Exercise Might Beat Puzzles for Protecting the Aging Brain

The subject of this blog has been (mostly) strategies for enjoying eldrification without the assistance of those wonderful bundles of genetic material called "adult children."  The mind is a complex and wonderful tool (I have a joke about that, but later).  We are far from understanding how and why it works.  Here is a piece from the Wall Street Journal about one aspect of keeping your tool firm and sharp.

(Not THAT tool!  I mean your MIND!)

From the Wall Street Journal:

Exercise Might Beat Puzzles for Protecting the Aging Brain

http://online.wsj.com/article/SB10001424052970203630604578072723552695696.html

By JENNIFER CORBETT DOOREN

To help stave off the cognitive decline of aging, you might want to drop the crossword puzzle and head out for a brisk walk or a bike ride.

In a study published in the journal Neurology of almost 700 people born in 1936, researchers found physically active people showed fewer signs of brain shrinkage and other deterioration than those who got less exercise.

At the same time, social and intellectual activities such as visiting family and friends, reading, playing intellectually stimulating games or learning a new language did nearly nothing to ward off the symptoms of an aging brain, the study said.

"People who exercise more have better brain health," said Alan Gow, one of the study's researchers and a senior research fellow at the University of Edinburgh in Scotland.

The researchers noted, however, that "the direction of causation is unclear," meaning they couldn't tell if a healthier brain was a result of physical activity, or if people showing signs of cognitive decline weren't able to exercise. Other studies have also suggested exercise can improve brain health. Exercise increases circulation in the body and helps bring more oxygen, glucose and other needed substances to the brain.

This research is just the latest looking at cognitive function in the so-called Lothian Birth Cohort, which involves a group of people born in 1936. In 1947, almost all 11-year-old children attending school in Scotland were given intelligence and mental-health tests.

Researchers at the University of Edinburgh then recruited people from that age group who underwent those intelligence tests when they were about age 70. Participants filled out questionnaires about the types and frequency of leisure and physical activities they participated in. Physical activity was rated on a six-point scale with the lowest being "moving only in connection with necessary household chores," to heavy exercise or a competitive sport several times a week. Then at about age 73, 700 study participants were given a magnetic resonance imaging (MRI) brain scan. Brains normally shrink with age.

"What we want to do is understand more about how people age better with respect to cognitive function," Dr. Gow said.

Researchers found that higher levels of physical activity were associated with less brain atrophy, or shrinkage, and less brain damage. They found no link between brain health and leisure activities.

"We are coming to appreciate the fact that people who remain physically active are less likely to show cognitive decline," said Stephen Rao, the director of the Cleveland Clinic Schey Center for Cognitive Neuroimaging. Dr. Rao, who wasn't involved in the Scottish study, noted, however, that it looked at exercise and other activities at one point in time rather than over a lifetime. Dr. Rao is completing his own study comparing exercise and cognitive training in a different group of people.

Dr. Gow said previous research with the Lothian group suggested people who participated in more social and intellectual activities at age 70 and had better cognitive abilities were the ones who scored higher on mental ability tests at age 11.

Study participants are currently in the process of undergoing a second MRI scan now that they are age 76. Researchers said they plan to compare the two scans to see if links between exercise and better brain health hold up.


(But, doesn't using THAT OTHER tool constitute EXERCISE?)

Michael

Care by Consensus

In March I wrote about the idea of establishing a Board of Advisors to help guide us through the elding years and keep us from scams (see "Getting Scammed", March 4, 2012).  Here is a link to the New Old Age blog on the NY Times that discusses the similar concept of establishing a care committee to manage your care when there is no one else to watch out for your interests.  It was written shortly after my post (I only just now found it), so obviously they copied my idea.

http://newoldage.blogs.nytimes.com/2012/03/21/care-by-consensus/

Embedded in the blog is a link to a law firm that has drafted a Care Committee Agreement.  Here is the link:

http://cohenoalican.com/resources/118-forms/1212-care-committee.html

If you can't find it, let me know.  I have downloaded a copy.

I think it is a good idea.  The trick will be finding the right responsible advisors.

Michael

This has nothing to do with aging alone, but.....

...its just to good to pass up.  It is a video of an invocation given at a conference of Home Instead Senior Care franchisees.

The Home Instead Senior Care family network of locally owned franchise offices is an in-home care agency, to help elders in their home as they grow older.

