by Carol Leish, MA

The Ventura County Area Agency on Aging offers different types of Fall Prevention Classes. These classes include: A Matter of Balance; Stepping On; Tai Chi: Moving for Better Balance; and, Walk with Ease. These classes, which are part of the Fall Prevention Program, strives to assist adults to maintain their independence at home.

A Matter of Balance is an 8-week, 2 hours per week class. It is designed for those 60 and older who are inactive with poor balance, who have fallen, and who may have developed a fear of falling. It helps to improve balance and strength of individuals. Stepping On is a 7- week class that meets 2 hours per week in which participants 65 and older have access to a physical therapist; a vision expert; a public safety expert and a pharmacist in order to realize how vision issues can be linked to falls and how medications affect someone’s links to falls. Participants will also learn strength and balance exercises.

Tai Chi: Moving for Better Balance is a 12-week class that meets twice weekly for 1.5 hours each class. It includes easy-to-do exercises that increases strength, stamina, mindfulness and body awareness to provide better balance. Walk with Ease is a 6-week structured walking class that starts out with walking a minimum od 30 minutes a day. It includes health information and motivational tips. Both Tai Chi: Moving for Better Balance and Walk with Ease are for those who are 60 and older.

“There is an educational aspect that deals with nutrition and emotional/physical wellness in all the classes offered,” according to Jannette Jauregui, MSJ, Public Information Officer at the Ventura County Area Agency on Aging. “The classes are all evidence-based, designed with those 60 and older in mind. Studies have been done to show the effectiveness of the classes in improving and strengthening balance and mobility. A Fall Prevention Forum will be offered in September of this year.”

All classes are FREE and open to any Ventura County resident 60 or older. For more information, call: (805) 477-7800 (option 6), or email: [email protected]. Find more information at: https://www.vcaaa.org/our-services/fall-prevention/.

(Future articles will focus on other programs offered by the Ventura County Area Agency on Aging dealing with: Care Management; Information provided by the Assistance Team; and, the Senior Nutrition Program.)

Alzheimer’s disease is a brain disorder that slowly destroys memory and thinking skills, and, eventually, the ability to carry out the simplest tasks. In most people with Alzheimer’s, symptoms first appear later in life. Estimates vary, but experts suggest that more than 6 million Americans, most of them age 65 or older, may have dementia caused by Alzheimer’s.

Alzheimer’s disease is currently ranked as the seventh leading cause of death in the United States and is the most common cause of dementia among older adults.

Dementia is the loss of cognitive functioning — thinking, remembering, and reasoning — and behavioral abilities to such an extent that it interferes with a person’s daily life and activities. Dementia ranges in severity from the mildest stage, when it is just beginning to affect a person’s functioning, to the most severe stage, when the person must depend completely on others for help with basic activities of daily living.

The causes of dementia can vary, depending on the types of brain changes that may be taking place. Other dementias include Lewy body dementia, frontotemporal disorders, and vascular dementia. It is common for people to have mixed dementia — a combination of two or more types of dementia. For example, some people have both Alzheimer’s disease and vascular dementia.

Alzheimer’s disease is named after Dr. Alois Alzheimer. In 1906, Dr. Alzheimer noticed changes in the brain tissue of a woman who had died of an unusual mental illness. Her symptoms included memory loss, language problems, and unpredictable behavior. After she died, he examined her brain and found many abnormal clumps (now called amyloid plaques) and tangled bundles of fibers (now called neurofibrillary, or tau, tangles).

Scientists continue to unravel the complex brain changes involved in Alzheimer’s disease. Changes in the brain may begin a decade or more before symptoms appear. During this very early stage of Alzheimer’s, toxic changes are taking place in the brain, including abnormal buildups of proteins that form amyloid plaques and tau tangles. Previously healthy neurons stop functioning, lose connections with other neurons, and die. Many other complex brain changes are thought to play a role in Alzheimer’s as well.

The damage initially appears to take place in the hippocampus and the entorhinal cortex, which are parts of the brain that are essential in forming memories. As more neurons die, additional parts of the brain are affected and begin to shrink. By the final stage of Alzheimer’s, damage is widespread and brain tissue has shrunk significantly.

