A new study estimates more than one in 10 older Americans binge drink. That’s an increase from the previous decade. The study, from the Journal of the American Geriatrics Society, determined binge drinkers 65 and older were more likely to be men; they’re also more likely to use tobacco or cannabis.

Binge drinking is defined as five or more drinks at a time for men, and four or more drinks at a time for women. Researchers say the habit can be more dangerous for older people, putting them at risk for a range of health problems.

One of the findings of the study is that an estimated 70 percent of all hospitalized older persons, and up to 50% of nursing home residents, have alcohol-related problems in general.

“When we think about binge drinking, the image we usually think about is younger adults or college students, but this is in fact a growing trend in older Americans,” said Dr. Tara Narula on “CBS This Morning” Wednesday. “It’s been under-reported in both the scientific literature and in the media, but the problem is that the alcohol has a very strong effect on people who are older. They’re more vulnerable to the health problems than even a younger population.

“Currently around 10.6% of older Americans are binge drinkers. In the previous decade, it was anywhere from 7% to 9%. So, that number is growing. Also growing just general increase in alcohol use and any sort of harmful alcohol use.”

Co-host Anthony Mason asked, “Is it more dangerous for older Americans?”

“It can be,” Dr. Narula replied. “There are a couple of reasons why. They are more sensitive to the alcohol, so they’re at a higher risk of getting impaired at the same level that might not impair somebody who’s younger. Many of them have chronic health problems. In fact, in this series, 24% of them had [conditions] like diabetes, hypertension, or cardiovascular disease. So [binge drinking] can exacerbate those. It can allow them to develop new problems, like pancreatitis or gastritis or certain cancers.

“Many of them are on prescription medication that might interfere. Also, it increases the risk of injury or accidents and falls in people who already may have issues with balance or coordination or reflexes.”

When asked about guidelines for binge drinking for older Americans, Dr. Narula said, “Really no American who is older should be drinking more than three drinks a day. If you have some sort of chronic disease or on prescription meds, you should speak to your doctor and they may recommend something even lower. Low-risk drinking is less that two drinks a day for a man, or one drink a day for a woman.

“It’s really important that doctors screen for this and also educate about it. A lot of these people may be at home drinking alone. Nobody really knows what’s going on. The problems may be attributed to, ‘Oh, they’re getting older, that’s why they’re confused and falling.’ It can be a little silent unless we actually look for it.”

The study noted that for the metabolism of a person who is 65 years or older, drinking two or three beers at that age has the same effect as seven or eight beers on someone at age 20. “They’re exquisitely sensitive to it,” said Dr. Narula.

Mason asked, “What do you do if you have a loved one who’s doing this? How do you deal with this?”

“I think a lot of people tend to shy away from it or avoid it; they don’t know how to deal with it,” said Dr. Narula. “I think it’s important to be compassionate, loving and respectful to these older Americans you may feel have a problem, but also you want to be proactive. You want to address it, because early intervention is really essential.

“One of the things that can be helpful is seeking advice from a professional who can guide you as to what type of treatment they should be getting, and interestingly how to approach them. Should it be a doctor that approaches them? Maybe a friend might be better or a family member.

“All of the recommendations really say, don’t use the world alcoholic; don’t talk to them while they may be intoxicated. You wait ’til they’re sober. Be patient, be direct with them. You don’t want to treat them like a child. You want to treat them like an adult, with respect, when you approach them.”

Clinical ResearchGerontologyHealth Care Research

Middle-aged adults who develop functional impairments—difficulty performing activities of daily living (ADLs) such as bathing and dressing—are at higher risk for hospitalization and nursing home admission than unimpaired adults the same age, according to an NIA-supported study. The findings, published online in JAMA Internal Medicine, raise questions about how clinicians can help those in midlife prevent or delay struggles with daily activities that affect health and quality of life.

Researchers at the University of Pennsylvania and the University of California, San Francisco, wanted to find out how middle-aged adults became functionally impaired and if their impairments posed the same risks as in older adults. Nearly 15 percent of adults age 55 to 64 are functionally impaired, meaning they have difficulty performing one or more of six basic ADLs: bathing, dressing, transferring (such as from a bed to a chair), toileting, eating, and walking across a room.

