by Dr. Daman Jamarai, Chief Medical Officer, UnitedHealthcare, Southern California

As we age, we begin to learn – sometimes firsthand – how devastating a fall can be. It isn’t quite as easy as it once was to hop back up and continue on our way.

Each year millions of older adults experience falls and fall-related injuries. California ranked 20thth in a state-to-state comparison with 25.4 percent of adults age 65+ reporting a fall in the past 12 months, according to new local data from the 2021 America’s Health Rankings Senior Report.

About one in four people in the United States over age 65 reports falling each year. Among older adults, 1 out of 5 falls causes a serious injury, including 90% of hip fractures and 51% of traumatic brain injuries.

Contributing factors for falls include poor balance, poor vision, certain medications, alcohol consumption, physical inactivity, osteoporosis, physical disabilities and general frailty.

Being aware of the risk factors and following these tips can reduce your chances of serious injury, and help you maintain and improve the quality of your health and remain independent.

Medications: Any time you get a new prescription, ask your pharmacist or doctor about side effects like dizziness or drowsiness that can affect balance.

Review Your Health Benefits: As we approach the Medicare annual enrollment period in October, older adults should consider whether their current plan includes programs that can help reduce the chances of a fall. Many Medicare Advantage plans, for example, include benefits that Original Medicare does not cover that can help reduce the risk of falls like vision and hearing benefits; gym memberships; and disease management programs.

Stay Active – Do exercises that can strengthen your legs and improve balance. Many Medicare plans offers benefits to help seniors stay active like UnitedHealthcare’s fitness program RenewActive®, which includes access to balance classes.

Talk to Your Provider: A health care provider can help assess and reduce your fall risk. Medicare-eligible individuals can access care through an Annual Wellness Visit, which is free to anyone on Medicare. UnitedHealthcare Medicare Advantage members can take advantage of the HouseCalls program, which brings an annual health assessment to the convenience and privacy of home, at no additional cost.

Footwear – Make sure your shoes fit, have good traction, and are comfortable. See a doctor if you are experiencing foot pain.

Check Your Home – Most falls happen at home. Remove clutter, fix steps that are uneven and make sure there is adequate lighting. Install grab bars and handrails in the bathroom and on stairways. Use a cane, walker, crutches or other support if needed.

Falls can present a more significant health threat than many may realize, but by understanding risk factors and how to reduce them, older adults can empower themselves to live healthier lives.

As we age, our brains change, but Alzheimer’s disease and related dementias are not an inevitable part of aging. In fact, up to 40% of dementia cases may be prevented or delayed. It helps to understand what’s normal and what’s not when it comes to brain health.

Normal brain aging may mean slower processing speeds and more trouble multitasking, but routine memory, skills, and knowledge are stable and may even improve with age. It’s normal to occasionally forget recent events such as where you put your keys or the name of the person you just met.

People with dementia have symptoms of cognitive decline that interfere with daily life—including disruptions in language, memory, attention, recognition, problem solving, and decision-making.

Studies show that healthy behaviors, which can prevent some kinds of cancer, type 2 diabetes, and heart disease may also reduce your risk for cognitive decline. Although age, genetics, and family history can’t be changed, the Lancet Commission on dementia prevention, intervention, and care suggests that addressing risk factors may prevent or delay up to 40% of dementia cases.

Here’s what you can do:

Quit smoking. Quitting smoking now may help maintain brain health and can reduce your risk of heart disease, cancer, lung disease, and other smoking-related illnesses. Free quitline: 1-800-QUIT-NOW (1-800-784-8669

Maintain a healthy blood pressure level. Tens of millions of American adults have high blood pressure, and many do not have it under control. Learn the facts.

Be physically active.

Maintain a healthy weight. Healthy weight isn’t about short-term dietary changes. Instead, it’s about a lifestyle that includes healthy eating and regular physical activity.

Get enough sleep. A third of American adults report that they usually get less sleep than the recommended amount. How much sleep do you need? It depends on your age.

Stay engaged. There are many ways for older adults to get involved in their community.

Manage blood sugar. Learn how to manage your blood sugar especially if you have diabetes.

Some prescription and over-the-counter medicines can cause dementia-like symptoms. If you have these symptoms, it is important to talk to your health care provider to find out if there are any underlying causes for these symptoms.

What To Do if a Loved One is Showing Symptoms
Talk with your loved one about seeing a health care provider if they are experiencing symptoms of Alzheimer’s dementia to get a brain health check up.

