Enea's advice: Establish a durable power of attorney

Have you witnessed siblings, family members and friends battle for control of the finances and care of their aging parents and loved ones. While the litigation may be for the authority to make day-to-day financial and health care decisions, sadly, the root cause is often times inheritance and monetary control.

It is anticipated that controversies and court fights involving aging parents will rapidly grow in direct proportion to the aging U.S. population. The largest transfer of inter-generational wealth, estimated to be approximately $10 trillion dollars, will be transferred from the World War II generation to the baby boomers. Unfortunately, the victim in these controversies is often the family unit.  The bitterness, resentment and destruction of relationships can lead to something akin to a  “family divorce,” the impact of which may be felt for generations, says elder law attorney Anthony J. Enea.

High-Potency Vitamin D Comes in a Softgel

Research shows that Vitamin D may protect against a number of ailments, including osteoporosis, diabetes, glucose intolerance,hypertension, stroke, autoimmune diseases and some forms of cancer.  Vitamin D is naturally synthesized in the skin following exposure to sunlight, but deficiencies may occur as a result of decreased time spent outdoors, reduced sun exposure in colder climates and heavy use of sunscreen. Cardium Therapeutics has introduced a high-potency bioavailable Vitamin D supplement, D-Sorb. provides 2000 IUs of Vitamin D3 in softgels .A lipid-based delivery system allows the Vitamin D to become more water soluble, which has been clinically proven to provide increased absorption and bioavailability. Vesisorb D-Sorb colloidal droplets also protect the Vitamin D from light oxidation and stomach acids. D-Sorb utilizes Vitamin D3, which is considered to be a more effective form of Vitamin D than Vitamin D2.  Vitamins D2 (ergocalciferol) and D3 (cholecalciferol) are both naturally occurring precursors that are converted in the liver and kidneys to the biologically active form of Vitamin D.  Studies have shown that Vitamin D3 is more effective than Vitamin D2 in raising and maintaining levels of biologically active Vitamin D.

Making Progress on a New Drug for Overactive Bladder

Astellas Pharma Inc. (Tokyo) is seeking U.S. Food and Drug Administration and European Medicines Agency approval for mirabegron (generic name/code name: YM178) for the first in a new class of medicine for the indication of overactive bladder (OAB) associated with symptoms of urgency, urinary frequency, and urge urinary incontinence.Phase 3 clinical trials in the U.S. and Europe met primary endpoints compared to placebos.

The average caregiver is a middle-aged woman; however, support of the entire family is often needed to help care for a loved one

Typically, she is a 49-year- old woman who works outside of the home and spends nearly 20 hours per week providing unpaid care to her mother over the course of nearly five years.  Almost two-thirds of family caregivers are women and more than eight in 10 are caring for a relative or friend age 50 or older.  The support and services they provide are critical to aging adults remaining at home and in the community, but often comes at substantial cost to caregivers themselves, to their families, and to society.

In 2009, about 42.1 million family caregivers in the U.S. provided care to an adult with limitations in daily activities at any given point in time, and about 61.6 million provided care at some time during the year, reports AARP’s Public Policy Institute. The estimated economic value of their unpaid contributions was approximately $450 billion in 2009, up from an estimated $375 billion in 2007. If family caregivers were no longer available, the economic cost to the U.S. health care and long-term services and supports (LTSS) systems would increase astronomically. The report, “Valuing the Invaluable: The Growing Contributions and Costs of Family Caregiving, 2011 Update,” explains the contributions of family caregivers, details the costs and consequences of providing family care, and provides policy recommendations to better support caregiving families.

Helix-D formulated to restore skin to youthful appearance

TheCosmoProf Convention in Las Vegas was the launch pad for Helix-D, a skincare technology that  “isn’t simply an anti-wrinkle product,” says Louis Rinaldi, the pro

duct’s chief cosmetic officer, “it is a comprehensive, multi-functional anti-aging solution.  Savvy skincare consumers, tired of expensive products that fail to deliver on their promises, will find that Helix-D is just what they have been waiting for.