The researchers analyzed health data for 5,540 adults age 50 to 56 from the nationally representative Health and Retirement Study (HRS). None was functionally impaired when they entered the HRS in 1992, 1998, or 2004, but 1,097 of them (19.8 percent) reported that they developed an impairment in at least one ADL by age 64. Examining data reported every 2 years through 2014, the researchers found that functionally impaired participants had a significantly higher risk of hospitalization and nursing home admission than participants their age without functional impairment. The risk of death in the two groups was about the same after adjusting for factors such as health status and health behaviors like smoking.

The study found similar risks for hospitalization and nursing home admission, as well as for death, in the 857 HRS participants (15.5 percent) who developed trouble performing at least one instrumental ADL. These activities include managing money, managing medications, shopping for groceries, preparing meals, and making telephone calls.

The authors noted that not all functional impairments are permanent; sometimes they are temporary or disappear and then recur. Participants with functional impairments were more likely to be women, racial or ethnic minorities, unmarried, and to have lower socioeconomic status. They also had poorer health status and were more likely to smoke, exercise infrequently, and lack health insurance.

As in older adults, functional impairment in middle-aged adults can affect health and quality of life, the authors concluded. Clinicians could address risk factors such as chronic disease, depression, and obesity to prevent or delay functional impairment, and intervene to prevent adverse outcomes in middle-aged adults who become functionally impaired.

This study was supported in part by NIA grants K23AG045290, K76AG057016, P30AG044281, K24AG049057, and R01AG0478897.

by in Health

You probably don’t remember having chickenpox as a child or getting a chickenpox vaccine. You probably haven’t given the illness a passing thought in decades. But you might want to think about it now. While chickenpox is usually an illness reserved for children, it can come roaring back in adulthood as shingles.

If you have had chickenpox, you are at risk of shingles, and you won’t soon forget the severe pain it can cause. There is no telling if and when shingles will strike, but luckily there are vaccines available to help prevent it. Here are a few things you should know about shingles.

Shingles is an illness that is related to chickenpox and caused by the same virus: the varicella-zoster virus. Before the chickenpox vaccine was developed, most children got chickenpox at some point. After you contract chickenpox, the virus remains in your body. Later in life, the virus can become active again and cause shingles.

Most children today receive a chickenpox vaccine. Like the natural virus that causes chickenpox, the vaccine virus can also become active later in life and cause shingles. However, people who had a chickenpox vaccine have a lower risk of getting shingles than people who had chickenpox.

The first sign of shingles is usually pain, which can be severe. After a few days, a person with shingles may develop a rash and fluid-filled blisters. Shingles can also cause burning, numbness, itching, and sensitivity to touch. It usually affects only one area of the body at a time, often appearing as a stripe of blisters on one side of the torso. People with shingles are contagious to those who have not had chickenpox or the chickenpox vaccine, but they are only contagious while they have open sores. If somebody catches the virus from a person with shingles, they will develop chickenpox, not shingles.

If you have had chickenpox, you can get shingles at some point during your lifetime. Almost one in three Americans will get shingles at least once, and the risk increases with age. Older adults and people with a weakened immune system have a higher likelihood of being hospitalized with complications. The most common complication of shingles is severe pain after the shingles rash has healed, and the risk for this complication also increases with age.

There are some medications available that can improve some of the shingles symptoms. These antiviral medicines do not cure shingles, but they can shorten the duration and lessen the severity of the illness. Contact your doctor when shingles symptoms appear and start treatment as soon as possible. Other treatments for shingles include pain management options like numbing cream and pain relievers.

A shingles vaccine can lower the risk of getting the illness. It is recommended for everyone over age 50, even if they have been vaccinated in the past or if they have had shingles.

“Although most people who get shingles only get it once, it is possible to get it multiple times,” says Skyler Peterson, executive director at Carrollton Health and Rehabilitation Center. “The risk of getting more than one bout of shingles is higher for elderly people and others with weakened immune systems. It is important to get the shingles vaccine, whether or not you have had the illness, to help prevent recurrences.”