When the timing is right, talk about issues related to safety including driving and carrying identification. Symptoms of dementia include getting lost in familiar places, difficulty judging distance, determining color or contrast, and reading which can make driving especially difficult.
Help your loved one start gathering important documents such as their advanced health care directive or living will, durable power of attorney for health care, and financial or estate planning documents.

Schedule a family meeting. When caring for someone with Alzheimer’s disease or a related illness, family meetings are important to ensure information is shared, to put care plans in place, and to help divide tasks among family members.

Memory problems are often one of the first signs of Alzheimer’s. Symptoms vary from person to person, and may include problems with:

• Word-finding, or having more trouble coming up with words than other people the same age.
• Vision and spatial issues, like awareness of the space around them.
• Impaired reasoning or judgment, which can impact decisions.
• Other symptoms may be changes in the person’s behavior, including:
• Taking longer to complete normal daily tasks.
• Repeating questions.
• Trouble handling money and paying bills.
• Wandering and getting lost.
• Losing things or misplacing them in odd places.
• Mood and personality changes.
• Increased anxiety and/or aggression.

How Is Alzheimer’s Diagnosed and Treated?

Doctors may ask questions about health, conduct cognitive tests, and carry out standard medical tests to determine whether to diagnose a person with Alzheimer’s disease. If a doctor thinks a person may have Alzheimer’s, they may refer the person to a specialist, such as a neurologist, for further assessment. Specialists may conduct additional tests, such as brain scans or lab tests of spinal fluid, to help make a diagnosis. These tests measure signs of the disease, such as changes in brain size or levels of certain proteins.

There is currently no cure for Alzheimer’s, though there are several medicines approved by the U.S. Food and Drug Administration (FDA) that can help manage some symptoms of the disease along with coping strategies to manage behavioral symptoms. In 2021, FDA provided accelerated approval for a new medication, aducanumab, that targets the protein beta-amyloid, which accumulates abnormally in the brains of people with Alzheimer’s. The new medication helps to reduce amyloid deposits, but has not yet been shown to affect clinical symptoms or outcomes, such as progression of cognitive decline or dementia.

Most medicines work best for people in the early or middle stages of Alzheimer’s. Researchers are exploring other drug therapies and nondrug interventions to delay or prevent the disease as well as treat its symptoms.

What Are the Stages of Alzheimer’s?

Alzheimer’s disease slowly gets worse over time. People with this disease progress at different rates and in several stages. Symptoms may get worse and then improve, but until an effective treatment for the disease itself is found, the person’s ability will continue to decline over the course of the disease.

Early-stage Alzheimer’s is when a person begins to experience memory loss and other cognitive difficulties, though the symptoms appear gradual to the person and their family. Alzheimer’s disease is often diagnosed at this stage.

During middle-stage Alzheimer’s, damage occurs in areas of the brain that control language, reasoning, sensory processing, and conscious thought. People at this stage may have more confusion and trouble recognizing family and friends.

In late-stage Alzheimer’s, a person cannot communicate, is completely dependent on others for care, and may be in bed most or all the time as the body shuts down.

How long a person can live with Alzheimer’s disease varies. A person may live as few as three or four years if he or she is older than 80 when diagnosed, to as long as 10 or more years if the person is younger. Older adults with Alzheimer’s disease need to know their end-of-life care options and express their wishes to caregivers as early as possible after a diagnosis, before their thinking and speaking abilities fail.

Scientists recently discovered a process by which immune cells can drive aging in the brain, and how to block this pathway to improve memory and maze navigation in older mice. The findings suggest a potential avenue to develop new treatments for cognitive conditions like Alzheimer’s disease. The study, led by researchers from Stanford University, was published in Nature on Jan. 20.

Inflammation is part of the immune system response to infection or injury. But as people age, they may have chronic low-level inflammation, which is linked to age-related diseases and cognitive decline.

Normally, immune cells — including a group of cells called macrophages — create immune responses that protect the brain, such as disposing of abnormal forms of proteins that are tied to neurodegeneration. But as people — and mice — age, immune cells can start encouraging inflammation rather than protecting against it.

A compound called prostaglandin E2 (PGE2) is involved in regulating inflammation. PGE2 levels increase during aging and in neurodegenerative diseases. The researchers wanted to know how PGE2 might affect macrophages and the aging process. When they looked at macrophages from older mice and people older than 65, they found that these vintage immune cells produced more PGE2 than those of younger mice and humans.

By adding PGE2 to macrophages from both older mice and older humans in the lab, the researchers found that when this compound linked up to a receptor on the macrophages’ surface, it changed the way the macrophages’ metabolism worked. Instead of producing energy, the macrophages now stored their fuel. These energy-sapped cells switched from being immune system protectors to actually driving more inflammation.

