Value of Informal Caregiving Now Estimated at $306 Billion

Peter Arno, PhD, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, has recently updated estimates of the value of informal caregiving by family and friends. In 2004, informal caregiving was valued at $306 billion per year, greatly exceeding the combined costs of nursing home care ($115 billion) and home health care ($43 billion). The economic value of informal caregiving ($306 billion) represents 6% of total U.S. health expenditures in 2004 ($1,878 trillion). For more information, visit http://www.va.gov/occ/Conferences/caregiverforum/Docs/Arno-Handout.pdf.

Caring for Older Spouses Can Hasten Death

"Health effects of a spouse's illness on a partner should be taken into account by doctors, nurses, social workers, and policymakers." The illness or hospitalization of a spouse can have detrimental health effects on the partner of the spouse, including increased mortality. For nine years, researchers studied 518,240 couples with a mean age of 75 for the men and 72 for the women. The researchers found that the effect of a spouse’s illness varied among diagnoses, but hospitalization of a spouse was associated with an overall increased risk of death. For example, if a wife was hospitalized with colon cancer, there was almost no effect on the husband’s subsequent mortality. But if the wife was hospitalized with heart disease, the risk of death for the husband was 12% higher compared with the wife not being sick at all. And if one’s wife was hospitalized with the principal diagnosis of dementia, mortality risk for the husband was 22% higher. Overall, death of a spouse increased a man’s risk of dying in the next year by 21% and a woman’s risk by 17%. The researchers concluded that the health effects of a spouse’s illness on the partner should be taken into account by doctors, nurses, social workers, and policymakers.

Profile of Frail Older Americans and Their Caregivers

The Urban Institute (March 2006)

Using data from the 2002 Health and Retirement Study to profile caregivers and frail older adults ages 65 and older who are not residing in nursing homes, this report concludes that the community-based disabled population is sizeable, and that mental health problems are widespread within the frail older population. Most frail older persons live alone, but have children nearby who can provide assistance. Many within this population have modest financial resources, often do not qualify for public benefits, and have not purchased private long-term care insurance. Further, many of them who live at home receive assistance from family and friends, and few receive paid home-care services. For more information, visit http://www.urban.org/publications/311284.html.

New Resource for Long-Distance Caregivers

Long-distance caregiving can entail figuring out how to help a loved one sort through medical bills or planning how to make the most of a weekend visit.  So Far Away: Twenty Questions for Long-Distance Caregivers focuses on some of the issues unique to long-distance caregiving and offers ideas and resources that can help make the situation more manageable and satisfying. The booklet is organized in a question/answer format, and each of the 20 commonly asked questions has a brief, stand-alone answer. See the new booklet at http://www.nia.nih.gov/HealthInformation/Publications/LongDistanceCaregiving/.

Medicare Guide for Families and Friends

Centers for Medicare and Medicaid Services (March 2006)

The revised resource, Medicare Basics: A Guide for Families and Friends of People with Medicare, is now available at http://www.medicare.gov/Publications/Pubs/pdf/11034.pdf.

Life Storybooks Are Effective

There are few interventions that document how to help people with dementia retain or regain a sense of self. This controlled pilot study examined a life review/life storybook intervention delivered by care assistants to 30 persons with dementia residing in assisted living facilities in Northern Ireland. The analysis showed significant changes by group, particularly relating to factors such as depression, communication, positive mood, and cognition. Results suggest that staff-led reviews of life stories offer a potentially promising technique to assist people with dementia.

Green Tea May Protect Aging Brain

People who regularly drink green tea may have a lower risk of mental decline as they grow older. The observational study included 1,003 adults ages 70 and older in Japan who completed detailed questionnaires about their diets over the previous month, as well as their overall physical health and lifestyle habits. They also completed a standard test of cognitive functions such as memory, attention, and language use. The researchers found that older adults who drank two or more cups of green tea per day were about half as likely to show cognitive impairment as those who drank three cups or less each week. The connection between green tea and mental function persisted when the researchers accounted for overall diet and factors such as smoking and exercise habits. The findings cannot demonstrate, however, a cause-and-effect relationship, but they do build on evidence from lab experiments showing that certain green tea compounds may protect brain cells from the damaging processes that mark conditions like Alzheimer’s and Parkinson’s disease.