Memory problems are typically one of the first signs of cognitive impairment related to Alzheimer’s. Some people with memory problems have a condition called mild cognitive impairment (MCI). With MCI, people have more memory problems than normal for their age, but their symptoms do not interfere with their everyday lives. Movement difficulties and problems with the sense of smell have also been linked to MCI. Older people with MCI are at greater risk for developing Alzheimer’s, but not all of them do so. Some may even revert to normal cognition.

The first symptoms of Alzheimer’s vary from person to person. For many, decline in nonmemory aspects of cognition, such as word-finding, vision/spatial issues, and impaired reasoning or judgment may signal the very early stages of the disease. Researchers are studying biomarkers (biological signs of disease found in brain images, cerebrospinal fluid, and blood) to detect early changes in the brains of people with MCI and in cognitively normal people who may be at greater risk for Alzheimer’s. More research is needed before these techniques can be used broadly and routinely to diagnose Alzheimer’s in a health care provider’s office.

by National Institute on Aging

Undergoing cataract removal was associated with a lower risk of developing dementia among older adults, according to a new study, supported in part by NIA. Published in JAMA Internal Medicine on Dec. 6, 2021, the study suggests that the improvement in the quality of life for the affected individual and family is likely considerable given the substantial association and its lasting effect beyond 10 years.

Dementia affects nearly 50 million people worldwide. With no cure currently, efforts to reduce the risk or delay dementia onset are increasingly important. Several studies suggest sensory loss may be a potentially modifiable risk factor for dementia later in life. The prevalence of hearing (1 out of 3) and vision impairment (1 out of 5) in adults age 70 or older in the United States is high. Because sensory impairment and dementia are both strongly associated with aging, more knowledge about the association may have important implications for adults as they age, particularly if interventions to improve sensory function reduce dementia risk.

For this prospective, longitudinal cohort study, researchers analyzed data from a subset of participants from the Adult Changes in Thought (ACT) study – an ongoing population-based cohort of randomly selected members of Kaiser Permanente Washington. Participants were 65 years or older, were dementia-free at the start of the study, and were diagnosed with cataracts before the onset of dementia. Of the 3,038 participants, 59% were women, 41% were men and 91% were self-reported white race. Data used in the analyses was collected from 1994 through September 2018.

Researchers found that participants who underwent cataract removal surgery had nearly 30% lower risk of developing dementia compared with participants without surgery, even after controlling for numerous additional demographic and health risks. In comparison, glaucoma surgery, which doesn’t restore vision, did not have a significant association with dementia risk. One of the major strengths of this study is that it was based on a large prospective, community-based, observational cohort that allowed for years of follow-up starting before participants developed dementia. However, researchers noted that because the study population was predominately white, the findings may not be representative of other groups. Recent enrollment efforts for the ACT study include new strategies to recruit a more diverse population.

Some of the limitations of this study were that participants were primarily white individuals, and researchers evaluated only the participant’s first cataract surgery and it’s unknown whether subsequent surgery in the other eye impacted dementia risk. If validated in future studies, cataract surgery may have clinical relevance in older adults at risk of developing dementia.

According to the researchers, participants who underwent cataract removal surgery had a lower risk of developing dementia compared with participants without surgery. However, they note that additional studies are needed to determine how cataract removal impacts dementia risk.

This research was supported by NIA grants R01AG060942, P50AG005136, and U01AG006781.

Reference: Lee CS, et al. Association between cataract extraction and development of dementia. JAMA Internal Medicine. 2021; doi:10.1001/jamainternmed.2021.6990

Emerald Nguyen, Social and Behavioral Science Administrator,
Division of Behavioral and Social Research (DBSR).

NIA recognizes that far too many people continue to struggle due to climate change and related weather conditions. Now more than ever, it’s crucial to better understand the science of changing climates and their impact on the health and well-being of older adults. The 2020 report of The Lancet Countdown on health and climate change identified older adults as a vulnerable population experiencing excess morbidity and mortality associated with extreme weather, such as alarming heatwaves, widespread wildfires, and violent hurricanes. NIA behavioral and social research program priorities (PDF, 433K) include supporting research to investigate older adults’ health outcomes and their preparedness, adaptation, and resilience to climate change and extreme weather conditions.

