Can Hearing Aids Have a Cognitive Benefit for Seniors?

Use of hearing aids by adults with hearing loss was linked to a significant 19% relative reduction in risk of any cognitive decline, compared with uncorrected hearing loss across long-term studies with follow-up ranging from two to 25 years.

MedPage Today’s recent article entitled “Use It, or Lose It: Hearing Aids Linked to Cognitive Benefit” reports that hearing aid or cochlear implant use was also linked to a 3% improvement in short-term cognitive scores, according to Benjamin Kye Jyn Tan, MBBS, of the National University of Singapore, and colleagues.

“Importantly, this benefit is evident for both normal baseline cognition and baseline mild cognitive impairment,” after “adjusting for possible confounders, including age and gender, education, socioeconomic status, and comorbidities,” the group reported in JAMA Neurology.

Hearing loss has been identified as a top modifiable risk factor for dementia, the researchers noted. “This study adds to the growing evidence base and serves as an impetus for clinicians treating patients with hearing loss to persuade them to adopt hearing restorative devices, to mitigate their risk of cognitive decline, such as dementia.”

While the analysis couldn’t establish causality, the findings support inclusion of hearing evaluation “as part of a standard workup for patients who may be experiencing cognitive decline,” agreed an accompanying editorial by Justin S. Golub, MD, MS, of Columbia University Vagelos College of Physicians and Surgeons in New York City, and coauthors.

However, there’s been a hypothesis that hearing loss and cognitive decline might occur independently as a result of a common mechanism of age-related neurodegenerative processes, Tan’s group acknowledged.

While noting that “hearing loss in dementia is likely to be multifactorial,” the study authors discussed several theories for how hearing aids might exert cognitive benefits. For example, the “sensory deficit hypothesis suggests that lack of sensory input may lead to structural alterations [in the brain], including atrophy,” they wrote. “Allowing hearing restorative devices to provide sensory stimulation before prolonged deprivation may cause cortical changes that could prevent cognitive deterioration.”

Another possible mechanism, they added, is that “hearing aid use may prevent social isolation [well-known to accompany hearing loss] and its resultant development of cognitive impairment, although further studies are required to analyze this association.”

The analysis examined long-term associations between hearing aid use and cognitive decline in a pooled analysis of eight studies with a total of 126,903 participants, as well as short-term outcomes in 11 studies with a total of 568 participants. Most were prospective cohorts or other observational designs; the two randomized clinical trials had only short-term data available.

Reference: MedPage Today (Dec. 5, 2022) “Use It, or Lose It: Hearing Aids Linked to Cognitive Benefit”

Will I Live Longer If I Walk Every Day?

In a study of more than 25,000 older adults who didn’t regularly exercise, engaging in three sets of vigorous activity for up to two minutes each at some point during the day was connected with a 39% lower risk for all-cause mortality versus no activity at all, according to Emmanuel Stamatakis, PhD, of the University of Sydney in Australia, and colleagues.

MedPage Today’s recent article entitled “Can Just Minutes of Daily Activity Prolong Life?” reports that even the minimum of 1½ minute-long sessions of exercise daily reaped mortality benefits compared with not engaging in any activity at all. However, those at the top of the range in this study — getting 11 short bursts of vigorous activity daily (about 16 minutes total) — saw all-cause mortality risk drop by even more.

Engaging in just a few minutes of vigorous intermittent lifestyle physical activity (VILPA) throughout the day was also protective against cardiovascular disease-related mortality, the group reported in Nature Medicine. Engaging in three one-minute bouts per day was linked with a 49% lower cardiovascular mortality risk. Those that engaged in the maximum frequency again saw the greatest benefit. Nonetheless, even engaging in the minimum was still significantly protective against heart-related death.

The researchers also found the same pattern for cancer-related mortality risk.

“We found that as little as 3 to 4 minutes of VILPA per day was associated with substantially reduced mortality risk compared to doing no VILPA,” Stamatakis told MedPage Today, noting how these were “very sizeable effect sizes.”

“We were not surprised that we detected beneficial associations; we knew that vigorous physical activity is very potent, especially when it is intermittent and repeated,” he said. “But the large magnitude of the associations was quite surprising, considering how little daily physical activity we are talking about.”

