by the NCOA

Diabetes, arthritis, hypertension, lung disease, and other chronic diseases can make life difficult to manage for millions of older adults, often forcing them to give up their independence.

Every day, millions of people with chronic diseases struggle to manage their symptoms.

About 80% of older adults have one chronic disease.

68.4% of Medicare beneficiaries have two or more chronic diseases and 36.4% have four or more.

Chronic diseases can affect a person’s ability to perform important activities, restricting their engagement in life and their enjoyment of family and friends.

The Cost of Chronic Diseases

The traditional medical model of caring for people with chronic diseases—which focuses more on the illness than on the patient—is expensive and often ineffective.

More than two-thirds of all health care costs are for treating chronic diseases.

95% of health care costs for older Americans can be attributed to chronic diseases.

Less than 1% of health care dollars are spent on prevention to improve overall health.

NCOA’s Role

Addressing chronic diseases requires new strategies to delay health deterioration, improve function, and address the problems that people confront in their day-to-day lives.

NCOA and Stanford University have collaborated for nearly a decade to disseminate proven programs in-person and online that empower individuals with chronic diseases to manage their own care and improve their quality of life.

Probably the best known and most highly regarded self-management program for people with chronic diseases is Stanford’s Chronic Disease Self­-Management Program (CDSMP).

Through a partnership with the U.S. Administration for Community Living, NCOA promotes CDSMP and its variants through community-based workshops.

CDSMP is also supported in communities by grants from the Centers for Disease Control and Prevention and other funders. Since 2006, more than 300,000 people have participated in these impactful programs.

As part of our social enterprise partnership with Canary Health, NCOA continues to promote the online suite of self-management programs, known as Better Choices, Better Health®. We also remain committed to research and development work on evidence-based self-management and patient engagement.

What is CDSMP?

CDSMP is a low-cost program that helps adults with chronic diseases learn how to manage and improve their health. Interactive workshop sessions focus on problems that are common to individuals dealing with any chronic disease. Topics include pain management, nutrition, exercise, medication use, emotions, and communicating with doctors.

Workshops are led by two trained facilitators, at least one of whom has a chronic disease. Fifteen hours of content are covered during weekly sessions held over a six-week period. Throughout the program, approximately 10-15 participants focus on building skills to manage their conditions by sharing experiences and providing mutual support.

CDSMP:

Helps people with diverse medical diagnoses such as diabetes, arthritis, and hypertension develop skills and coping strategies to manage their symptoms.

Employs action planning, interactive learning, behavior modeling, problem-solving, decision­ making, and social support for change.

Is offered via two venues—online and in-person held in community settings such as senior centers, churches, community health clinics, and libraries.

Has disease-specific variants for diabetes, chronic pain, cancer survivors, HIV/AIDS, and arthritis.

Is available in Spanish for the chronic disease and diabetes self-management programs, and the Stanford-developed CDSMP trainer manual is available in over 19 different languages.

How Effective is CDSMP?

Based on a recent national study of CDSMP, the program resulted in significant, measurable improvements in the health and quality of life of adults with chronic diseases. CDSMP also appears to save enough through reductions in health care expenditures to pay for itself within the first year.

Health Benefits

Improved self-reported health.

Improved health status in six indicators: fatigue, shortness of breath, depression, pain, stress, and sleep problems.

Improved health-related quality of life, unhealthy physical days, and unhealthy mental days.

Improved communication with doctors, medication compliance, and health literacy.

Cost Savings

$714 per person savings in emergency room visits and hospital utilization.

$364 per person net savings after considering program costs of $350 per participant.

Potential savings of $6.6 billion by reaching 10% of Americans with one or more chronic disease.

An experimental blood test was highly accurate in detecting Alzheimer’s disease, scientists have reported. A promising breakthrough that could make diagnosis simple, affordable and widely available.

The test was able to determine whether people with dementia had Alzheimer’s instead of another condition, the New York Times reported. It also identified signs of Alzheimer’s 20 years before memory and thinking problems were expected in people with a genetic mutation that causes the degenerative, deadly disease, the outlet said.