Research on older adult health and well-being affected by climate change builds on NIA’s established interest in disaster preparedness, our support for research institutions affected by disasters, and our partnerships with other federal agencies to support older adults in emergencies. NIA recently awarded six grants for projects in response to the Environmental Influences on Aging: Effects of Extreme Weather and Disaster Events on Aging Processes funding opportunity. NIA’s expanding interests in this area of research include but are not limited to:

Impacts of exposure to air pollution, heat, and wildfires, and other extreme weather events on health and well-being in midlife and later life.

The impact of age-related change in affective, social, and cognitive factors on individual responses to extreme weather events.

How individuals initiate and maintain the behavior changes needed for preparedness and adaptation to extreme weather events.

The contribution of extreme weather events and related natural disasters to social structure and social adversity, and their effects on aging processes across the life course in studies of animals in their natural habitats.

Impacts of extreme weather events on individuals with functional limitations or disabilities, persons living with Alzheimer’s disease and related dementias, as well as caregivers/care partners.

by DiversityEconomicsHealth Care Research

Three recent studies, funded in part by NIA, analyzed aspects of the Medicare Advantage program, including quality incentives and the use of hospitalization services and spending. According to a study published in JAMA Health Forum, the Medicare Advantage program reduces the use of hospitalization services and spending for beneficiaries as compared to traditional Medicare. Two other studies published in Health Affairs found that the Medicare Advantage quality bonus program has not improved plan quality or enrollment. Moreover, one of the studies found that the Medicare Advantage double bonus payments create a racial disparity in the distribution of Medicare funds, largely affecting Black Medicare beneficiaries.

Medicare Advantage is a federally funded health insurance program in the United States that provides Medicare benefits through private insurance company plans. Different Medicare Advantage plans, sometimes called “Part C” or “MA Plans,” have their own health care networks, including doctors and care facilities.

In 2012, Medicare introduced the quality bonus program to award financial incentives to Medicare Advantage plans that achieve high-quality ratings. The plans are rated from one to five stars based on more than 40 factors that evaluate how well the plan delivers care, such as preventive services, chronic disease management, and customer service. For highly rated Medicare Advantage plans, Medicare pays a bonus equal to 5% of the amount the plan receives for benefits administration. This bonus doubles to 10% for plans in counties that have a history of high enrollment and low fee-for-service Medicare spending — when the doctor or clinic is paid separately for each service provided to a patient.

To compare the effects of enrolling in a Medicare Advantage plan versus traditional Medicare, a research team from Harvard University and the University of Pennsylvania analyzed insurance claims data from a single private insurance company. This allowed researchers to evaluate health care use and spending by older adults as they moved from group or individual health insurance plans to Medicare.

During the first year of Medicare coverage, Medicare Advantage beneficiaries had lower hospital use and spending estimated at $95 per beneficiary per month, relative to traditional Medicare. This resulted in 63 fewer stays in the hospital or a nursing facility per 1,000 beneficiaries per year. No significant changes in the use or spending for professional services, such as doctor visits, were found. In comparison to traditional Medicare, Medicare Advantage was associated with a 36% overall reduction in total health care spending in the first year of coverage. These findings were published in JAMA Health Forum.

A national study led by a team from the University of Michigan used health insurance claims data to evaluate the effectiveness of the Medicare Advantage quality bonus program on improving plan performance. Claims information from 2009 to 2018 was collected for adults, age 50 to 74 years, enrolled in either a Medicare Advantage plan or a commercial health insurance plan without a quality bonus incentive. The researchers evaluated the data for changes in nine indicators of Medicare health care plan quality in both groups, before and after the start of the bonus program.

Although the bonus program was associated with significant quality improvement for Medicare Advantage beneficiaries on four measures, there were significant declines on four other measures and no significant change in the overall quality performance of the Medicare Advantage plans. These findings, published in Health Affairs, suggest that in contrast to the program’s goal, the quality bonus did not improve the overall quality of the Medicare Advantage plans.

The findings from these studies provide important insights for policymakers to consider when making decisions about future Medicare payment policies. Additional research is needed to help understand quality differences for beneficiaries in Medicare Advantage plans and the potential impact of the double bonus payments on racial health disparities in Black beneficiaries.

This research was supported in part by NIA grants P01AG032952 and 2P01AG032952-11.

by National Institute on Aging

Asking questions is key to good communication with your doctor. If you don’t ask questions, he or she may assume you already know the answer or that you don’t want more information. Don’t wait for the doctor to raise a specific question or subject; he or she may not know it’s important to you. Be proactive. Ask questions when you don’t know the meaning of a word (like aneurysm, hypertension, or infarct) or when instructions aren’t clear (for example, does taking medicine with food mean before, during, or after a meal?).