But when the researchers added compounds that prevented the macrophages from taking in PGE2, the macrophages switched back to burning fuel. Next, the researchers turned to mice that were genetically engineered to prevent macrophages from taking in as much PGE2, as well as to normal mice treated with compounds that blocked PGE2 intake. The macrophages of these older mice did not become sources of inflammation; instead, the cells continued to have the metabolism of a younger mouse’s macrophages.

To test whether blocking the PGE2 pathway could help with cognition, researchers put the mice through several memory and maze tests. They found that older mice in the study — with their more youthful macrophages — performed just as well as younger mice and significantly better than older control mice. The results suggest that maintaining macrophages’ normal metabolism can forestall aging-related cognitive declines in mice. Finding this new pathway that affects how macrophages respond during aging could help researchers look for potential new treatments for aging-related problems with thinking and memory.

Depression is a serious mood disorder. It can affect the way you feel, act, and think. Depression is a common problem among older adults, but clinical depression is not a normal part of aging. In fact, studies show that most older adults feel satisfied with their lives, despite having more illnesses or physical problems than younger people. However, if you’ve experienced depression as a younger person, you may be more likely to have depression as an older adult.

Depression is serious, and treatments are available to help. For most people, depression gets better with treatment. Counseling, medicine, or other forms of treatment can help. You do not need to suffer — help and treatment options are available. Talk with your doctor if you think you might have depression.

There are several types of depression that older adults may experience:

Major Depressive Disorder – includes symptoms lasting at least two weeks that interfere with a person’s ability to perform daily tasks

Persistent Depressive Disorder (Dysthymia) – a depressed mood that lasts more than two years, but the person may still be able to perform daily tasks, unlike someone with Major Depressive Disorder

Substance/Medication-Induced Depressive Disorder – depression related to the use of substances, like alcohol or pain medication

Depressive Disorder Due to A Medical Condition – depression related to a separate illness, like heart disease or multiple sclerosis.

Other forms of depression include psychotic depression, postmenopausal depression, and seasonal affective disorder. Find detailed descriptions of different types of depression from the National Institute of Mental Health.

If you are thinking about harming yourself, tell someone who can help immediately.
Do not isolate yourself.
Call a trusted family member or friend.
Call 911 or go to a hospital emergency room to get immediate help.
Make an appointment with your doctor.
Call the toll-free, 24-hour National Suicide Prevention Lifeline: 800-273-TALK (800-273-8255) or 800-799-4TTY (800-799-4889).

There are many things that may be risk factors of depression. For some people, changes in the brain can affect mood and result in depression. Others may experience depression after a major life event, like a medical diagnosis or a loved one’s death. Sometimes, those under a lot of stress — especially people who care for loved ones with a serious illness or disability — can feel depressed. Others may become depressed for no clear reason.

Research has shown that these factors are related to the risk of depression, but do not necessarily cause depression:

Medical conditions, such as stroke or cancer
Genes – people who have a family history of depression may be at higher risk
Stress, including caregiver stress
Sleep problems
Social isolation and loneliness
Lack of exercise or physical activity
Functional limitations that make engaging in activities of daily living difficult
Addiction and/or alcoholism —included in Substance-Induced Depressive Disorder

Everyone feels tired now and then. But, after a good night’s sleep, most people feel refreshed and ready to face a new day. If you continue to feel tired for weeks, it’s time to see your doctor. He or she may be able to help you find out what’s causing your fatigue. In fact, your doctor may even suggest you become more active, as exercise may reduce fatigue and improve quality of life.

Sometimes, fatigue can be the first sign that something is wrong in your body. For example, people with rheumatoid arthritis, a painful condition that affects the joints, often complain of fatigue. People with cancer may feel fatigued from the disease, treatments, or both.

Many medical problems and treatments can add to fatigue. These include:

Taking certain medications, such as antidepressants, antihistamines, and medicines for nausea and pain
Having medical treatments, like chemotherapy and radiation, or recovering from major surgery
Infections
Chronic diseases like diabetes, heart disease, kidney disease, liver disease, thyroid disease, and chronic obstructive pulmonary disease (COPD)
Untreated pain and diseases like fibromyalgia
Anemia
Sleep apnea and other sleep disorders
Managing a health problem may make the fatigue go away. Your doctor can help.

Can emotions cause fatigue?
Are you fearful about the future? Do you worry about your health and who will take care of you? Are you afraid you are no longer needed? Emotional stresses like these can take a toll on your energy.

