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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”

What’s Being Done to Help Seniors Age in Place?

Seasons’ recent article entitled “Federal grant will fund $15 million in aging-in-place home projects” provides everything you need to know about the latest on aging in place. The U.S. Department of Housing and Urban Development is making $15 million available to assist seniors with home modifications. This funding is made available through HUD’s Older Adult Home Modification Program.

“The funding opportunity … will assist experienced nonprofit organizations, state and local governments, and public housing authorities in undertaking comprehensive programs that make safety and functional home modifications, repairs and renovations to meet the needs of low-income elderly homeowners,” HUD officials said in a statement.

The goal of the program is to assist low-income and older adult homeowners (at least age 62) to remain in their homes by providing low-cost, low barrier and high-impact home modifications to reduce their risk of falling, improve general safety, increase accessibility and to improve functional abilities in the home.

“This is about enabling older adults to remain in the comfort of their family home, where they have made their life,” the spokesperson said, “rather than having to move to a nursing home or other assisted care facilities.”

With an estimated 20% of the population reaching age 65 by 2040, the home modification program aims to assist older adults who remain in their homes safely with honor and respect.

“We must allow our nation’s seniors to age-in-place with dignity,” said HUD Secretary Marcia L. Fudge in a statement. “This funding will give seniors the flexibility to make changes to their existing homes—changes that will keep them safe and allow them to gracefully adjust to their changing lifestyle.”

Eligible applicants include experienced nonprofit organizations, state and local governments and public housing authorities that have at least three years of experience in providing services to the elderly. Individuals, foreign entities and sole proprietorship organizations are not eligible to apply or receive funds, according to HUD. As a result, there’s no individual application homeowners or family members need to fill out to receive funding. Homeowners, family members, caregivers and other interested parties who want to get help and receive home modifications need to apply through a certain institution by contacting organizations in their area in the process of applying for funds or that have already received funds.

“Caregivers can contact the local organization that has a home modification grant, and let the grantee know that they are caregivers for a family with a family member that is age 62 and older, who owns the home they live in and are interested in having the family’s home modified under HUD’s Home Modification grant program to help them age in place,” a HUD spokesperson said.

Reference:  Seasons (Sep. 19, 2022) “Federal grant will fund $15 million in aging-in-place home projects”

Estate Plans Can Protect against Exploitation

Financial exploitation is far more common than most people think, especially of the elderly. There are several types of individuals more at risk for exploitation, according to a recent article from mondaq titled “How An Estate Plan Can Protect Against Financial Exploitation.” These include someone with a cognitive impairment, in poor physical health, who is isolated or has a learning disability.

Exploiters share common characteristics as well. They are often people with mental health illness, substance abusers or those who are financially dependent on the person they are exploiting.

There are warning signs of financial abuse, including:

  • Changes in patterns of spending, transfers, or withdrawals from accounts
  • Isolation from friends and family
  • Unexplainable financial activity
  • An inability to pay for routine bills and expenses
  • Sudden changes to estate planning documents, beneficiary designations, or the addition of joint owners to accounts or property titles

One way to avoid financial exploitation is with an estate plan prepared in advance with an eye to protection. Instead of relying on a durable power of attorney, a funded revocable trust may provide more robust protection. A revocable trust-based plan includes safeguards like co-trustees and a requirement for independent party consent to any trustee change or amendment.

A support system is also important to protect a person if someone is attempting to exploit them. Estate planning attorneys team up with financial advisors, CPAs and other professionals to create a plan to avoid or end elder abuse. Other steps to be taken include:

  • Consolidating accounts with a trusted financial advisor, so all assets are easily observed
  • Have a family member or trusted person receive copies of account statements
  • Consider a credit freeze to avoid any possibility of being coerced into opening new credit card accounts or taking out loans.
  • Establishing a budget and sharing information with advisors and a trusted person, so any spending anomalies are easy flagged.

Elder financial abuse is an all-too common occurrence but taking proactive steps to safeguard the vulnerable family member is a good strategy to deter or thwart anyone intent on taking advantage of a loved one.

Reference: mondaq (Sep. 23, 2022) “How An Estate Plan Can Protect Against Financial Exploitation.”