“Interestingly, is not unlikely that participants in this study did not know that they were doing vigorous physical activity,” Stamatakis remarked.

These short bursts of vigorous-intensity physical activity were considered a part of daily life. They included instances of short bursts of fast walking during a commute or climbing a set of stairs.

Reference: MedPage Today (Dec. 8, 2022) “Can Just Minutes of Daily Activity Prolong Life?”

How to Talk to Parents about Estate Planning

Research from the National Alliance for Caregiving (NAC) and AARP shows that more than 50 million Americans currently serve as unpaid caregivers. This number has increased by nearly 25% since 2015. Statistically, baby boomers and women take on the biggest caregiving burden when it comes to providing care for aging family members. As life expectancy increases, and baby boomers advance well into senior years of their own, the need for caregiving will only continue to rise.

Forbes’ recent article entitled “Holiday Season Tips For Caregivers” says that as the number of seniors in America continues to grow, we find ourselves on the verge of the largest transfer of wealth in history. It is estimated that 45 million Americans will transfer some $68 trillion over the next 25 years.

As a result, having estate planning conversations has become more important than ever.

Discussions about money and mortality can be challenging and emotional. Here are some tips on how to broach this sensitive subject with family and loved ones.

Schedule a time: This can be an overwhelming topic, but don’t ignore it. Scheduling dedicated time to open the dialogue and creating a timeline to complete the basic estate planning documents can make the process more manageable and keep everyone involved accountable.

Share your wealth of knowledge: Share your knowledge about what the documents mean, how and when they come into play, as well as what happens if there’s no estate plan in place. Remind them that this is their chance to ensure that their wishes are carried out.

Ask questions: Provided the person is in a sound state of mind, they’re in a position to be involved in the decision-making. Ask open-ended questions like what steps have already been taken and document as much as possible without judgment.

Share your plan: Sharing your ideas and discussing your own plans can ease tension and help eliminate fears. It shows others that they’re not alone in the planning process.

Leave the conversation open-ended: The key to these planning conversations is empathy because many seniors are experiencing a variety of emotions. Reassure them that you’re available for future conversations and will plan to check back in at the times set forth in the timeline you created together.

You should also ask an experienced estate planning attorney for assistance.

Reference: Forbes (Nov. 29, 2022) “Holiday Season Tips For Caregivers”

What Games are Best for Brain Health?

Researchers at Columbia University in New York City and Duke University in Durham, North Carolina, recently found that older participants — with an average age of 71 — who were trained to complete computerized crossword puzzles showed more of a cognitive improvement compared with those who were trained to use web-based cognitive video games, reports Money Talks News’ recent article entitled, “Crossword Puzzles or Video Games: Which Better Protects Your Brain?”

In a summary of the study’s findings, Dr. D.P. Devanand, professor of psychiatry and neurology at Columbia, remarked:

“This is the first study to document both short-term and longer-term benefits for home-based crossword puzzles training compared to another intervention. The results are important in light of difficulty in showing improvement with interventions in mild cognitive impairment.”

The researchers explain that mild cognitive impairment is a stage between the cognitive decline that is normal with aging and full-blown dementia. Those with mild cognitive impairment may struggle with memory, language, thinking or judgment.

The researchers went on to note that those with mild cognitive impairment are at a significant risk for dementia, including Alzheimer’s disease.

As part of the study, 107 participants with mild cognitive impairment were trained for 12 weeks in either crossword puzzles or cognitive games.

Follow-up “booster sessions” were then held for up to 78 weeks.

While both forms of training were equally effective early in the course of disease, crossword puzzles were better in the later stages. Those who used crossword puzzles showed less brain shrinkage at 78 weeks.

Dr. Devanand says the study results show that further research on developing a home-based digital therapeutic for delaying Alzheimer’s disease “should be a priority for the field.”

Reference: Money Talks News (Nov. 5, 2022) “Crossword Puzzles or Video Games: Which Better Protects Your Brain?”

How to Find New Doctor for Mom if She Moves

Seasons’ recent article entitled “How do I help an older adult switch doctors after a move?” advises that breaking the process into manageable pieces will help you make sure you don’t miss any details.

First, check mom’s insurance because Medicare options are different when moving states. Check with Medicare to determine the process based on your mom’s existing coverage. Then you can find new health care providers.