Depression, MCI and Dementia

Older persons with symptoms of depression are more likely than those without depression to develop mild cognitive impairment (MCI) within six years. Researchers in California examined 2,220 participants in the Cardiovascular Health Study, a longitudinal prospective study of adults 65 and older, and measured the subjects’ depressive symptoms using a standard scale. Six years later, a team of dementia experts found that 19.7% of subjects with moderate to high depression had developed MCI. About 13% with low depressive symptoms had cognitive impairment, and only 10% of subjects with no depressive symptoms went on to develop MCI. The study’s findings showed that approximately half of persons diagnosed with MCI go on to develop dementia within three years.

ADEAR Makeover

The Alzheimer’s Disease Education and Referral (ADEAR) Center launched a redesigned website at a new URL. With a new look and feel, the site is now more fully integrated as part of the National Institute on Aging’s website. You can still view comprehensive, credible content, order publications, sign up for e-mail alerts, and search clinical trials and literature databases. Check out and bookmark http://www.alzheimers.nia.nih.gov.

Take a Tour of the Human Brain

Alzheimer's Association (February 2006)

What happens in the brain of a person with Alzheimer’s disease? This new, web-based, interactive tour with 16 slides explains how the brain works and how Alzheimer’s affects it. To take the tour, go to www.alz.org/brain/overview.asp.

No Pain Medication for Many in Need

Less than half of nursing home residents with recurrent pain get any medication. An interdisciplinary team of researchers used a Nursing Home Pain Medication Appropriateness Scale (PMAS) to screen the overall suitability of nursing homes’ prescribing practices. They found that the mean total PMAS was only 64% of optimal dosing, and they also determined that less than half of the residents who had “predictably recurrent pain” were actually receiving pain medication. Still, they found that the prescribing of pain medication on the PMAS was better in situations where residents were not in recurrent pain. Poor pain management has a tendency to lower a person’s overall quality of life and leads to other health consequences, including sleep deprivation, poor nutrition, depression, and delayed healing.

The Quality of Home Care

Millions of older Americans receive publicly funded personal care services in their homes to help them with daily activities such as dressing, bathing, and toileting. The heavy reliance on Medicaid to fund services for persons with disabilities has led federal and state governments to devote increased attention to the quality of care being provided. Yet, the public agencies funding these services often find it difficult to assess and monitor the care provided in homes by numerous workers and family caregivers. This report examines the efforts in three states – South Carolina, Washington, and Wisconsin – to improve home care quality by using a more person-centered approach. The 32-page report, Home Care Quality: Emerging State Strategies to Deliver Person-Centered Services, is available at www.aarp.org/research/health/carequality/Articles/inb119_hcc.html.

Many Women Not Tested for Bone Density

According to a new study, less than one-quarter of older women have undergone valuable bone density screening.  Of 43,802 women eligible for osteoporosis screening, 22.9% were tested between 1999 and 2001, the first three full years of Medicare coverage. Researchers at the Medical College of Wisconsin found that just 27% of women ages 65 to 70, 25.6% of women ages 71 to 75, and less than 10% of women older than age 75 underwent the test. Older women are at the highest risk for hip fractures, and in the three years after Medicare reimbursement for osteoporosis screening began, adoption of bone density testing was lowest in women in age groups at highest fracture risk.

Diet Supplements and the Risk of Fractures

Researchers recruited 36,282 postmenopausal women ages 50 to 79 years of age who were already enrolled in a Women’s Health Initiative (WHI) clinical trial. They were randomly assigned to receive 1,000 mg of calcium carbonate with 400 IU of vitamin D daily or placebo. Fractures were ascertained for an average follow-up period of seven years and bone density was measured at three centers.  Among healthy postmenopausal women, calcium with vitamin D supplementation resulted in a small but significant improvement in hipbone density, did not significantly reduce hip fracture, and increased the risk of kidney stones.