If you think you may have shingles, visit your doctor as soon as possible to get treatment. If you haven’t had shingles, or even if you have, get a vaccine to give yourself the best protection from the illness.

by Sally C. Pipes

Earlier this year, the Trump administration proposed a rule that would have ensured that tens of billions of dollars of hidden rebates and discounts went to patients. Sadly, the White House just chose to abandon this sensible, bipartisan reform. 

It’s a shame President Trump did not see this effort through. Millions of patients would have benefited from the change in the form of lower pharmacy bills and better health outcomes. 

The rule impacted Medicare Part D, the federal prescription drug benefit for roughly 45 million seniors. Under Part D, private insurers compete to sell prescription drug plans to Medicare beneficiaries. The government subsidizes and regulates these plans, but largely lets the private sector take the lead.

As a result of this competition, beneficiaries can choose from dozens of plans, each with different premiums, copays, and formularies — the lists of medicines covered by plans. 

Insurers often hire pharmacy benefit managers (PBMs) to design their drug benefits. PBMs decide which drugs to include on formularies and how much patients will have to pay out-of-pocket. 

Drug makers offer massive discounts to PBMs — $166 billion in 2018.   

PBMs keep a small slice of these rebates for themselves and hand most of the rebates back to insurers, who use them to lower premiums. 

Those savings do little good for the sickest patients who need many prescriptions. When these patients get to the pharmacy, they generally fork over copays or coinsurance — a set percentage of a drug’s cost.

President Trump wanted to reform this system to bring relief to America’s sickest patients: those in need of multiple drugs. His now-dead rule would have made it illegal for drug companies to offer rebates to PBMs and insurers, unless those middlemen pass the savings directly to patients through lower copays and coinsurance.  

Seniors could have seen significant savings under the policy. Sharing 100 percent of rebates would save diabetes patients $3.7 billion each year. That’s around $800 per patient.  

Another estimate found if the proposal were enacted, patients battling cancer, autoimmune diseases, and other debilitating conditions could have saved $20 billion over the next decade.  

President Trump’s plan would have saved lives. Cost concerns are one of the most common reasons for patients to skip their pills. Medication non-adherence kills around 125,000 Americans a year. Patients live longer when copays and coinsurance are lower — it’s as simple as that.

The president’s decision to scrap the proposal is bad news for patients. Let’s hope the Trump administration suggests a viable alternative soon. 

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book is The False Promise of Single-Payer Health Care (Encounter 2018). Follow her on Twitter @sallypipes.

by Judith Graham

By all accounts, the woman, in her late 60s, appeared to have severe dementia. She was largely incoherent. Her short-term memory was terrible. She couldn’t focus on questions that medical professionals asked her.

But Malaz Boustani, a doctor and professor of aging research at Indiana University School of Medicine, suspected something else might be going on. The patient was taking Benadryl for seasonal allergies, another antihistamine for itching, Seroquel (an antipsychotic medication) for mood fluctuations, as well as medications for urinary incontinence and gastrointestinal upset.

To various degrees, each of these drugs blocks an important chemical messenger in the brain, acetylcholine. Boustani thought the cumulative impact might be causing the woman’s cognitive difficulties.

He was right. Over six months, Boustani and a pharmacist took the patient off those medications and substituted alternative treatments. Miraculously, she appeared to recover completely. Her initial score on the Mini-Mental State Examination had been 11 of 30 — signifying severe dementia — and it shot up to 28, in the normal range.

An estimated 1 in 4 older adults take anticholinergic drugs — a wide-ranging class of medications used to treat allergies, insomnia, leaky bladders, diarrhea, dizziness, motion sickness, asthma, Parkinson’s disease, chronic obstructive pulmonary disease and various psychiatric disorders.

Older adults are highly susceptible to negative responses to these medications. Since 2012, anticholinergics have been featured prominently on the American Geriatrics Society Beers Criteria list of medications that are potentially inappropriate for seniors.

“The drugs that I’m most worried about in my clinic, when I need to think about what might be contributing to older patients’ memory loss or cognitive changes, are the anticholinergics,” said Rosemary Laird, a geriatrician and medical director of the Maturing Minds Clinic at AdventHealth in Winter Park, Fla.