“The point of difference is found in the  new  Helix Delivery System (HDS), which features a dual-liposome, low polar, friction-free delivery system which suspends the active ingredients in a protective matrix, preserving their potency until activated at the skin surface.  When the matrix and base are blended at the skin surface during application, the formulation is activated and the delivery system transports the actives past the protective outer layer of the skin—the stratum corneum—to targeted skin layers beneath. As the delivery system penetrates the skin’s surface, first the exterior, then the interior liposomes dissolve, providing a sustained, time-release of actives to the surrounding cells.  These state-of-the-art actives—which feature the most advanced power-peptides, matrikines, antioxidants, and nanohydrators—rejuvenate, rehydrate, and restore skin to its youthful appearance.

Organiceutical formulated to slow aging skin

The aging process involves more than just time and there are a variety of factors that contribute to this process which include sun exposure, smoking, repetitive facial expressions, sleeping positions and even gravity.While the aging process is inevitable, studies have shown that 80% of premature skin aging can be avoided, according to Stiefel, a GSK company, which recently introduced a line of Revaleskin system with Coffeeberry Whole Fruit Extract to help to slow the aging process.

Retinoid complex reduces fine lines and wrinkles

Jan Marini Skin Research has introduced  two retinoid-antioxidant-peptide complex product solutions – Retinol Plus and Retinol Plus MD.   Retinol Plus MD, containing a high concentration 1.0% Retinol, is provided exclusively through the physician retail marketplace while Retinol Plus (0.5% Retinol) is available to licensed skin care professionals and physicians.

The Retinol Plus products offer significant advantages beyond just those of high-concentration retinoids. Key integrated peptides, antioxidants, hydrators and soothing agents enhance clinical benefits while simultaneously reducing the acclimation and sensitivity historically associated with high concentration retinoids.  The advanced combination formula provides rapid and clinically proven improvement for smoother, more uniform looking skin with marked reduction in the appearance of fine lines and wrinkles with little to no acclimation and sensitivity. Jan Marini,  CEO of Jan Marini Skin Research,  says the products combine the most concentrated levels of retinol allowed with powerful anti-aging peptides and protective and soothing antioxidants in a stabilized lightweight hydrating cream.

The ability to provide reliable monitoring and medical care for seniors in their home is expected to emerge as a major trend in the search for savings in the  U.S. healthcare system, projects Visual Healthcare Corp. (Reno, NV). In anticipation of this trend the supplier of smart distributive and inferential technologies plans to step up delivery of its home care applications for seniors and the disabled.

The sudden reversal of spending patterns to follow new U.S. budget cuts is certain to impact Medicare and Medicaid. These come at a time when demographic pressures of an aging population make it increasingly difficult to continue providing easy access to a wide range of expensive medical facilities as in the past.

“We are seeing the emergence of a multi-billion dollar market for smart home care applications that can not only monitor heart function, blood pressure, sugar levels, fever and oxygen source at home, but more importantly can also have it transmitted to a smart clinical system that will be reading the signs and providing suitable alerts in realtime. These transmission protocols will require no human intervention and will be working through automated routes such as the GSM network,” says Chairman Gerard Dab. “The ability to treat seniors at home will generate some of the serious savings required by policy makers.”

Provider organizations and their suppliers are part of a new generation of caregivers who will increasingly rely on our proprietary enabling platforms, real smart clinical tools and adapted mobile devices to improve ambulatory care and keep patients out of expensive hospital stays.Visual Healthcare  designs  and develops innovative information platforms, specifically conceived for the automation of a wide range of scientific disciplines. These include pharmaceutical research, clinical trials, laboratory automation, true quality assurance tools, total quality control applications.

They also include quantitative analytic tools such as proprietary frameworks for electronic health records, electronic prescription, infection and disease control, and smart cancer registries. The company’s extensive portfolio of proprietary technologies is the result of a unique collaboration between senior clinicians from the McGill University Faculty of Medicine and affiliated tertiary care centers, medical software architects, and a Fortune 100 healthcare service company, investing some $50 million in the process. The Company licenses its technology to operating companies in exchange for an equity stake or a royalty stream. It owns significant stakes in various companies including VisualMED Clinical Solutions Corp. (NASDAQ OTC: VMCS), a leader in the field of Intelligent Electronic Health Records.

The sudden reversal of spending patterns to follow new US budget cuts is certain to impact Medicare and Medicaid. These come at a time when demographic pressures of an ageing population make it increasingly difficult to continue providing easy access to a wide range of expensive medical facilities as in the past.