Caregivers should have at least one dedicated three-ring notebook with dividers specifically for their loved one’s important information. Two is even better: one for financial information and one for medical information. Separate notebooks allow you to take the one with medical information to appointments without having sensitive financial information out and about at appointments.

Place some blank calendar pages in the front of the medical notebook. You’ll be able to organize your mom’s appointments in one place, as well as have a record of past appointments.

If you also use an online calendar like Google Calendar or iCalendar, create a color specifically for your mom’s appointments, so you can easily see the dates and times of her appointments.

Try using the paper option even if you also use an online calendar because this makes certain the information is easily accessible in case you need to share information with another person who helps with the caregiving.

Having all of your loved one’s medical information in one place that’s easily accessible will be invaluable when going to appointments at different doctors’ offices. You’ll have all of the info ready to share with different medical providers.

Once you get a system started to keep your mom’s information in an easily accessible place, it will be a pretty simple process to keep doctor appointments and medical information organized.

Reference: Seasons (Nov. 28, 2022) “How do I help an older adult switch doctors after a move?”

What are Biggest Medicare Open Enrollment Mistakes?

MSN’s recent article entitled “Don’t make these 5 common Medicare mistakes during open enrollment,” provides some of the common Medicare open enrollment mistakes:

Not checking your doctors for 2023. If you have a Medicare Advantage plan, you have to get medical care from doctors in the plan’s network. However, a plan’s network can change at any time. Therefore, before you decide to stick with the plan you’re in, make certain your preferred medical providers are still in the plan’s network in 2023. The best thing is to call the doctor’s office and just confirm with them.
Failing to compare prescription drug plans. No matter if you have Original Medicare or Medicare Advantage, your prescription drug coverage comes from a private insurance company. As a result, it may change what it covers each year. Your regular prescription medication may cost more in 2023, or an insurer may not cover it at all. Another plan may also cover it for less. It is, therefore, wise to plug your drugs into Medicare.gov to see what plans they suggest for you. If you log into your account at Medicare.gov, your medication history is already there.
Believing all doctors will take your PPO plan. A preferred provider organization (PPO) plan is a health plan that lets members see out-of-network doctors but usually at a higher price. People sometimes think because they have a Medicare Advantage PPO, they’ll be able to go to any doctor they want. However, providers don’t always take out-of-network coverage and can simply refuse someone at the point of service, if they don’t want to bill the plan.
Being influenced by the splashy ads. Medicare open enrollment season means Medicare commercials abound, and Medicare Advantage plans have appealing things to offer such as no premiums and some coverage for hearing, dental and vision care. However, shopping for your health coverage is about more than the side benefits. In fact, most don’t cover much dental, and hearing aid coverage is limited. This isn’t the reason to change your plan. It is more important to make sure that the plan covers your doctors and prescriptions for next year.
Waiting too long to ask for help. Medicare open enrollment ends December 7. However, you don’t want to wait to start your research. If you have questions, you can get help through programs like the State Health Insurance Assistance Program, or SHIP. Counselors at SHIP programs can offer free assistance with your Medicare choices.

Reference: MSN (Nov. 21, 2022) “Don’t make these 5 common Medicare mistakes during open enrollment”

How Can Seniors Be Prepared for Winter?

Snow, storms, power outages, extreme heat, wildfire smoke and other weather events and emergencies can pose extra hazards for seniors. The Spokesman-Review’s recent article entitled “Seniors should make plan to stay safe at home during emergencies” says that good communication, planning and a willingness to ask for and give help are essential in any emergency situation, regardless of age. However, there’s some preparation we can do that’s specific to older adults.

Have medications on hand: Anticipate prescription medication needs and see if your pharmacy will provide mail order or delivery.

Stay warm enough: Older adults can lose body heat faster, so identify a backup heat source for power or gas outages, like a wood-burning stove or backup generator, and know how to use it safely. Don’t use a gas oven or stove to heat indoors because it can cause carbon monoxide poisoning.

Stay cool enough: People also have less heat tolerance as they get older, so make sure the air conditioning is in good working condition with clean filters, or have a plan for staying somewhere cool when the temperatures spike.

Make sure you’re connected: Have a plan with a friend, neighbor, or relative nearby to check in with older adults during heat waves, power outages and storms. If the power goes out, phones can be out, so get a cellphone and learn how to use it.