Due to COVID-19, health care providers may offer more telehealth services to keep patients and health care providers safe. You can talk to your health care provider online through video or email, or by phone.

Sometimes, doctors need to do blood tests, X-rays, or other procedures to find out what is wrong or to learn more about your medical condition. Some tests, such as Pap tests, mammograms, glaucoma tests, and screenings for prostate and colorectal cancer, are done regularly to check for hidden medical problems.

Before having a medical test, ask your doctor to explain why it is important, what it will show, and what it will cost. Ask what kind of things you need to do to prepare for the test. For example, you may need to have an empty stomach, or you may have to provide a urine sample. Ask how you will be notified of the test results and how long they will take to come in.

Questions to ask your doctor before a medical test

Why is the test being done?

What steps does the test involve? How should I get ready?

Are there any dangers or side effects?

How will I find out the results? How long will it take to get the results?

What will we know after the test?

When the results are ready, make sure the doctor tells you what they are and explains what they mean. You may want to ask your doctor for a written copy of the test results. If the test is done by a specialist, ask to have the results sent to your primary doctor.

Can I find information about medical tests online?

Yes—there is a lot of information online about medical tests. The National Library of Medicine’s MedlinePlus website provides links to many trustworthy resources. You can get information on preparing for lab tests, explanations of different tests, and tips on interpreting lab test results.

A diagnosis identifies your disease or physical problem. The doctor makes a diagnosis based on the symptoms you are experiencing and the results of the physical exam, laboratory work, and other tests.

Ask the doctor to tell you the name of the condition and why he or she thinks you have it. Ask how it may affect you and how long it might last. Some medical problems never go away completely. They can’t be cured, but they can be treated or managed.

Questions to ask your doctor about your diagnosis

What may have caused this condition? Will it be permanent?

How is this condition treated or managed? What will be the long-term effects on my life?

How can I learn more about my condition?

Understand your medications

Your doctor may prescribe a drug for your condition. Make sure you know the name of the drug and understand why it has been prescribed for you. Ask the doctor to write down how often and for how long you should take it.

Make notes about any other special instructions. If you are taking other medications, make sure your doctor knows what they are, so he or she can prevent harmful drug interactions. Check with your doctor’s office before taking any over-the-counter medications.

Let the doctor know if your medicine doesn’t seem to be working or if it is causing problems. If you want to stop taking your medicine, check with your doctor first.

Get answers to commonly asked questions about medicines and learn more about how you can save money on costly prescriptions.

Don’t hesitate to ask the doctor about the cost of your medications. If they are too expensive for you, the doctor may be able to suggest less expensive alternatives. You can ask if there is a generic or other less expensive choice. You could say, for instance: “It turns out that this medicine is too expensive for me. Is there another one or a generic drug that would cost less?”

For more information about questions to ask the doctor

Centers for Disease Control and Prevention (CDC)
800-232-4636
888-232-6348 (TTY)
[email protected]
www.cdc.gov

by Nina Silverberg, Ph.D., director of the NIA Alzheimer’s Disease Research Centers program

Imagine being able to look inside the brain of a person with Alzheimer’s disease and see the changes that are interfering with that person’s thinking, memory, and other important brain functions. Scientists working in the field of neuropathology are doing just that.

Using a variety of methods, neuropathologists view patterns of abnormal protein clusters and cellular damage in brain tissue under a microscope and through computer-driven imaging. They use that information to characterize the changes that occur in the brain with particular diseases or conditions.

For example, in 1906, the psychiatrist and neuropathologist Alois Alzheimer first identified the abnormal buildup of protein fragments — amyloid plaques and neurofibrillary (tau) tangles — in the brain tissue of a woman who had died from a previously unknown disease that caused a decline in her ability to think, remember, and speak. This illness was later named Alzheimer’s disease, which is the most common form of dementia. Neuropathologists today continue to actively work on identifying the changes that can be seen in the brain after death and connecting those to symptoms and biological processes observed during life.

Neuropathology is the study of diseases of the brain, spinal cord, and nerves through analyzing tissues removed during autopsy or biopsy. This analysis is central to research on Alzheimer’s disease and other neurodegenerative diseases. Neuropathology researchers look for signs of disease and disease progression and can identify whether changes in the brain are related to the protein accumulations seen in Alzheimer’s disease, like in the image below, or to other underlying causes of dementia.