“This blood test very, very accurately predicts who’s got Alzheimer’s disease in their brain, including people who seem to be normal,” Dr. Michael Weiner, an Alzheimer’s disease researcher at the University of California, San Francisco, told The Times.

The research was published in JAMA Network Open and presented at the Alzheimer’s Association International Conference.

The blood test — which performed as accurately as more invasive methods such as MRI brain scans, PET scans and spinal taps — provides a much simpler and more affordable way to diagnose whether people with cognitive problems were experiencing Alzheimer’s, as opposed to another type of dementia.

Such a blood test also may eventually be used to predict whether someone without symptoms would develop the disease, according to The Times.

“It’s not a cure, it’s not a treatment, but you can’t treat the disease without being able to diagnose it. And accurate, low-cost diagnosis is really exciting, so it’s a breakthrough,” said Weiner, who was not involved in the study.

The test could be available for clinical use in as little as two to three years, experts said.

by Matt Sutterer Health Specialist, Division of Neuroscience (DN)

The ability to stand or sit without falling seems simple enough, but it actually involves a complex orchestration behind the scenes of our visual, positional, and vestibular systems. Aging can affect all three of these sensory systems, resulting in balance disorders such as dizziness or vertigo and increased risk for falls. According to the Centers for Disease Control and Prevention, one in four Americans aged 65 or older reports falling each year, and 20% to 30% of those who fall suffer moderate to severe injuries.

Robust research has helped us understand how vision contributes to balance in older adults. However, there has been significantly less research conducted on how balance is affected by the aging vestibular system — the organs of the inner ear that help us sense movement and orientation in space. How these systems interact in the brain, both in healthy aging and in older adults with neurodegenerative diseases and conditions such as Alzheimer’s disease and related dementias and Parkinson’s disease, is not well understood.

Seeking a steadier research landscape

In April 2019, NIA, in partnership with the National Institute on Deafness and Other Communication Disorders (NIDCD), hosted a two-day workshop, “Central and Peripheral Control of Balance in Older Adults.” Workshop co-chairs Coryse St. Hillaire-Clarke (Program Director, Division of Neuroscience) and Lyndon Joseph (Program Director, Division of Geriatrics and Clinical Gerontology) led the effort that featured presentations from an array of researchers and clinicians across diverse fields, including gerontology, geriatrics, neurology, neuroscience, movement science, and rehabilitation. A white paper was recently published highlighting the workshop’s outcomes.

The discussion focused on three key questions:

How does aging impact vestibular function?

We lack a good understanding of aging’s impact on vestibular organs and the brain areas to which they connect and how these changes relate to clinical symptoms.

How do we tease apart the different contributions of age-related sensory and motor changes in an older adult with balance problems?

Common symptoms like dizziness, disequilibrium, unsteady walking, and increased falls can result from age-related changes in the vestibular system, other sensory systems, and even musculature or cognition. Determining the effects of each is vital for identifying treatments for balance disorders.

How can we develop a better classification system of balance problems in older adults?

The field currently lacks a widely accepted model of balance that reflects its multimodal nature. This is needed to guide the development of clinical outcome measures and to translate balance interventions into clinical or community settings.

NIA is interested in helping to answer the question of how aging affects the vestibular system and how these changes interact with other factors that lead to balance impairment. Given the multidisciplinary and multisystem nature of balance, a team science approach will be critical to this effort.

Funding available — let’s hear your ideas!

If you are interested in tackling these and other questions about the vestibular system and balance in aging, please apply for the funding opportunity announcement released earlier this year in collaboration with NIDCD by October 2, 2020. Contact Dr. Joseph or Dr. St. Hillaire-Clarke for more details. We would love to hear your questions or comments!

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by Jayson Cohen American Legacy Solutions

In June We celebrated World Elder Abuse Awareness Day. There can be many ways the elderly are abused by family or those close to them. Let’s look at abuse from a financial aspect.

Financial abuse can be a complicated subject, but at its most basic level it involves taking advantage of an older adult through manipulation or intimidation to steal their money or property.

Elderly adults are some of the most vulnerable to financial abuse. Some of the biggest risk factors for older adults include:

Isolation – Isolation can cause extreme loneliness in seniors, leaving them desperate for any sort of social connection. Many abusers target elder adults for this reason.