“We are seeing the emergence of a multi-billion dollar market for smart home care applications like ours that can not only monitor heart function, blood pressure, sugar levels, fever and oxygen source at home, but more importantly can also have it transmitted to a smart clinical system that will be reading the signs and providing suitable alerts in real time. These transmission protocols will require no human intervention and will be working through automated routes such as the GSM network,” says Chairman Gerard Dab. “The ability to treat seniors at home will generate some of the serious savings required by policy makers.” The products will serve a new generation of caregivers who will increasingly rely on software platforms, smart clinical tools and adapted mobile devices to improve ambulatory care and keep patients out of expensive hospital stays.

Alzheimer’s is the defining disease of baby boomers and one of the biggest challenges facing the country today,” says Marie Marley, Ph.D., the Kansas City-based author of “Come Back Early Today: A Memoir of Love, Alzheimer’s and Joy.” The book recounts the recounts the years she spent caring  for the love of her life,  Edward Theodore, a lawyer and University of Cincinnati professor,  and one of the many faces of dementia.

Like many people, she was caught off guard  by  the early symptoms of Alzheimer’s. She knew something was wrong when she looked intohis face one evening. He was angry, depressed, even delusional. He couldn’t find his scissors — because he couldn’t find his kitchen. “Kitchen? What’s a kitchen? I don’t have a kitchen,” he told her. The behavior of this former brilliant  a charming yet eccentric Romanian scholar and gentleman deteriorated into dementia. For a time, his drinking increased. He was verbally abusive. He was increasingly confused. He slept most of the day.

Dr. Marley, a veteran medical grant writer at the University of Cincinnati, has acquired a keen understanding of many geriatric issues, including dementia.  Yet nothing, she says,  could have prepared her for the often heartbreaking task of loving and caring for a loved one with Alzheimer’s disease.”Fortunately I discovered there can be hope amidst the darkness of dementia,” says Marley. “Even though Ed was still demented, psychotropic medications helped transform him from an angry, depressed patient into one of the most contented, loving, adorable people you’d ever want to meet. Not the face of your typical Alzheimer’s patient.”The use of such medications, however, is highly controversial. Years ago nursing homes often used them to drug problem patients into submission. They were given in high doses that sedated patients and typically turned them into zombies. “Families were aghast,” says Marley.

Today’s newer medications can be used to treat non-dementia problems such as depression, obsessive compulsiveness, aggression, or anxiety — all, asserts Marley — in doses that do not overly sedate patients. The patients are still demented, of course, but these drugs can improve the overall quality of life for both the patient and the caregiver.Every 69 seconds someone develops Alzheimer’s. It impacts people in every walk of life — sports coaches, music stars, even presidents. In fact, more than 5.4 million people in the U.S. suffer from its debilitating effects.

September is the first World Alzheimer’s Month, and September 21st is Alzheimer’s Action Day, when the Alzheimer’s Association is asking people to wear purple and take action in the fight against Alzheimer’s.

Dr. Marley is a medical grant writer at the American Academy of Family Physicians in Leawood, Kansas. Her book is available at Amazon.com and at the book’s website, ComeBackEarlyToday.com.

Profile: My Elders

Their findings, publishedin the online edition of Journal of the American Geriatrics Society, suggests that “nature” (in the form of protective longevity genes) may be more important than “nurture” (lifestyle behaviors) when it comes to living an exceptionally long life.  Nir Barzilai, M.D., director of the Institute for Aging Research at Einstein, was the senior author of the study.

Dr. Barzilai and his Einstein colleagues interviewed 477 Ashkenazi Jews who were living independently and were 95 and older (95-112, 75% of them women). They were enrolled in Einstein’s Longevity Gene’s Project, an ongoing study that seeks to understand why centenarians live as long as they do. (Descended from a small founder group, Ashkenazi Jews are more genetically uniform than other populations, making it easier to spot gene differences that are present.)

The elderly participants were asked about their lifestyles at age 70, considered representative of the lifestyle they’d followed for most of their adult lives. They answered questions about their weight and height so that their body mass index (BMI) could be calculated. They also provided information about their alcohol consumption, smoking habits, physical activity, and whether they ate a low-calorie, low-fat or low-salt diet.