Air quality matters: The prevalence of chronic obstructive pulmonary disease (COPD) is two to three times higher in people over 60, so seniors and people with health concerns should limit time outdoors when air quality is poor. Air filters improve indoor air quality and keep your air conditioning and furnaces running smoothly.

Avoid falls in the dark, wet or snow: Seniors frequently aren’t as stable on their feet, and falls are a leading cause of hospitalization. In snow, it can be useful to use a four-wheel walker with brakes or a quad-cane to walk. In a power outage take extra care when moving around with a flashlight. Consider getting a fall detection and medical alert device that can call the medics and get help quickly in an emergency.

People like to be independent, and that includes seniors.

A little bit of advanced preparation and planning for good communication during an emergency or severe weather can help keep everyone safe and comfortable and avoid a crisis.

Reference: The Spokesman-Review (Nov. 10, 2022) “Seniors should make plan to stay safe at home during emergencies”

Can I Protect My Elderly Parents?

Estate planning requires the ability to be realistic about current health and assets, while considering the inevitable changes to come. For adults with aging parents, having a well-thought out estate plan, regardless of the size of the estate, becomes more urgent as the time to use the documents draws closer. A recent article, “Accessing needs of aging parents,” from The News-Enterprise explains the steps adult children need to take to protect their parents.

There are four key factors to consider: medical needs, housing and care needs, finances and legal needs. All require candid, non-emotional assessments.

Start with medical, housing and care needs. Consider the next five years. Is it likely their medical condition may decline? How will their present home work, if they are unable to manage steps or need to sleep and toilet on the same level? If their home is not conducive for aging in place, will they consider moving to a better situation—or can they afford to make any changes?

Next, examine health and care needs. Do they have long-term care insurance or do they expect to apply for Medicaid? If one spouse will need memory care or one spouse dies, will the surviving spouse have the resources needed to remain in home and receive the care they need? An experienced estate planning attorney will be able to evaluate their financial situation with regard to becoming eligible for Medicaid, if this will be needed. There is a five-year look-back period for Medicaid, so advance action is necessary to protect assets.

Do they have any estate planning documents in place? Is there a will, and when was it prepared? Ask any estate planning attorney how many times seniors have told their children a will exists, only for the children to learn the will is forty years old, woefully out of date and declared invalid by the probate court. Deceased individuals may be listed as agents for Power of Attorney and Medical Power of Attorney. Funds left for heirs may no longer exist. Laws for power of attorney may not include required provisions as a result of changes to the law.

More complicated issues may exist. If appreciated real estate property has been deeded to loved ones to protect the property from nursing home costs, are the beneficiaries prepared to pay the resulting taxes? If deeded real estate property was intentionally left unrecorded, transferring property could become a legal quagmire.

The best solution is to have an experienced estate planning attorney meet with the parents, review any existing documents and prepare an updated set of documents to achieve the parent’s goals, protect them in case of medical emergencies and allow parents and children to gain the peace of mind of knowing they are ready for the future. This includes a will, power of attorney, health care power of attorney, HIPAA release, living will and, depending upon the situation, may also include trusts.

Reference: The Times-Enterprise (Nov. 5, 2022) “Accessing needs of aging parents”

Does the Early Bird Really Catch the Worm?

Researchers from the University of Pittsburgh said that activity patterns – not just the intensity of activity – are just as important for healthy aging and mental health, reports Seasons’s recent article entitled “Why early birds (who also stay active) are happier and mentally stronger.”

“There’s something about getting going early, staying active all day and following the same routine each day that seems to be protecting older adults,” Stephen Smagula, PhD, first author of the study and associate professor of psychiatry and epidemiology at the University of Pittsburgh, said in a statement. “What’s exciting about these findings is that activity patterns are under voluntary control, which means that making intentional changes to one’s daily routine could improve health and wellness.”

The research team recruited 1,800 adults 65+ to study daily activity patterns. They wore an actigraph – a device that measures movement – on their wrists for seven days and completed questionnaires to evaluate cognitive function and depression symptoms.

“We don’t know exactly what people were doing, except whether they were active, how much, and when,” he said.

The results showed that 37.6% of the participants woke up early in the morning and remained active throughout the day and followed consistent routines.