Lack of knowledge of financial matters – Elder adults who don’t pay much attention to or don’t understand financial issues can be tricked into giving over secure information.

Disability – Whether the older adult has a physical or mental disability, they are dependent on others to take care of themselves. This leaves them vulnerable to manipulation and intimidation by caregivers. Disability can also make an elder adult seem less likely to take action against the abuser.

Who is most likely to abuse?

Unfortunately, abusers are rarely unknown to the abused. In fact, those who are most likely to abuse are the ones who are closest to the elder individual or someone that he or she trusts. The most common financial abusers include:

Family members – Family members can have different motivations for committing financial abuse. They may feel entitled to their relative’s money or property, especially if they are due to inherit from the elder or are in a caretaking position.

Caretakers – A caretaker can be a family member or someone who is paid to provide care to an older adult in the elder’s own home. As such, a caretaker is the person who has the most access to the elder.

Professionals in whom the elder trusts – Professionals are people in whom the elder adult depends on to take care of the things he or she is not capable of handling alone anymore. These services can range from attorneys to someone your relative hires to take care of the lawn. Abusers can take advantage of older adults by overcharging for services or manipulating them into signing documents that they don’t understand.

Scammers and con artists – Some predators prey specifically on elder adults, counting on their social isolation and lack of knowledge about financial matters to be able to gain access to their victim and their financial assets.

What types of financial abuse exist?

Financial abuse can take different forms, depending on the relation of the abuser to the elder adult. Common tactics include (but are not limited to):

Theft of money or property

Using manipulation or intimidation to force him or her to sign legal/financial documents

Forging his or her signature

Fraud

Telemarketing and email scams

How can you prevent financial abuse of elders?

The best thing that you can do to prevent elder financial abuse is to keep your older relative or friend from being isolated. Check in regularly, make sure you know who has access to him or her, and know the signs of financial abuse. Keep an eye out for suspicious signatures on checks, suddenly unpaid bills, and new and unexplained “friends.” By knowing the signs, you can help prevent the financial abuse of your loved one.

Millions of America’s seniors could face disruptions to audiology and speech-language pathology therapy services vital to their health and quality of life unless Congress and the Centers for Medicare & Medicaid Services (CMS) act to protect them, the American Speech-Language-Hearing Association (ASHA) have warned

At issue is CMS’s 2021 proposed Medicare Physician Fee Schedule rule, released on August 3, in which the agency recommends significant payment reductions to more than three dozen health care provider groups, including audiologists and speech-language pathologists. This is an effort to offset increasing payments for office/outpatient evaluation and management (E/M) codes typically used by primary care physicians.

Audiologists are facing a 7% cut to Medicare reimbursement, and speech-language pathologists are facing a 9% cut—which would translate into significant reductions in therapy services for a range of communication, cognition, and swallowing problems common in seniors. These problems are often a result of conditions including stroke, brain injury, Alzheimer’s disease, Parkinson’s disease, and head and neck cancers, along with hearing loss—one of the most common health conditions that seniors experience.

“The services provided by audiologists and speech-language pathologists are absolutely essential to our seniors as they recover from serious medical events and live with chronic conditions such as neurological disorders and hearing loss,” said Theresa H. Rodgers, MA, CCC-SLP, ASHA 2020 President. “Medicare cuts are most unfortunate, and especially ill-advised, given the treatable nature of many of these conditions—and the tremendous improvements that our members witness every day when patients have appropriate access to needed diagnostic and rehabilitative services. Our seniors deserve better.”

The proposed cuts are the product of a Medicare statutory requirement known as budget neutrality, which requires that any increase in costs to the Medicare program (in 2021, higher spending on E/M codes) must result in decreased spending elsewhere under Medicare. The cuts will go into effect in 2021, unless Congress and CMS act to waive the budget neutrality requirement.

ASHA, along with the American Occupational Therapy Association (AOTA), the American Physical Therapy Association (APTA), and many other physician and nonphysician provider groups, has engaged in vigorous advocacy efforts over the past several months aimed at Congress, CMS, the Department of Health and Human Services, and the Office of Management and Budget to curtail these cuts and stress the serious impact that such cuts would have on seniors.