To compare these long-lived individuals with the general population, the researchers used data from 3,164 people who had been born around the same time as the centenarians and were examined between 1971 and 1975 while participating in the National Health and Nutrition Examination Survey.

Overall, people with exceptional longevity did not have healthier habits than the comparison group in terms of BMI, smoking, physical activity, or diet. For example, 27% of the elderly women and an equal percentage of women in the general population attempted to eat a low-calorie diet. Among long-living men, 24 percent consumed alcohol daily, compared with 22% of the general population. And only 43%t of male centenarians reported engaging in regular exercise of moderate intensity, compared with 57% of men in the comparison group.

“In previous studies of our centenarians, we’ve identified gene variants that exert particular physiology effects, such as causing significantly elevated levels of HDL or ‘good’ cholesterol,” said Dr. Barzilai, who is also professor of medicine and of genetics at Einstein. “This study suggests that centenarians may possess additional longevity genes that help to buffer them against the harmful effects of an unhealthy lifestyle.”

The research did find, however, that overweight centenarians tended to have lower rates of obesity than the control group. Although male and female centenarians were just as likely to be overweight as their counterparts in the general population, the centenarians were significantly less likely to become obese:  only 4.5% of male centenarians were obese vs. 12.1% of controls; and for women, 9.6 percent of centenarians were obese versus 16.2% of controls. Both of these differences are statistically significant.

While longevity genes may protect centenarians from bad habits, healthy lifestyle choices remain critical for the vast majority of the population. The U.S. Census Bureau estimates there were nearly 425,000 people aged 95 and older living in the U.S. in 2010 − a fraction (.01) of the 40 million U.S. adults 65 and over.

“Although this study demonstrates that centenarians can be obese, smoke and avoid exercise, those lifestyle habits are not good choices for most of us who do not have a family history of longevity,” said Dr. Barzilai. “We should watch our weight, avoid smoking and be sure to exercise, since these activities have been shown to have great health benefits for the general population, including a longer lifespan.”

Researchers also asked study participants why they believed they had lived so long. Most did not attribute their advanced age to lifestyle factors. One-third reported a history of family longevity, while 20% believed that physical activity also played a role in their lifespan. Other factors included positive attitude (19%t), busy or active life (12%), less smoking and drinking (15%), good luck (8%), and religion or spirituality (6%).

The paper is titled “Lifestyle Factors of People with Exceptional Longevity.” Other Einstein authors were Yingheng Liu, Ph.D., Orit Ben-David, Saritha Reddy, M.B.B.S., Gil Atzmon, Ph.D., and Jill Crandall, M.D. Swapnil N. Rajpathak, M.B.B.S., Dr.PH., now at Merck Pharmaceuticals, was the study’s lead author.

einstein.yu.edu.

The report, Raising Expectations:  A State Scorecard on Long-Term Services and Supports for Older Adults, People with Physical Disabilities, and Family Caregivers, examines four key dimensions of state LTSS system performance: affordability and access; choice of setting and provider; quality of life and quality of care; and support for family caregivers. It assesses each state’s performance as a whole and on 25 individual indicators, some of which were measured for the first time.

“This report will help states make and sustain targeted improvements so that people can live and age with dignity in their own homes and communities,” said Susan Reinhard, senior vice president for public policy at AARP.  “Achieving a high-performing long-term supports and services system will require a concerted effort from both the public and private sectors.”

Impact of State Policy on Care and Costs

This Scorecard finds that generally states with the highest level of performance have enacted public policies designed to:

* Improve access to services and choices in their delivery by directing state Medicaid programs to serve more people in need and offer alternatives to nursing homes that most consumers prefer.

* Establish a single point of system entry to help people find needed information and more easily access services.

* Improve support for family caregivers by offering legal protections as well as other services to address caregiver needs.

The study shows that states with the lowest overall performance—such as Mississippi, Alabama, and West Virginia—have some of the lowest median incomes and highest rates of both poverty and disability in the nation. Despite these challenges, each of these states scores in the top quartile for at least one of the 25 indicators. The Scorecard points out that lower performing states can improve their overall ranking by adopting policies and procedures shown to provide better outcomes.