Aging Boomers

Civic Ventures has created a new online guide for journalists covering the aging of Baby Boomers, but anyone can access quick facts and links to major studies and resources. The guide addresses topics such as “Boomers and Retirement,” “Boomers and Work,” and “Boomers Giving Back.”  Visit the “Expert Sources” section for names of, biographies about, and contact information for a large group of recognized experts. Peruse the guide, free of charge, at www.civicventures.org/jguide.

What Americans Know about Aging

The facts and fallacies of growing old are scrutinized in this study of how much adult Americans know – or think they know – about aging. While the people surveyed are moderately knowledgeable, the study found that many still have misconceptions about aging and older adults. To measure attitudes and understanding, interviews included questions about factual aspects of aging. Respondents answered approximately half of the 25 questions correctly, demonstrating a knowledge level that has remained unchanged since 1994, when a similar survey was conducted using an almost identical questionnaire. Despite significant demographic shifts in America and extensive media attention to aging issues like funding of Social Security and prescription drug coverage, the measures used in this study are remarkably stable from 1994 to 2004. To read the full report, go to www.aarp.org/research/reference/publicopinions/aresearch-import-926.html.

The Power of Positive Thinking

Archives of Internal Medicine (February 27, 2006)

Previous research has suggested that being optimistic boosts overall physical health and lowers the risk of death from all causes. A positive attitude also has been shown to help patients who suffer from heart disease caused by narrowed arteries. In a new study, the most optimistic persons among a group of 545 Dutch men ages 64 to 84 had a roughly 50% lower risk of cardiovascular death over 15 years of follow-up. The study measured participants’ level of optimism about their lives by having them respond to a series of varying statements. Higher optimism scores were associated with being younger, better educated, living with others, better health, and physical activity.

Yoga Improves Physical but Not Cognitive Function

Researchers wanted to determine if the requirement to actively pay attention during yoga could affect cognitive function. A group of 135 healthy men and women ages 65 to 85 were divided into three groups: a Hatha yoga class, a walking class, or no exercise class (on a waiting list). After six months, the participants completed surveys. Neither the yoga nor walking participants showed changes in cognitive and alertness measures. Yoga participants improved in physical functioning and quality-of-life measures such as increased feelings of well-being and increased energy. The researchers concluded that there were no relative improvements in cognitive function among healthy older adults in the yoga or exercise group compared with the wait-list group.

Stroke Victims Slow to Go to ER

Neurology (February 14, 2006)

Few people get to the hospital in time to receive a clot-busting drug that reduces the chance of disability, according to the conclusions of two new studies that examined whether Americans are getting the most advanced treatment for stroke caused by a blood clot. The treatment, tissue plasminogen activator (tPA), can break up a blood clot if given three to six hours after symptoms begin. For more than a decade, medical professionals have said that a stroke should be treated as a medical emergency. Yet, studies show that most people don’t take this to heart. In one study, only 43 persons among 2,097 stroke patients, or 2%, were diagnosed with this type of stroke in time for the clot-busting medication to prevent permanent damage from the lack of blood flow.

No Crisis Over Aging Generation’s Health

United States Census Bureau (March 9, 2006)

"The percentage of those more than 65 years of age who had a disability fell to 19.7% in 1999 from 26.2% in 1982."

The American population aged 65 and older will double in size in 25 years, but the economic and social impact may be gentler than previously feared because of a significant drop in the percentage of older adults with disabilities. According to a comprehensive new report by the United States Census Bureau, today’s older Americans are markedly different from previous generations. They are more prosperous, better educated, and healthier. These differences will only accelerate as the first Baby Boomers hit retirement age in 2011. The study showed that the percentage of those more than 65 years of age who had a disability fell to 19.7% in 1999 from 26.2% in 1982. The report, however, was not all good news. Divorce is on the rise among older Americans, leading to concerns that broken families combined with low birth rates may create a situation where fewer people are available or willing to help care for their aging relatives. Also, the drop in poverty has not happened across all population groups. Read more of the 243-page report at http://www.census.gov/prod/2006pubs/p23-209.pdf.