Watch it all.  Well done.

http://stg.do/9i0c

Michael

Reverse Mortgages

This is a link to a blog post (The New Old Age, NY Times) on reverse mortgages, with a link to the full article in the New York Times. I have saved the article to read when I am older.  As of this writing, a reverse mortgage is not part of our elding strategy.  I think we can do better than that.


http://newoldage.blogs.nytimes.com/2012/10/15/growing-concerns-about-reverse-mortgages/

Michael

Guess we're not the only ones thinking about this.

Here is a link to a piece in the NY Times written by Kelly Flynn titled "But Who Will Care for Me?"  Kelly writes about finding herself in a familiar situation;  Aging, and childless.

http://www.nytimes.com/2012/10/10/booming/10story-booming.html

It is a well written piece, and she seems to be worried about how to deal with the things we have been discussing here for a while.  But what I find really interesting about this piece is the tone of the comments written by others.  Some are critical of the decision (in those cases where it is a decision and not something that just happened) to not have children.  (See my earlier post concerning our decision to not have children.)   There were also comments such aas the following:

Sorry, but anatomy is destiny.
A woman was given a womb to hold a child.
A woman was given breasts to nurture that child.
A woman who makes a decision not to have any children becomes a study in tragedy and sorrow when she ages in an empty home.
So sad. So tragic. So selfish.

Are we talking about a woman, or a horse?

Others commented on the unreliability of children to provide happiness and security as their parents eld.  Some where happy to have husbands and families, some happy that they did not have to suffer the indignity of an ailing or un-faithful husband or ungrateful kids.

I guess my point is that in thinking about eldering without childering, there is a danger in getting hung up on decisions of the past, to foal or not to foal, circumstances that may have prevented or encouraged foaling, an involuntary act of conception that resulted in unanticipated or premature foaling.  Hey, snap out of it!  Looking back, looking for regrets, for missed opportunities, for things that might have been had not something else been instead, only promotes sadness.  And sadness does not get us where we want to go.

Here we are looking for strategies that will result in a happy elderhood.  I propose that an important aspect of an effective strategy is the ability to look forward, with enthusiasm and anticipation, not fear or regret.

• Yes, I will likely move into assisted living some day.
• I will meet new people there.
• Some will be incredibly annoying
• Some will not appreciate my humor or like my curried skittles.
• Some will become my best friends.
• I will cry when friends pass on.
• I will look back on our times together and smile, not with regret but with gratitude that we had a some great, interesting times.

Attitude is key.  Developing the habit (Oh, God, not with the HABITS again!) of a positive outlook is key.  If you must look at the movie of your past, think of it as a comedy.  Smile.  Laugh.  Then look forward.

"We did not have any kids.  I did have a foal once.  Named him Hargus.  Boy, what a stupid kid I was back then.  Hey, Kelly, want a beer?  Lets play some dominos!"

Michael

The Keys, Please.

Below is a link to an NPR piece (yes, I listen to NPR for news, but I do browse the "other medias" as well) on the pending surge in us older folks out on the streets driving our 20 year old Audi's.  The serious question (one I have touched on in these posts before) is, "when it comes time to give up the keys, who will tell us, the tellees, who have no tellers handy in the family, that time is up?"

Bunni Dybnis, a social worker at the Los Angeles-based geriatric care service LivHome, says this is typically how older drivers decide to give up the car keys: Their child or grandchild intervenes. "I could probably say it's 99.99 percent not the older adult saying, 'I want to stop driving; help me,' " says Dybnis, because giving up driving feels like giving up one's independence.

Here is what I plan to do.  I have already established the HABIT of getting an annual physical exam by my primary care physician.  My next exam is some time in March or April (it is iBuried somewhere in my iPhone iCalendar).  At that exam I intend to ask my PCP to incorporate the following steps into the exam program:  a)  discontinue doing a P.S.A. exam at age 65, and b) if possible, in this state, if he sees any signs of diminished capacity that could affect my ability to drive safely, to prescribe a driving test or class.  Since I also see a neurologist once a year, I will ask her to do b) as well (she has never offered to do a), much to my relief).

Actually, first I will ask them if it is wise to ask them to do this, as I don't want to screw up my medical records and insurance.  But I think this is the second most important thing to do about driving skills.  The first is to develop the HABIT of objectivity concerning driving.  Even now, in my prime, I can look into the rear view mirror and tell myself "That other driver was NOT an asshole.  I was the asshole in this situation.  DON'T DO THAT AGAIN!"