“They also tend to follow the same pattern day in, day out,” he said. “Lo and behold, those same adults were happier, less depressed and had better cognitive function than other participants.”

The authors found that 32.6% of older adults had consistent daily patterns, but they were active for about 13.4 hours each day because they woke up at a later time in the morning. Those participants scored lower on cognitive tests and described more depressive symptoms, compared to the participants who woke up earlier in the day. Although this finding suggests that activity intensity and what you do is important for health, the duration and how long you’re active might be more important.

“This is a different way of thinking about activity,” he said. “You may not need to be sprinting or running a marathon but simply staying engaged with activities throughout the day.”

The remaining participants (29.8%) showed disrupted activity and inconsistent patterns during the day. They showed the highest rates of depression and had the worst performance on cognitive tests.

“Now we know a bit more on what to look for and what these disrupted patterns might be related to,” he said. “This is useful because it can guide future clinical research aimed at restoring strong routines and improving health.”

“We know that consistently engaging in morning activity – especially if you get sunlight exposure – can help set a strong circadian rhythm (which helps tell your body when to do what, when to be awake/alert and when to sleep),” Smagula said.

Regularly engaging in activities, whether physical, social or intellectual, also forces people to flex and use their brain muscles to solve problems, think, learn and converse, said Krithika Srivats, SVP of clinical practice and products for HGS AxisPoint Health.

“Moreover, keeping an active routine, even with low-impact activities, can fill your day with movement, interaction, purpose and meaning,” she said.

Finally, regular activity patterns are linked to a lower risk of heart disease and dementia and help people maintain independence.

Reference: Seasons (Sep. 18, 2022) “Why early birds (who also stay active) are happier and mentally stronger”

How Many Americans Suffer from Dementia?

In a nationally representative cross-sectional study of about 3,500 older adults, 10% (95% CI 9-11) were classified as having dementia and 22% (95% CI 20-24) as having mild cognitive impairment, according to Jennifer Manly, PhD, of Columbia University Irving Medical Center in New York City, and colleagues.

MedPage Today’s recent article entitled “Dementia Strikes One in Ten Americans Over 65” notes that dementia prevalence rates were similar by sex but varied by age, education, and race, and ethnicity, they reported in JAMA Neurology.

The findings are from the first representative study of cognitive impairment in more than 20 years and are based on participants in the Harmonized Cognitive Assessment Protocol (HCAP) project of the ongoing, longitudinal Health and Retirement Study (HRS). HCAP is a cross-sectional random sample of HRS participants who were ages 65 or older in 2016.

“Because the HCAP study is part of the nationally representative and long-running Health and Retirement Study, these data not only show the burden of dementia now, but will be used in the future to track the trends in dementia burden in the decades ahead,” co-author Kenneth Langa, MD, PhD, of the University of Michigan in Ann Arbor, said in a statement.

“Following those trends will be especially important given the likely impact of COVID and other recent population health changes on the risk for dementia in the coming decades,” Langa added.

Of the nearly 10,000 age-eligible HRS participants, roughly 3,500 were selected for HCAP and completed a comprehensive neuropsychological test battery and an in-person interview between June 2016 and October 2017.

Compared with White participants, dementia was more common among Black participants, and mild cognitive impairment was more prevalent among Hispanic participants. The rates rose dramatically with age: 3% of people between ages 65-69 had dementia versus 35% of people ages 90 and older. Every 5-year increase in age led to higher risks of dementia and mild cognitive impairment.

Each additional year of school was also linked with a drop in risks of dementia and mild cognitive impairment. The findings were similar to other recent estimates of dementia prevalence in the U.S.

“With increasing longevity and the aging of the Baby Boom generation, cognitive impairment is projected to increase significantly over the next few decades, affecting individuals, families, and programs that provide care and services for people with dementia,” Manly said in a statement.

The study provides a snapshot in time and cannot assess cognitive impairment incidence or rates of progression among people with mild cognitive impairment, the researchers said.

The HCAP study’s cross-sectional design “does not allow for examination of survival bias, which could inflate prevalence if some groups are living longer with dementia or decrease estimates in groups with higher mortality,” Manly and colleagues added.

Reference: MedPage Today (Oct. 24, 2022) “Dementia Strikes One in Ten Americans Over 65”

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