Here’s what older adults should know about these drugs:

The basics

Anticholinergic medications target acetylcholine, an important chemical messenger in the parasympathetic nervous system that dilates blood vessels and regulates muscle contractions, bodily secretions and heart rate, among other functions. In the brain, acetylcholine plays a key role in attention, concentration, and memory formation and consolidation.

Some medications have strong anticholinergic properties, others less so. Among prescription medicines with strong effects are antidepressants such as imipramine (brand name Trofanil), antihistamines such as hydroxyzine (Vistaril and Atarax), antipsychotics such as clozapine (Clozaril and FazaClo), antispasmodics such as dicyclomine (Bentyl) and drugs for urinary incontinence such as tolterodine (Detrol).

In addition to prescription medications, many common over-the-counter drugs have anticholinergic properties, including antihistamines such as Benadryl and Chlor-Trimeton and sleep aids such as Tylenol PM, Aleve PM and Nytol.

Common side effects include dizziness, confusion, drowsiness, disorientation, agitation, blurry vision, dry mouth, constipation, difficulty urinating and delirium, a sudden and acute change in consciousness.

Unfortunately, “physicians often attribute anticholinergic symptoms in elderly people to aging or age-related illness rather than the effects of drugs,” according to a research review by physicians at the Medical University of South Carolina and in Britain.

Seniors are more susceptible to adverse effects from these medications for several reasons: Their brains process acetylcholine less efficiently. The medications are more likely to cross the blood-brain barrier. And their bodies take longer to break down these drugs.

This column is produced by Kaiser Health News, an independent news service that is not affiliated with Kaiser Permanente.

by in Health

Bouts of dizziness are common for seniors, with 30 percent of people over age 60 and 50 percent of people over age 85 experiencing dizziness. But while this issue is common, that does not mean it can be shrugged off as a natural part of aging.

With the right care, dizziness can often be treated. Here are five things that can cause dizziness and what can be done to treat it.

Vertigo

You may think vertigo and dizziness are the same thing, but vertigo is a specific kind of dizziness in which individuals feel like their world is spinning. The most common kind of dizziness for seniors is benign paroxysmal positional vertigo (BPPV), which is caused by crystals in the inner ear becoming dislodged. If BPPV is the cause of your dizziness, it can be treated with some simple maneuvers that help the crystals move back into place.

“Vertigo can not only be frustrating for seniors, but it can also be deadly,” says Clay Gardner, executive director at Vista Knoll Specialized Care Facility. “Untreated, dizziness can lead to falls, which can cause broken bones and even death. Getting appropriate treatment can help cure vertigo and avoid dangerous complications.”

Infections

Sudden vertigo that lasts up to a week could be the result of a prior infection. Vestibular neuritis is often caused by a viral respiratory illness like the flu that causes the nerve cells in the inner ear to become inflamed. Vertigo caused by infections can be treated with anti-nausea medication or physical therapy. Steroids for inflammation can also help bring down the swelling in the inner ear.

Medications

Some medications can cause dizziness, especially among elderly patients. For people with high blood pressure, hypertension medication could be to blame for dizziness that happens when they get up too quickly. Other medications like salicylates and some cancer drugs can cause permanent damage to the inner ear, affecting a person’s hearing and balance. Unfortunately, people who are taking medicine for dizziness could actually end up with more dizziness, as some sedatives can worsen the symptoms.

Meniere’s Syndrome

If you have dizziness along with ringing in your ear, distorted hearing, and nausea, you may have Meniere’s syndrome. These attacks can last for a few minutes or for several hours. Meniere’s can be treated on several fronts, including diet and medication. Limiting salt and caffeine can help, and anti-nausea medication might provide some relief.

Stroke or TIA

Strokes, or transient ischemic attacks (TIA), aren’t the most common reasons for dizziness in seniors, but they are one of the most serious. Because time is of the essence when treating a stroke, it is important to rule stroke out when sudden dizziness occurs. Symptoms of a stroke can be similar to vestibular neuritis, so you should seek medical attention the first time you experience dizziness to figure out what is causing it. People who are having a stroke often have other symptoms like confusion, numbness, or slurred speech. Even without other symptoms, someone with dizziness could still be having a stroke or TIA, which can lead to a stroke.