Long before the symptoms of memory loss appear, many molecular and cellular changes take place in the brain of a person with Alzheimer’s. Neuropathology research has been essential in helping to identify these biological changes, called biomarkers, and revolutionizing the methods scientists and doctors can use to diagnose and treat these diseases. For example, 20 years ago, the only sure way to know whether a person had Alzheimer’s was through autopsy. Since then, researchers have developed and tested methods to “see” evidence of protein fragments associated with Alzheimer’s on brain scans, in cerebrospinal fluid, and even in blood while people are still alive. Being able to diagnose Alzheimer’s in the early stages is helping researchers to test new treatments that may slow or stop progression of the disease.

Still, as far as neuropathology has evolved, there is much to learn. For example, not everyone with amyloid plaques and tau tangles — the hallmark signs of Alzheimer’s — will eventually develop this disease. In addition, many people who are diagnosed with Alzheimer’s dementia have evidence of other pathologies in their brain, either instead of or in addition to those associated with Alzheimer’s. What factors influence the development of these different dementia-related pathologies? How can science help to better identify the underlying causes of dementia symptoms, so that we can better diagnose, treat, and prevent dementia? What causes the variability in the rate, severity, and type of cognitive decline among people with Alzheimer’s?

To address these questions and other complexities of dementia diseases, NIA-supported researchers are using the power of neuropathology in both traditional and innovative ways. For example, large studies of healthy adults over many years, new technologies to understand changes in individual brain cells, and collaboration among scientists with different expertise is equipping researchers with the information needed to map the connections between brain changes and risk factors that lead to dementia.

Neuropathology led to the discovery of Alzheimer’s disease and continues to provide invaluable insights today. NIA supports a wide range of neuropathological research to identify how and why these brain changes happen and to help develop tailored treatment and prevention strategies across diverse populations.

If you or a loved one has been diagnosed with Alzheimer’s disease or a related dementia, it may be difficult to think beyond the day to day. However, taking steps now can help prepare for a smoother tomorrow.

Over time, the symptoms of Alzheimer’s and related dementias will make it difficult to think clearly. Planning as early as possible enables you to make decisions and communicate those decisions to the right people.

Advance directives are legal documents that outline your preferences and apply only if you are unable to make decisions. For health care planning, they communicate a person’s wishes ahead of time. Doctors and other providers follow these directives for your medical treatment. There are two main documents that are part of an advance directive:

A living will lets doctors know how you want to be treated if you are dying or permanently unconscious and cannot make your own decisions about emergency treatment.

A durable power of attorney for health care names someone as a “proxy” to make medical decisions for you when you are not able.

If advance directives are not in place and a patient can no longer speak for him or herself, someone else will need to make medical decisions on their behalf. Talk to your family, friends, and health care providers about what types of care you would want. It can also be helpful to talk with your doctor about common problems associated with your condition.

Advance directives for financial planning are documents that communicate the financial wishes of a person. These must be created while the person still has the legal capacity to make decisions. Three common documents are included in a financial directive:

A will specifies how a person’s estate — property, money, and other financial assets — will be distributed and managed when they die. It may also address care for minors, gifts, and end-of-life arrangements, such as funeral and burial.

A durable power of attorney for finances names someone who will make financial decisions for you when you are not able.

A living trust names and instructs someone, called the trustee, to hold and distribute property and funds on your behalf when you are no longer able to manage your affairs.

Lawyers can help prepare these documents with you and your family members. A listing of lawyers in your area can be found on the internet, at your local library, through a local bar association, or by contacting the National Academy of Elder Law Attorneys.

As symptoms progress, long-term care may be needed. People diagnosed with Alzheimer’s or a related dementia and their family members should begin planning for the possibility of long-term care as soon as possible. Geriatric care managers, often nurses or social workers, can work with you to create a long-term care plan.

Start discussions early with your family members.

Put important papers in one place and make sure a trusted person knows where.

Update documents as situations change.

Make copies of health care directives to be placed in all medical files.

Give the doctor or lawyer advance permission to talk directly with a caregiver if needed.

Planning now will help you and your loved ones later when symptoms of Alzheimer’s or a related dementia worsen.