

· More than 5,000 Americans turn age 65 every day, over 1,800,000 per year

· The fastest growing segment of the senior market are those 85 and older

· Persons 65 and older represent almost 13 percent of the total population and growing

· Seniors control 65 percent of the nation's wealth

· Only about one in seven people over age 65 live with their children.

Approximately 25 percent have net incomes of $25,000 and over, about 10 percent have incomes of $50,000 and over

· Over 52 percent live in nine states, (in order of rank) California, Florida, New York, Texas, Pennsylvania, Ohio, Illinois, Michigan, and New Jersey

· Over 20 percent use the Internet

· What they want: (in order of preference) health care, security, entertainment, independence

· Their fears: outliving their money, maintaining their lifestyle, retirement security, being a burden on their families

Currently, Social Security provides only about 20 percent of the income needed for retirement. Almost 55 percent of people over 65 will encounter disability of some type and 35 percent will suffer severe disability.

Over 44 percent of Americans are not covered by an employer sponsored pension plan. Longer life expectancies increase the possibility of outliving one's money in retirement. In 1980, life expectancy for males who had reached the age of 65 was age 78 and age 81 for females. In 2000, the life expectancy for males age 65 was 81 and 86 for females. At age 65 the chances of spending time in a nursing home is 1 in 3, for an individual age 75 it increases to 2 to 1. In 1990, approximately 7 million Americans were in nursing homes, this grew to more than 9 million in 2000, and is expected to jump to 20 million by the year 2050. In 1950, it took 15 people paying into Social Security to support one retiree. In 1992, it was three workers supporting one retiree and by 2020 it is estimated that 1.78 workers will be supporting one retiree.

The need for long term care has become an increasing problem with the changing demographics of our aging population. For example:

· Over 50 percent of persons entering a nursing home have depleted all their assets after one year. (Harvard University studies.)

· Over 60 percent (more than one out of every two) persons age 75 and over will require long term care, the average stay is 3 years. (Business Week)

· For a couple turning 65, there is a 75 percent chance that one of them will require long term care. (The Wall Street Journal, 6/2000)

· Over 50 percent of all Americans will need long term care during their lifetime (Americans for Long Term Care Security 8/1999)

· On the average, persons in 1996 spent 6 percent of their annual household income on their long term care insurance. This is expected to increase to 10 percent by 2005.

· Less than 10 percent of nursing home costs are paid by Medicare. Approximately 51 percent by Medicaid.

· One in five Americans over age 50 will require long term care within the next 12 months. (Harvard School of Public Health and Louis Harris & Assoc. Long Term Care Awareness Survey January 1996)

· Women are one and a half times more likely than men to enter a nursing home after age 65. (HIAA, Guide to Long Term Care Insurance, 1966)

· According to the U.S. General Accounting Office, 40 percent of persons receiving long term care are under age 65.

The Costs Of Nursing Home Care

· Nursing home costs range from $90 to $200 per day, or $30,000 to $70,000 annually and this figure is increasing. (Long Term Care Insurance: A Special Guide from Kiplinger's Retirement Report, June 1999)

· The nationwide average cost is $50,000 per year. (Long Term Care Insurance: A Special Guide, Kiplinger's ……)

· Basic care in an assisted living facility averages $26,000 per year. (Long Term Care Insurance: A Special Guide, Kiplinger's ……)

· Annual costs for limited care at home following a disability are $36,000 and up depending on location. (Long Term Care Insurance: A Special Guide, Kiplinger's ……)

· According to the U.S. General Accounting Office costs for long term care will at least triple between 1991 and 2011.

· According to figures from the Congressional Budget Office (March 1999) total expenditures for long term care are projected to rise from $123 billion in 2000 to $295 billion in 2030. (This is roughly equivalent to the budget for national defense.)

Of those suffering an initial heart attack, 95 percent will survive

· Currently, over 30 percent of cancer victims are completely cured and 50 percent survive at least five years

· Of stroke victims, 87 percent will survive and be discharged from the hospital

Four in ten baby boomers save less than $1,000 per year –– Experts estimate that when baby boomers begin to retire in 2011 approximately $1 million in savings will be required to provide an income of $50,000 per year.

· Two-thirds of corporate workers have no pension plan –– With the average pension plan producing $6,000 per year of income in retirement, this along with Social Security will not be adequate to maintain a standard of living.

· With medical advances the average life span of a 60-year-old man is 79 and there is a 30 percent chance that a 60-year-old woman may reach 89 –– Retirement plans must be geared to provide for 35 to 40 years in retirement. Anything less and one stands a good chance of outliving his or her money.

· Almost 60 percent of baby boomers have no idea of how much will be required for retirement or how long it will be needed –– It is the agent's responsibility to assist in compiling a plan that will allow a comfortable retirement based on the client's realistic goals, and one that he or she cannot outlive.

Between ages 35 and 65, seven out of ten people will become disabled for a three-month period or longer (Health Insurance Association of America)

· One of seven employees will be disabled for 5 years or more before retirement (Health Insurance Association of America)

· Seven out of ten persons will suffer disability after age 65

Organisation for Economic Cooperation and Development (OECD 2006): “Live Longer, Work Longer,” which notes that given the aging of nations around the world, many employment and social policies, practices and attitudes that discourage work at an older age are no longer useful and should be changed. The report discusses how work needs to be made a more attractive and rewarding proposition for older workers, and urges implementation of various measures including the creation of strong financial incentives to carry on working, eliminating subsidized pathways to early retirement, adapting wage and employment practices to hire and retain older workers, and changing the attitudes to working at an older age (by both employers an older workers themselves).

Older women: there were 34.9 million women of this age in the U.S. in 2004, of which 10.7 million were in the labor force (working or looking for work). This represents 46 percent of the 55 and over workforce. Their labor force participation rates are increasing, from 25.6 percent in 1999 to 30.5 percent in 2004. The five leading occupations were secretaries and administrative assistants (720,000); elementary and middle school teachers (371,000); registered nurses (353,000); bookkeeping, accounting, and auditing clerks (339,000); and nursing, psychiatric, and home health aides (251,000).

Vision Loss Tips (Ryan Mackey 2007)

Up to 30 % of seniors’ today face partial vision loss at the hands of macular degeneration. The retina gradually declines with age in macular degeneration, and impairs the vision used to read and look into another person’s face. The macula, which is the center of the retina, deteriorates to a point that sight is restricted to the edges of the retina only. Here are some helpful tips to alleviate the problems a loved one may face if they are in a hospital or a nursing home.

Tell a loved one to be up front about their vision loss with any aides and hospital staff that may take for granted their ability to see food, people, and hand motions.

Make sure staff at the hospital or nursing home makes a special note about a loved one’s reduced vision levels, and does not merely describe their vision loss as “glaucoma.”

Be understanding of the person’s capacity to see and do certain tasks. If there is something they struggle with such as writing their signature or reading small print, make sure the doctors know ahead of time.

Make sure any visitors or staff members introduce themselves to your loved one when they enter the room instead of simply walking in the room and assuming they have been recognized.

Ensure that the lighting in the loved one’s room is sufficient enough for them to see as best as possible. The stronger the light, the better chance the senior has to see things clearly and make out certain images.

Have the staff at the hospital or nursing facility make known the meals they bring in and arrange the meal so the senior can adjust to an eating position.

Other vision conscious items such as large number playing cards, books on tape, and large button phones can assist the senior in making the adjustment to loss of eyesight smoothly.

My comment- I have a friend with considerable  vision loss. The main thing is bright light