How to Manage Aging Parent’s Finances

A day will come when age begins to catch up with your parents and they will need help with their finances. Even if your parents don’t want to feel dependent, when you think they need your assistance, you can approach the issue with sensitivity and extend your support for the management of their finances, says Real Daily’s recent article entitled “5 Tips to Manage an Aging Parent’s Finances.” Here are some tips:

  1. Start the conversation early. Your parents may not need your help with the handling of their financial matters right away. However, it is smart to begin the conversation early. Approach the issue of who will manage the financial responsibilities when they’re no longer able to do it. Parents should select a trusted family member by providing their advance written consent. This will let you to talk about your parents’ financial issues with financial advisors, doctors and Medicare representatives and carry out timely financial planning.
  2. Create a list of all pertinent legal and financial documents. Prepare a list of your parents’ important contacts, bank account details and locations of any stored documents, like wills, property deeds, insurance policies and birth certificates. Make certain all information and documentation is accurate and up to date. If information needs to be modified because of a change of circumstances, this is time to apprise them of it and help them do what’s needed.
  3. Consider executing a power of attorney. A competent adult can sign a power of attorney to authorize another person to make decisions on their behalf. A power of attorney for a specific purpose may cover medical, financial, or other decisions, and it may be designed to give limited or more sweeping powers. When your parents sign a power of attorney with you named as their attorney in fact, it will legally empower you to make key decisions when they can’t. An elder law attorney can help you draft an appropriate power of attorney according to your situation.
  4. Document your actions and keep others in the know. Transparent communication will help you avoid misunderstandings or controversy within your family. Keep your parents, siblings and any other loved ones involved with your family informed about your actions. No matter how noble your intentions may be, if others are kept in the dark, it can raise questions about your motives. Managing the finances of aging parents is a lot of work, and you can ask for the support of family members or at least keep the lines of communication open.
  5. Don’ comingle your finances with your parents’ plans. While it may look to be a convenient or cost-effective thing to do, it’s never a good idea to combine your parents’ finances with your own. Keep them separate. Using your parents’ money for your purposes or your own money to help them out is usually a slippery slope that should be avoided. Don’t forget about your own financial goals and retirement savings while you focus on helping your parents.

Reference: Real Daily (Sep. 9, 2022) “5 Tips to Manage an Aging Parent’s Finances”

Can My Teeth Tell Me about My Health?

AARP’s recent article entitled “8 Surprising Things Your Teeth Can Tell You About Your Health” gives us some signs that our teeth can say about out health.

  1. Damaged tooth enamel can be a sign of eating disorders. While bulimia and anorexia are most common in young women, studies show that 13% of American women over 50 have signs of eating disorders. Bulimia is an illness characterized by a cycle of binge eating and self-induced vomiting, often leads to tooth damage. Acid created in the stomach by vomiting erodes the inner enamel or thin outer coating of the teeth. Anorexia is also a serious illness characterized by weight loss, difficulty maintaining an appropriate body weight, and distorted body image. Many people with bulimia are also anorexic, so those with anorexia may also have damage to their tooth enamel.
  2. Pale gums can be a sign of anemia. Anemia is a condition that develops when not enough rich, healthy red blood cells are produced in the body. This makes a person feel weak and tired. It can also cause shortness of breath, dizziness, headaches, and an irregular heartbeat. About 10% of the 35 million people in the U.S. over 65 are considered anemic.
  3. Osteoporosis can put people at risk for tooth loss. This is a bone disease that develops when bone density, mass, and structure in the body changes and can result in loss of bone strength and risk of bone fractures. About 54 million Americans have osteoporosis and low bone mass.
  4. Complications of kidney disease can lead to tooth loss. When the blood can’t be filtered properly, the result is kidney disease. Those with kidney disease often have compromised immune systems and chronic inflammation. A compromised immune system is susceptible to the overgrowth of bacteria or fungus in the body, which can lead to periodontal disease. This is a common bacteria-induced inflammatory disease that causes bleeding gums, wobbly teeth, and tooth loss.
  5. Oral thrush can be a sign of HIV. This is a fungal infection caused by a fungus called candida, which is normally present in low numbers in the mouths of many people. The problem happens when there’s an overgrowth of candida. This can be caused by several factors, including a compromised immune system.
  6. Acid reflux can cause damage to tooth enamel. Acid reflux happens when the contents of your stomach or stomach acid regurgitates into the esophagus. A dentist should easily be able to detect tooth damage by erosion from acid reflux.
  7. Poor dental hygiene is associated with cognitive decline. This can be a sign of cognitive decline, especially in those who have previously taken good care of their teeth. As brushing, flossing and dental visits become harder, the ability to maintain the health of the teeth lessens. Research has also connected tooth loss to a higher risk of dementia. When a senior who’s previously taken good care of his or her teeth has food debris in the mouth, the lack of self-care could indicate decline. Caregiver support may be needed.
  8. Teeth grinding can be a sign of sleep apnea. Sleep apnea causes breathing to stop or become very shallow during sleep. The National Sleep Foundation has found that 1 in 4 people with sleep apnea also grind their teeth at night. Untreated sleep apnea is associated with serious health problems like high blood pressure, type 2 diabetes, liver problems, and even dementia.