“This Scorecard is a critical first step toward creating a much more person- and family-centered system of care that delivers services honoring each individual’s dignity and choices,” said Bruce Chernof, president and CEO of The SCAN Foundation.  “To fully realize the vision of a high-performing long-term services and supports system, we must measure performance, track improvements and create opportunities for states to learn from each other.”

Room for Improvement

The report shows all states can do better in areas where performance lags. Wide variation in performance in specific dimensions makes this clear:

* Percent of LTSS spending going for home- and community-based services—60% in the top five states, 13% in the bottom five, the average is 37%.

* Percentage of Medicaid LTSS coverage of low- and moderate-income people with disabilities—the top five states cover 63%, the bottom five cover 20%, the national average is 36%.

* Percent of Medicaid LTSS recipients receiving home- and community-based services before nursing home placement— 77% in top five states, 26% in bottom five states, average is 57%.

* Rate of Medicaid LTSS recipients receiving self-directed services—143 per 1,000 in the top performing state, fewer than 1 per 1,000 in the bottom 6 states, 22 per 1,000 people national average.

* Hospitalization rates of nursing home residents—10% in top five states, 29% in bottom five states, median of 19%.

Gaps in available data made it difficult to measure important characteristics of a high-performing LTSS system, such as how well states ensure effective transitions between hospitals, nursing homes and home care, say the authors. They note that improving consistent, state-level data collection is essential to evaluating state LTSS system performance more comprehensively.

“Millions of older adults and those with disabilities need access to high quality services and there isn’t enough information out there to allow consumers and policymakers to make sound choices,” said Mary Jane Koren, M.D., vice president for long-term care quality Improvement at The Commonwealth Fund. “It is essential that care providers publish data about their services and outcomes so states can address the growing need for these services.”

If all states reached levels currently achieved by leading states, the study finds, the U.S. could realize significant gains in health, better care experiences and potentially lower costs:

* 667,171 more individuals with disabilities would be covered by Medicaid if all states could achieve the rate of the top-performing state on this indicator;

* There would be 201,531 fewer costly and unnecessary nursing home admissions if all states could do as well as the state with the lowest rate of unnecessary nursing home admissions; and,

* There would be 120,602 fewer avoidable hospitalizations—at a savings of $1.3 billion nationally—if all states could achieve the rate of avoidable hospitalizations of the state that performs best on this indicator.

Photo: Will Clayton

At some time in his life, nearly every man gets exercised about sex. And as many men get older, they wonder if sex is a good form of exercise or if it’s too strenuous for the heart. These questions may sound like locker room banter, but they are actually quite important — and they now have solid scientific answers, reports Harvard Medical School.

Treadmill vs. mattress

To evaluate the cardiovascular effects of sexual activity, researchers monitored volunteers while they walked on a treadmill in the lab and during private sexual activity at home. In addition to 13 women, the volunteers included 19 men with an average age of 55. About three-quarters of the men were married, and nearly 70% had some form of cardiovascular disease; 53% were taking beta blockers. Despite their cardiac histories, the men reported exercising about four times a week, and they reported having sexual activity about six times a month on average.

Researchers monitored heart rate and blood pressure during standard treadmill exercise tests and during “usual” sexual activity with a familiar partner at home. All the sex acts concluded with vaginal intercourse and male orgasm.

Disappointingly perhaps, the treadmill proved more strenuous. On an intensity scale of 1 to 5, with 5 being the highest, men evaluated treadmill exercise as 4.6 and sex as 2.7. Sex was even less strenuous for women in terms of heart rate, blood pressure, and perceived intensity of exertion.

Sex as exercise

Men seem to spend more energy thinking and talking about sex than on the act itself. During sexual intercourse, a man’s heart rate rarely gets above 130 beats a minute, and his systolic blood pressure (the higher number, recorded when the heart is pumping blood) nearly always stays under 170. All in all, average sexual activity ranks as mild to moderate in terms of exercise intensity. As for oxygen consumption, it comes in at about 3.5 METS (metabolic equivalents), which is about the same as doing the foxtrot, raking leaves, or playing ping pong. Sex burns about five calories a minute; that’s four more than a man uses watching TV, but it’s about the same as walking the course to play golf. If a man can walk up two or three flights of stairs without difficulty, he should be in shape for sex.