This habit is reinforced by SheWhoMustBeObeyed, who frequently says this, sometimes just the second sentence, even when I am not driving.

The link:

http://www.npr.org/blogs/health/2012/10/08/162392507/when-should-seniors-hang-up-the-car-keys?ft=3&f=111787346&sc=nl&cc=es-20121014

Michael

A Matter of Context

What is the difference between being observed, and being admitted?

Observation:  an activity of a living being, such as a human, consisting of receiving knowledge of the outside world (including knowledge of other humans) through the senses, or the recording of data using scientific instruments.

Admission:  the act of allowing to enter; entrance granted by permission, by provision or existence of pecuniary means, or by the removal of obstacles: the admission of aliens into a country.  Or, right or permission to enter: granting admission to the rare books room.

This is an important distinction when it comes to being precise about the written or spoken word.  It is even more important when these terms are applied by your local friendly hospital.

Note:  In a hospital context, it is possible to be observed after being admitted.  In fact, it is unavoidable.  When admitted to a hospital, ones every move is observed.  Movements are of particular import.  The absence of an expected movement can indicate a blockage (the state of being blocked;  an obstructed condition: the blockage of the streets by heavy snows.  The blockage of bowls by impacted.......stuff).

Note:  In a hospital context, it is possible to be observed without being admitted.  One may, in fact, be physically "in" the hospital, having one's blockages examined by all sorts of scientific instruments, passing knowledge to one's doctor, being "in" without being "admitted", without permission to say one is "here" more than momentarily, even thought a momentary observation might last days, even weeks.

In a hospital context, your doctor may allow you "in", without an admission that you have been admitted "in", that you do not belong "in" for anything other than to be "observed".  If you happen to be on Medicare, and you happen to have something wrong that will require further assistance or treatment, or "rehabilitation" (I'll not burden you with another definition), but the hospital is only "observing" you, not treating you, then Medicare MAY NOT PAY FOR YOUR REHABILITATION.  You will, like Arlo Guthrie, be doomed to answer, possibly forever, the question "Kid, have you been rehabilitated?" with a resounding "no, officer, I don't have the do-re-me."

Case in point:  Martha Leyanna, Newark, Delaware, fell.  Went to the ER.  Was placed in the hospital. Stayed for eight (8) days (I guess it took a few days to figure out that she could not walk).  Spent 40 days in a rehabilitation center (to which her doctor no doubt sent her after determining that mere observation was not helping her get back on her feet).  When the $11,000 bill for rehab arrived, her Medicare insurance would not pay it.  Why?  Because she had only been observed for 8 days.  She had not been admitted.

Under Medicare rules, they will pay for the first 20 days of rehab in a skilled nursing care facility, but only if the patient has spent at least three (3) full days in the hospital as an admitted patient. So for Martha, who was "in" the hospital for eight (8) days, receiving all the care that any "admitted" patient would receive, in fact the EXACT SAME CARE, the fact that none of those eight days of hospital care  were as an admitted person meant that she was not covered.

Now, there are those who would say that she should pay her own way lest she become one of those 47% of Americans who feel entitled to food stamps and health care, who do not take personal responsibility for their lives, who take advantage of the insurance they have already paid for to in order to somehow sponge off the rest of us.  As a politically agnostic blogger, I take no position on that.  But, given the rules as they are, if you are insured by Medicare, it is important you know the rules.

So here is what AARP says to do if you are "in" a hospital:

1. Ask about your status daily.  Your status can change at any time, without your knowledge.
2. If you are being "observed," ask the hospital doctor why.  Ask him to have the committee that decides this status to reconsider.
3. Ask you own doctor (if you can remember who he/she is) the same thing.
4. If you have been "observed" but need rehab care, ask your doctor if the rehab care can be done at your home so it costs less.
5. Worst cast scenario:  Rehab center needed, Medicare won't pay.  Then:
1. "Following the instructions given in your quarterly Medicare Summary Notice, formally appeal the ruling.  Explain that the basis for your appeal is that you should have been classified as an inpatient during your stay at the hospital."  Simple.
2. If denied, follow the instructions on your denial letter to appeal to a higher level.  Simple.
3. Yeah, right.  I've got macular degeneration and can't read, have no idea what pile of crap my Medicare Summary Notice is in, am not sure how to get back to my home to find it even if I COULD walk.  Yeah, right.