While recognizing the importance of funding the services provided by primary care physicians, ASHA notes the equally important value of its members’ diagnostic and rehabilitative services—calling for a holistic reimbursement approach. In a joint statement issued August 4, ASHA, AOTA, and APTA noted: “Our organizations call on Congress and CMS to advance well-reasoned fee schedule payment policies and waive budget neutrality.”

Further reinforcing this approach, ASHA joined with a broad coalition of organizations representing more than 330,000 physicians and 884,000 nonphysician providers. In a collective statement, those groups specified: “Our groups are calling on Congress and CMS to collaborate on developing a solution that will allow the changes to the E/M services to proceed, while at the same time preventing cuts to our health care professionals.”

For more information, visit www.asha.org.

Over the next two years, the National Council on Aging (NCOA) will connect 1.15 million eligible older adults to the Supplemental Nutrition Assistance Program (SNAP), thanks to a $4.35 million grant from the Walmart Foundation.

Even before the COVID-19 pandemic, over 9.8 million older adults experienced food insecurity, meaning they lack consistent access to adequate, nutritious food. Today, those numbers are quickly rising. SNAP is the nation’s most effective and widest-reaching anti-hunger program. Research by the Center for Budget and Policy Priorities shows that participation in SNAP reduces food insecurity overall by 30%, yet the U.S. Department of Agriculture estimates that only 48% of eligible older adults aged 60+ participate in the program.

During the coronavirus pandemic, older adults have been turning to NCOA for resources related to SNAP, food, and nutrition as they struggle to access and pay for food while being homebound. In the first week of the pandemic, more than 30,000 individuals downloaded a SNAP application on NCOA’s BenefitsCheckUp®, a free and confidential screening tool that connects eligible older adults to benefits.

“We’ve heard from older adults and our local partners that accessing and paying for food is a critical need right now,” said Josh Hodges, NCOA Chief Customer Officer. “Food, on average, is the second highest household expenditure for people aged 60+, and too often they have to stretch their food budget in order to make ends meet. That’s where SNAP can help.”

“Now more than ever, older adults need support accessing the resources that help them put nutritious food on the table,” said Eileen Hyde, director of sustainable food systems and food access for Walmart.org. “This new grant builds upon the innovative work on benefits access that NCOA has championed for several years.”

Over the past 7 years, with support from the Walmart Foundation, NCOA has helped 3.6 million older adults access their SNAP applications, resulting in 1.14 million enrollments.

The new grant will support both in-person and online SNAP outreach and enrollment. NCOA will fund 40 community-based organizations that provide trusted, in-person benefits counseling in communities across the country. The grant also will be used to find and connect eligible older adults to their SNAP applications using the virtual tool BenefitsCheckUp, which is accessible to anyone with an internet connection. Funding will target vulnerable and difficult-to-reach populations, including African Americans, Hispanic/Latinx, women, and rural Americans, many of whom have been severely impacted by the COVID-19 pandemic. Older adults can find out right now if they’re eligible for SNAP by visiting www.BenefitsCheckUp.org/SNAP.

The National Council on Aging (NCOA) is a trusted national leader working to ensure that every person can age well. Since 1950, our mission has not changed: Improve the lives of millions of older adults, especially those who are struggling. NCOA empowers people with the best solutions to improve their own health and economic security—and we strengthen government programs that we all depend on as we age. Every year, millions of people use our signature programs BenefitsCheckUp®, My Medicare Matters®, and the Aging Mastery Program® to age well. By offering online tools and collaborating with a nationwide network of partners, NCOA is working to improve the lives of 40 million older adults by 2030. Learn more at ncoa.org and @NCOAging.

by Peter J. Pitts, former FDA associate commissioner, is president of the Center for Medicine in the Public Interest.

For chronically ill Americans, the economic damage from COVID-19 could be nearly as life-threatening as the virus itself. More than 40 million workers have filed for unemployment since the beginning of the outbreak. For many, the financial challenges of joblessness have made it harder than ever to afford their insurance companies’ medication copays.

That’s why a new decision from the Trump administration couldn’t have come at a worse time. The rule, which was finalized in May, enables insurers to artificially inflate patients’ out-of-pocket drug costs. In so doing, it creates unnecessary challenges for Americans who are already struggling to stay healthy.