Sex as sex

Raking leaves may increase a man’s oxygen consumption, but it probably won’t get his motor running. Sex, of course, is different, and the excitement and stress might well pump out extra adrenaline. Both mental excitement and physical exercise increase adrenaline levels and can trigger heart attacks and arrhythmias, abnormalities of the heart’s pumping rhythm. Can sex do the same? In theory, it can. But in practice, it’s really very uncommon, at least during conventional sex with a familiar partner.

Careful studies show that fewer than one of every 100 heart attacks is related to sexual activity, and for fatal arrhythmias the rate is just one in 200. Put another way, for a healthy 50-year-old man, the risk of having a heart attack in any given hour is about one in a million; sex doubles the risk, but it’s still just two in a million. For men with heart disease, the risk is 10 times higher — but even for them, the chance of suffering a heart attack during sex is just 20 in a million. Those are pretty good odds.

How about Viagra?

Until recently, human biology has provided unintentional (and perhaps unwanted) protection for men with heart disease. That’s because many of the things that cause heart disease, such as smoking, diabetes, high blood pressure, and abnormal cholesterol levels, also cause erectile dysfunction. The common link is atherosclerosis, which can damage arteries in the penis as well as in the heart.

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) have changed that. About 70% of men with erectile dysfunction (ED) respond to the ED pills well enough to enable sexual intercourse. Sex may be safe for most men with heart disease, but are ED pills a safe way to have sex?

For men with stable coronary artery disease and well-controlled hypertension, the answer is yes — with one very, very important qualification. Men who are taking nitrate medications in any form cannot use ED pills. This restriction covers all preparations of nitroglycerin, including long-acting nitrates; nitroglycerin sprays, patches, and pastes; and amyl nitrate. Fortunately, other treatments for erectile function are safe for men with heart disease, even if they are using nitrates.

Safe sex

Sex is a normal part of human life. For all men, whether they have heart disease or not, the best way to keep sex safe is to stay in shape by avoiding tobacco, exercising regularly, eating a good diet, staying lean, and avoiding too much (or too little) alcohol. Needless to say, men should not initiate sexual activity if they are not feeling well, and men who experience possible cardiac symptoms during sex should interrupt the sexual activity at once.

With these simple guidelines and precautions, sex is safe for the heart — but it should be safe for the rest of the body, too. Sexually transmitted diseases pose a greater threat than sexually induced heart problems. When it comes to sex, men should use their brains as

health.harvard.edu

Each video features a wealth of information that can help families before and after the death of a loved one.  “Our research clearly showed that people were seeking meaningful information to help them move through what is often the most difficult times of their lives,”  says Steve Gackenbach, chief  commercial officer at Matthews International Corp., the program’s sponsor.

Shared experience

The video series  features clergy, hospice professionals, social workers, funeral directors, and nursing home administrators talking from their hearts about the key advice they have for families dealing with end-of-life issues.  ”When we previewed some of these videos at the National Hospice and Palliative Care Convention, the response was overwhelmingly positive,” says Gackenbach.   “Seeing clergy, hospice and social work professionals talking about the key things they want to tell families during this difficult time, has much greater impact than seeing the same information in written form.  These videos feel like a close friend is talking to you — not giving advice, but relating stories about what they’ve learned.  The authenticity and sincerity in the messages is something that could never have been scripted; it comes too deeply from the heart.”

In addition to advice and lessons from professionals, the series also features video interviews with regular people who convey their personal experiences about the people, services and rituals that helped them deal with the loss of a loved one.  The first series consists of four videos that will be introduced one per week starting September 13th.   The first videos feature a minister providing insights on ways to reduce funeral stress, a business executive talking about how hospice helped him and his wife with the passing of her mother; a grief counselor talking about “walking the mourner’s path” and lastly a young widow talking about ways she was helped in dealing with the loss of her husband.

The short videos are viewable 24 hours a day, by families who need this advice most.  “In researching this series we learned that often families most need information late at night, when they are worried, can’t sleep, and yet don’t know where to turn,”  says Gackenbach. “Now with the Internet and new technologies, we can provide meaningful advice to families in the privacy of their homes, when they need it most.”

remembranceprocess.com

Profile: My Elders