Dizziness is a common complaint among seniors, but it does not need to be a fact of life. If you are experiencing dizziness, get medical attention. Your doctor can help determine what is causing your dizziness and figure out the best treatment.

by Dr. Linda Chous, OD, chief eye care officer with UnitedHealthcare

Are my eyes going to keep getting worse as I age? Is there anything I can do to slow the progression of vision decline?

By no means is your eyesight guaranteed to deteriorate with age, but it is perfectly normal to notice changes to your vision as the years pass. Unfortunately, there is nothing that can be done to stop normal vision changes. However, it is important to maintain regular appointments with your eye doctor to help identify pressing concerns.

Although changes are often normal, they can also be signs of conditions like cataracts or even diabetes. If you experience sudden vision loss or any rapid change to your eyesight, contact your eye care provider immediately.

Many people notice tiny specks within their field of vision. These small spots are tiny threads of protein that float across the gel-like substance between your eye’s lens and retina.

Usually there is no need to worry if you only notice these spots occasionally and they disappear after a few minutes, but only a dilated eye examination can determine the cause of the “floaters”.

However, if your vision is overcome by these specks or you are noticing vision loss, contact your eye doctor as soon as possible, as it could be a symptom of a sight-threating condition.

Age-related macular degeneration (AMD)is the leading cause of vision loss in people over the age of 65. AMD causes damage to the macula, the small spot on the retina that enables people to see clearly and to view things straight ahead of them.

Common symptoms of AMD are distortion and blurring of the center of your field of vision. If caught in the early stage, there are potential benefits from taking certain prescription medications and nutritional supplements.

The lens in your eye is like a camera lens – it is clear and allows light to pass through to create an image. A cataract is the clouding of this lens, blocking the flow of light to the back of your eye (retina), which ultimately causes loss of sight.

There are many kinds of cataracts, and most usually form slowly and do not cause pain. If the clouding is small, it is possible you may not even notice it. However, significant clouding can form in some people and, ultimately, negatively impact vision.

The good news is cataracts are treatable via surgery that removes the clouded lens and replaces it with a clear plastic lens. Cataract surgery is generally safe and is one of the most common surgeries done in the United States and recovering after cataract surgery is also pretty easy too! Once a cataract is removed, it cannot grow back

Glaucoma is caused by increased pressure inside the eye, which can cause permanent vision loss and blindness if left untreated. There are several types of glaucoma, but the most common form usually has no noticeable symptoms in the early stages – the only way to detect it is by visiting your eye care provider for routine testing.

What are the best ways to keep my eyes healthy as I age?

Maintaining a healthy lifestyle is as important for your eye health as it is for your overall physical health. Some of the best ways to protect your eyes as you age include:

* Stop smoking. Smokers are up to four times more likely to develop AMD and may contribute to the development of cataracts.

* Maintain a healthy weight. Conditions associated with being overweight, like diabetes and heart disease, increase your risk of developing vision loss from cataracts, glaucoma and retinopathy.

* Wear sunglasses. Help protect your eyes from harmful ultraviolet rays (read on to learn why it is so important).

* Be physically active. A study found people who are physically active experienced less vision loss over 20 years compared to those who didn’t exercise.

* Eat a healthy diet. Colorful fruits and vegetables like leafy greens, tomatoes and blueberries, contain nutrients that can keep your eyes healthy and reduce the risk of AMD.

Staying on top of your eye exams is crucial to helping maintain your eye health as you age. You should aim to see your eye doctor annually even if your vision hasn’t changed.

The purpose of HICAP is to provide free unbiased counseling and community education on Medicare A, B, C, & D. HICAP completes comparisons on all products of C & D, retiree/employer Group vs. Medicare. HICAP resolves billing issues and to help apply for appeals. HICAP’s speaker bureau gives presentations on Medicare 101, Prevention Services, Long Term Care, on all aspects of Medicare products, and on Medicare changes for the new year. HICAP gives advice regarding healthcare insurance options for those contemplating retirement.