For many patients, high pharmacy bills were a heavy burden even before COVID-19. A November Kaiser Family Foundation survey found that half of patients in poor health had difficulty paying for their medications. Three in ten reported skipping doses for financial reasons.

This “non-adherence” causes 125,000 deaths each year and as many as a quarter of hospitalizations. It also inflates U.S. healthcare spending by up to $289 billion annually.

Now that coronavirus lockdowns have sent our economy into a tailspin, drug adherence rates are likely to plummet further as Americans look for new ways to make ends meet.

Consider that a quarter of the country has dipped into savings in recent weeks, while 14 percent have borrowed money from friends or family, per Northwestern Mutual. It’s only a matter of time before large numbers of Americans stop filling the prescription medicines they need.

In times like these, helping the hardest-hit patients take their medications ought to be a top priority. Yet the Trump administration has done precisely the opposite. The new rule from the Centers for Medicare and Medicaid Services (CMS) would help insurance companies nullify the prescription drug coupons that make medicines affordable for millions of Americans.

In many health plans, patients pay for their own drugs up to a certain limit, known as a deductible, after which they are responsible for a smaller copay. The patient remains on the hook for those copays until he or she reaches the federally mandated out-of-pocket limit, which in 2020 was $16,300 for families.

To help defray out-of-pocket costs, drug firms usually offer generous coupons on brand-name medications.

For cash-strapped patients, these discounts can be life-changing. About a fifth of commercially insured patients use coupons to lower their pharmacy costs. These coupons cut out-of-pocket drug spending by $13 billion in 2018. Just as important, drug coupons have been shown to increase adherence for everything from cholesterol medication to anti-inflammatory drugs.

These coupons only benefit patients if they count towards the out-of-pocket limit. Otherwise, patients would still be on the hook for huge pharmacy bills.

Unfortunately, the new CMS rule allows insurers to stop counting coupons towards the out-of-pocket cap. That means insurance giants will extract more money out of struggling Americans’ pockets.

Officials in states like Virginia, West Virginia, Illinois, and Arizona have already banned this practice. Unless other states follow suit — or Congress intervenes and passes legislation nullifying the rule — millions of Americans could face higher pharmacy bills while battling the worst financial crisis since the Great Depression.

Barring intervention, America could face a pandemic of non-adherence that puts millions of lives at risk. Unlike COVID-19, this new public health emergency won’t be caused by a wily virus, but by the callousness of Washington policymakers.

The Ventura County Area Agency on Aging is the recipient of two National Mature Media Awards and a California Association of Public Information Officers (CAPIO) award. Projects that received acknowledgement include LIVEWell and the Navigating Medicare Enrollment video production, both of which are being recognized among the state and nation’s best marketing, communications, and educational materials produced for older adults.

LIVEWell, which won a CAPIO Award of Distinction and a Silver Award from the National Mature Media Awards, is the premier resource guide for older adults, people with disabilities, and caregivers in Ventura County. LIVEWell is published annually with content available in English and Spanish. Click here to view the 2020 issue of LIVEWell.

Navigating Medicare Enrollment received a Silver Award from the National Mature Media Awards and was produced as part of the VCAAA’s Health Insurance and Advocacy Program (HICAP) with a goal to assist people who are new to, or have questions regarding, Medicare enrollment. Click here to view the video.

“The VCAAA is honored to receive this recognition and is proud of the impact our marketing and communication efforts have had on the community,” said Victoria Jump, Director of the VCAAA. “We take pride in the work we produce and strive to find new ways to strengthen our methods of communication so that we can continue to empower Ventura County residents to age optimally.”

For more information, visit www.vcaaa.org or call (805) 477-7300.

The Ventura County Area Agency on Aging, an agency of the County of Ventura, is the principal agency in Ventura County charged with the responsibility to promote the development and implementation of a comprehensive coordinated system of care that enables older individuals, caregivers, and individuals with disabilities to live in a community-based setting and to advocate for the needs of those 60 years of age and older in the county, providing leadership and promoting citizen involvement in the planning process as well as in the delivery of services.