Not getting enough sleep can also contribute to fatigue. Regular physical activity can improve your sleep. It may also help reduce feelings of depression and stress while improving your mood and overall well-being. Yoga, meditation, or cognitive behavioral therapy could also help you get more rest. Talk with your doctor if your mental well-being is affecting your sleep or making you tired.

Some lifestyle habits can make you feel tired. Here are some things that may be draining your energy:

Staying up too late. A good night’s sleep is important to feeling refreshed and energetic. Try going to bed and waking up at the same time every day.
Having too much caffeine. Drinking caffeinated drinks like soda, tea, or coffee late in the day can keep you from getting a good night’s sleep. Limit the amount of caffeine you have during the day and avoid it in the evening.
Drinking too much alcohol. Alcohol changes the way you think and act. It may also interact with your medicines.

Being bored can make you feel tired. That may sound strange, but it’s true. If you were very busy during your working years, you may feel lost about how to spend your time when you retire. When you wake up in the morning, you may see long days stretching before you with nothing planned. It doesn’t have to be that way.

Engaging in social and productive activities that you enjoy, like volunteering in your community, may help maintain your well-being. Think about what interests you and what skills or knowledge you have to offer and look for places to volunteer.

Try to avoid long naps (over 30 minutes) late in the day. Long naps can leave you feeling groggy and may make it harder to fall asleep at night.

by Carol Leish MA

Debbie Deem, a retired ‘Victim’s Specialist’ for the FBI, discussed various types of fraud in order for others to be aware of how to cope/stop them from happening.

Deem said that, “Regarding Government and business imposter fraud, the Federal Trade Commission (FTC), has an important warning about it. The FTC says that these, remote criminals contact you, usually via phone or text, saying that they are with the government, such as the IRS claiming that you owe back taxes. Or, that they are with Social Security insisting that your Social Security number has been ‘suspended’ or ‘stolen.’ Or, they may claim to be a Medicare representative who is asking for your Medicare number or offering to sell you equipment or tests, or perhaps another health care agency (especially regarding a COVID-19 related issue).

“They may also be impersonating utility companies, package deliveries jury duty or a bank that ‘threatens’ to close your account unless you take action. These calls sound legitimate and may threaten you with bad consequences unless you make a payment immediately or provide certain financial information. The payment is usually demanded immediately often with gift cards or increasingly crypto currency. If you get a call like this, hang up. Government and other legitimate businesses will not call you, email or text you to demand money or personal information.

For more information link to: https://www.consumer.ftc.gov/articles/how-avoid-government-impersonator-scam.”

“In terms of family (and friend) emergency fraud, Deem said that, “the Federal Trade Commission has several warnings about criminals using the phone, texting or emailing while pretending to be a relative or friend in an emergency (often a grandchild). The person calling may say that there has been a car accident, and that your loved one has been hospitalized, or has been taken to jail. Impersonators pretend to be doctors, lawyers, consulate staff and even pretend to be the family member themselves.

“The criminal imposter insists that you send money (sometimes repeatedly), quickly and secretly. They may even keep you on a cell phone until you have completed a transaction wiring money, sending gift card information, or sending funds via virtual currency. If you receive a call or text like this-hang up and don’t pay. For more information go to: https//www.consumer.ftc.gov/blog/2018/07/scammers-create-fake-emergencies-get-your-money.”
Deem said that, “The US Postal Inspection Services has information useful in learning about money mules, which is defined as a person who receives, and transfers money obtained from victims of fraud. Criminals may enlist victims to be money mules (or money movers) in work at home fraud schemes such as reshipping packages. It may also originate in lottery/sweepstake fraud or romance crimes.

“Victims may believe that they need to forward money or open a bank account and forward it to someone in hopes of receiving lottery money or to help in getting a romance imposter out of a difficult situation. However, transferring money/valuables on behalf of others only benefits criminals and may lead to serious consequences for the ‘mule.’ Being involved as a money mule is money laundering, even if you do not know that is the result of your innocent actions, is illegal.”

“For information concerning money mules,” Deem says to,” look at: https://www.uspis.gov/news/scam-article/mmoney-mule.”

With more knowledge of the above types of fraud and about money mules/money movers, you will be better able to avoid/stop fraud and to protect yourselves.

From NIH Research Matters by Erin Bryant

Changes in sleep patterns are common in people with Alzheimer’s disease and other dementias.

They may wake up often during the night and find it hard to get back to sleep. These sleep problems are thought to result from brain changes caused by the disease that affect the sleep-wake cycle.