Health Insurance Information and Assistance

Agencies offer assistance with filling out forms, submitting bills, and completing other paperwork necessary for reimbursement.

Frequently Asked Questions

What is HICAP-Medicare Program?

HICAP is short for Health Insurance Counseling and Advocacy Program funded through the Older American Act. This service is free. The United States Department of Aging sends funding to the Center of Medicare and Medicaid Services. HICAP is national volunteer Medicare program that gives free and unbiased counseling, and comparisons on all Medicare Health Insurance and Medicare Prescription Drug Plans. The HICAP program also resolves Medicare, HMO, and Prescription Drug complaints for Medicare beneficiaries.

How does it work?

Every year Medicare has its Annual Election Period beginning October 15 through December 7. This is the time all Medicare beneficiaries need to re-evaluate their health plan and prescription drug plan.

Why would a Medicare beneficiary need to reevaluate his or her current plan?

Medicare plans change every year, so it is important to reevaluate your plan every year. If you are a low-income subsidiary for Medicare Part D or a Medicare beneficiary, you will have to reevaluate your plan during the open enrollment period. HICAP can help you complete your choice for a plan that is right for you. You want to make sure that you don’t incur more expenses because your plan changes. Be aware that some plans terminate their contract with Medicare.

How does someone enroll to receive help?

If you will soon be eligible for Medicare or if you are already a Medicare beneficiary, you can call the HICAP program for a personal appointment to go over all your options on Medicare at 805-477-7310. HICAP services are free and unbiased. We do not sell any products.

by Geri Piazza, assistant editor, NIH Research Matters

Alzheimer’s disease is an irreversible brain disorder that affects more than 5 million Americans. It slowly worsens and destroys memory and thinking skills.

Previous research has linked memory and thinking problems with visible changes that take place in the brain. People with Alzheimer’s have abnormal deposits of proteins called amyloid plaques and tau tangles. Plaques obstruct communication between nerve cells (or neurons) in the brain. Tau tangles disrupt processes in the cells and cause them to die.

Treatment may slow memory loss, but there’s no cure for Alzheimer’s disease. A better understanding of how the disease progresses may lead to more effective treatments.

A research team led by Drs. Manolis Kellis and Li-Huei Tsai of the Massachusetts Institute of Technology set out to identify the unique sets of genes that are turned on, or expressed, during Alzheimer’s in every major cell type in the prefrontal cortex. This region of the brain is involved in functions affected by Alzheimer’s disease: high-level thinking, making decisions, and attention.

The study was funded in part by NIH’s National Institute on Aging (NIA) and other NIH support. Results were released online in Nature as an accelerated article preview on May 1, 2019.

Brain tissue samples were donated by religious clergy who participated in a long-term aging study. Some developed Alzheimer’s disease during the study, and all agreed to donate brain tissue for research after death. Information about plaques and tangles, cognitive function score, and other markers of Alzheimer’s disease had been collected for all the participants.

The research team assessed data from 24 people with high amyloid levels and 24 with low levels. There were equal numbers of men and women, and participants were matched for age and level of education.

The researchers used single-cell sequencing technology to look at the genes expressed in every single cell within a sample. They analyzed protein-coding genes from more than 80,000 brain cells. They were able to distinguish six main types, including neurons and nearby supporting cells, and 40 distinct subtypes.

Both neurons and supporting cells had gene expression patterns in the Alzheimer brains that weren’t seen in the control brains. One noteworthy difference was in the genes related to myelination, the process of wrapping a fatty coating around nerve cell fibers to help them transmit signals. Another was that men and women of the same age and disease severity had different gene expression patterns. The women’s patterns were more abnormal.

The team also compared differences in gene expression between early-stage and late-stage Alzheimer’s disease. They identified distinct changes in all the major cell types early in the disease process. Genetic signatures related to myelination were affected in most cell types, suggesting a key role in the disease.

“This study provides, in my view, the very first map for going after all of the molecular processes that are altered in Alzheimer’s disease in every single cell type that we can now reliably characterize,” Kellis says. “It opens up a completely new era for understanding Alzheimer’s.”