I guess it boils down to this:  If you are conscious when entering the ER, be sure to ask your doctor what your status is, why it is what it is, why he thinks why it is what it is is the right way to think should be, and if you are only being "observed", why you should not just go home to die instead of enduring the inconvenience of being "in" without belonging "in".  If you are conscious.  And aware.  Doesn't matter if you are 85 years old and believe that the women who says she is your daughter is some street walker that only wants to get in your underwear and steal you watch (that is where I always keep mine)(She IS in fact a street walker, because, now I remember, I DON'T HAVE ANY CHILDREN).  Just take some personal responsibility and fess up:  "Really, I can walk, I just don't CHOOSE to."
 
Or ask the daughter of the patient next to you (daughter, not son - you already know my feelings about sons and their worth when it comes to caring for elderly parents) to help, because frankly that fall and the concussion make you dizzy every time you even think about getting out of bed and walking to the bathroom.

Seriously, I wish there were better answers.  I wish the system included patient advocates that could protect old, confused, lonely people.  The American Medical Association has told Medicare that it supports the abolition of the three (3) day rule.  Others have lobbied to do away with the "observation" classification.  But when the AARP asked officials at the Centers for Mediare & Medicaid Services to comment for a recent article, they declined to be interviewed, citing ongoing lawsuits.

Lets hope the suits win.

A Pasticcio

Some interesting odds and ends that help put eldering in perspective:

¢ The average American aged 65 or older makes 8 visits per year to a doctor, a hospital and/or an emergency room, i.e., once every 1 ½ months (source: Center for Disease Control).

¢ 1% of the US population accounts for 21.8% of all health care expenditures.  5% of the population accounts for 49.5% of all health care expenditures.  15% of the population accounts for no health care expenditures (source: National Institute for Health Care Management).

¢ 50% of the US population accounts for just 2.9% of all health care expenditures (source: National Institute for Health Care Management).

¢ Americans born in 1946 or later will have to work at least until age 66 (to as much as age 67 for individuals born in 1960 or later) to achieve full retirement benefits from Social Security.  Once that retiree hits his/her unique full retirement age, postponing receipt of the retirement benefits will increase the payout by +8% per year (source: Social Security Administration).

¢ 62% of American adults believe the greatest risk to the success of their retirement years is living too long (source: MetLife Mature Market Institute).

¢ 70% of retirees surveyed in 2007 (i.e., 5 years ago) were "very" or "somewhat" confident that they would have a "comfortable" retirement.  Only 52% of retirees feel that way in 2012 (source: Employee Benefit Research Institute Retirement Survey).

¢ The life expectancy at birth of an average American was 62.9 years in 1940, 5 years after Social Security was created in 1935.  Life expectancy is 78.7 years today (source: Center for Disease Control).

¢ 25% of American families headed by a retired person do not pay off their outstanding credit card balance each month.  46% of families headed by an individual that works as an employee of a firm (i.e., not a business-owner) do not pay off their outstanding credit card balance each month (source: Federal Reserve).

¢ 51% of over 1,500 American households surveyed in May 2012 believe they are "behind" in their accumulation of retirement savings (source: Consumer Federal of America).

¢ 2 out of every 5 American males that live to age 65 will survive at least another 20 years to age 85 (source: Social Security).

¢ The average single-family home nationwide peaked in value on 6/30/07 but has dropped by 17% from that maximum value as of 6/30/12 (source: Office of Federal Housing Enterprise Oversight).

¢ An estimated 7,600 Americans will turn 65 years old each day this year (2012).  An estimated 11,400 Americans will turn 65 years old each day by the year 2029 (source: Government Accountability Office).

¢ A present value (PV) amount of $196,000 is required to fund a $1,000 per month payment for 20 years with a 3% annual increase for maintenance of purchasing power assuming a +5% annual rate of return is maintained into the future.  The PV amount is $269,000 if the required payment period is 30 years.  The calculations ignore the impact of taxes and are for illustrative purposes only and are not intended to reflect any specific investment alternative (source: BTN Research).

¢ If the fifth bullet is recalculated using a +6% assumed rate of return (+1% increase), only $179,000 is required to fund the 20-year payout and $237,000 is required for a 30-year payout (source: BTN Research).

¢ Social Security benefits were not subject to any federal income taxation until 1984.  Depending upon your adjusted gross income, as much as 85% of your social security benefits could be federally taxable today.  The first social security benefit checks were paid in 1937 (source: Social Security).