Studies have suggested that sleep patterns earlier in life may contribute to later dementia risk. Both insufficient sleep and sleeping longer than average have been linked to a greater likelihood of developing dementia. However, it has been hard to determine whether these sleep changes contribute to the disease or simply reflect early symptoms.

Many of the studies on sleep and dementia risk have followed participants for less than a decade and focused on people over the age of 65. A study led by Dr. Séverine Sabia of Inserm and University College London examined how sleep patterns earlier in life may affect the onset of dementia decades later.

The study was supported in part by NIH’s National Institute on Aging (NIA). Findings appeared in Nature Communications on April 20, 2021.

The researchers examined data from nearly 8,000 people in Britain starting at age 50. Participants were assessed on a wide variety of measures, including being asked on six occasions between 1985 and 2016 how many hours they slept a night. To assess the accuracy of this self-reporting, some of the participants wore accelerometers to objectively measure sleep time. Over the course of the study, 521 participants were diagnosed with dementia, at an average age of 77.

Analysis of the data showed that people in their 50s and 60s getting six hours of sleep or less were at greater risk of developing dementia later. Compared to those getting normal sleep (defined as 7 hours), people getting less rest each night were 30% more likely to be diagnosed with dementia.

The researchers adjusted their model to account for other factors known to influence sleep patterns or dementia risk, including smoking, physical activity, body mass index, and medical conditions like diabetes and heart disease. They also separated out people with mental illnesses like depression, which are strongly linked to sleep disturbances.

The findings suggest that short sleep duration during midlife could increase the risk of developing dementia later in life. More research is needed to confirm this connection and understand the underlying reasons.

“While we cannot confirm that not sleeping enough actually increases the risk of dementia, there are plenty of reasons why a good night’s sleep might be good for brain health,” Sabia says.

Quality sleep is known to play an important role in concentration and learning, as well as mood and overall health.

This research was supported in part by NIA grants R01AG056477 and RF1AG062553.

Alzheimer’s disease and related dementias get worse over time. Even simple everyday activities can become difficult to complete. To help cope with changes in memory and thinking, consider strategies that can make daily tasks easier. Try to adopt them early on so you will have more time to adjust. You can:

Write down to-do lists, appointments, and events in a notebook or calendar.

Set up automated bill payments and consider asking someone you trust to help manage your finances.

Have your groceries delivered.

Manage your medications with a weekly pillbox, a pillbox with reminders (like an alarm), or a medication dispenser.

Ask your doctor to provide a care plan and write down care directions (or have a family member or friend take notes during the visit).

Sleep Tips for People Living With Dementia

Dementia often changes a person’s sleeping habits. You may sleep a lot, or not enough, and wake up many times during the night. Poor sleep quality can make dementia symptoms worse.

Tips for better and safer sleep:

Follow a regular schedule by going to sleep and getting up at the same time each day, even on weekends or when traveling.

Develop a relaxing bedtime routine with lowered lights, cool temperature, and no electronic screens.

Avoid caffeine and naps late in the day.

Have a lamp that’s easy to reach and turn on, a nightlight in the hallway or bathroom, and a flashlight nearby.

Keep a telephone with emergency numbers by your bed.

Talk to your doctor if you have problems sleeping.

Healthy and Active Lifestyle Tips for People Living With Dementia

Participating in activities you enjoy and getting exercise may help you feel better, stay social, maintain a healthy weight, and have regular sleep habits.

Try these tips for a healthy and active lifestyle:

Try to be physically active for at least 30 minutes on most or all days of the week. But be realistic about how much activity you can do at one time. Several short “mini-workouts” may be best.

Aim for a mix of exercise types — endurance, strength, balance, and flexibility. For example, you could do a mix of walking or dancing, lifting weights, standing on one foot, and stretching. Even everyday activities like household chores and gardening help you stay active.

Your diet may need to change as dementia progresses to maintain a healthy weight. Talk with your doctor about the best diet for you, and choose nutritious foods such as fruits and vegetables, whole grains, and lean sources of protein and dairy products. Avoid added sugars, saturated fats, and sodium.

Stay social by talking on the phone with family and friends, joining an online support group, or going for a walk in your neighborhood.

Finding Care and Support: Tips for People Living With Dementia

Many people may be able to help in different ways. These people might include family members, friends, professional caregivers, community organizations, and others with dementia. For example, you can:

Ask friends or family to help with needs like cooking, paying bills, transportation, or shopping.

If you live alone, find people you trust who can visit often.

Consider letting trusted neighbors know of your diagnosis so they can help if needed.

Use social service agencies, local nonprofits, and Area Agencies on Aging to connect with in-home help, transportation, meals, and other services.

Learn more about support and services.