Reference: AARP (July 22, 2022) “8 Surprising Things Your Teeth Can Tell You About Your Health”

When Will Hearing Aids Be OTC (Over the Counter)?

Some people avoid purchasing hearing aids because of their hefty price tags. The cost for a single hearing aid ranges from hundreds of dollars to more than $4,000. Moreover, Medicare and most private insurers don’t usually cover the expense. Thus, affordability is a “significant barrier” to purchasing hearing aids, according to a paper in the Hearing Journal, a hearing health care publication.

However, an FDA rule is slated to take effect in mid-October, at which point hearing aid manufacturers will have 240 days to amend relevant product labels and marketing to comply with the new OTC requirements. OTC hearing aids will likely be more affordable and accessible to consumers than most other FDA-approved hearing aids on the market right now.

Forbes’ recent article entitled “FDA Rule Allows Over-The-Counter Hearing Aids To Hit Shelves As Soon As October, Improving Access Nationwide” reports that according to the FDA’s new rule, over-the-counter (OTC) hearing aids are hearing aids intended for people at least 18 years old with perceived mild to moderate hearing loss.

Hearing aids will be available at stores and online retailers (who aren’t required to be licensed sellers) without the need for a medical exam, prescription or fitting adjustment by an audiologist or hearing health professional. The OTC hearing aids must be controllable by the user and customizable to the user’s hearing needs, allowing them to make volume and frequency-dependent changes based on their preferences without the assistance of a professional.

Note that OTC hearing aids are different from personal sound amplification products (PSAPs), which are used to amplify sounds in certain environments and aren’t subject to FDA regulation.

While specific cost information hasn’t been announced by the FDA, OTC hearing aids are expected to be more affordable than prescription hearing aids. Those are frequently sold bundled with audiology services. Affordable OTC hearing aids have the potential to make hearing aids more easily available to people with some degree of hearing loss who may not otherwise be able to afford them. Users also won’t be required to present a prescription from an audiologist or other hearing health professional to get them.

However, members of some hearing health industry associations are concerned about consumers purchasing and using OTC hearing aids without first completing a hearing evaluation conducted by a hearing health professional.

They worry people might damage their ears from overamplification or simply not get a positive result with the products and give up on hearing aids altogether. That has many social and health implications.

However, the Hearing Loss Association of America (HLAA) openly supports a regulated market for OTC hearing aids.

Reference: Forbes (Aug. 16, 2022) “FDA Rule Allows Over-The-Counter Hearing Aids To Hit Shelves As Soon As October, Improving Access Nationwide”

How to Protect Yourself from Online Fraud

The messages come in through emails, texts, phone calls and pop-ups on computer screens. They pretend to be calling from “tech support,” sometimes claiming to be part of Microsoft or Apple. They speak with authority, according to a recent article titled “Tech Support Fraud Targets Seniors,” from Kiplinger.

There’s nothing wrong with your computer, and they are not calling from Bill Gate’s office. The FBI’s Internet Crime Complaint Center, known as IC3, received 13,900 complaints from older victims who lost a total of $238 million in 2021. Of all losses to tech support fraud, older victims make up 58% of the calls and 68% of the losses.

Scams targeting older adults have risen at an alarming rate, reports the IC3’s Elder Fraud Report 2021. There was a 74% increase in losses in 2021 from 2020. Tech support fraud is the most reported fraud among victims 60+ and older.

Why are seniors so attractive to scammers, and why are they so vulnerable?

Most scammers believe all seniors have substantial retirement funds. It is often true.  Seniors may also be isolated from younger generations who are savvier about technology. The past few years have seen an increase in training people actively engaged in the workforce about common security issues and ways to prevent fraud and theft. Retirees are not likely to be exposed to this kind of information on a regular basis.

Tech support scammers typically present themselves as calling from well-known tech companies. They offer help with non-existent problems, demanding payment for renewal for software or security subscriptions. They also impersonate customer support from banks, financial institutions, utility companies or cryptocurrency exchanges.

Adding another layer to the problem: seniors may not have the latest security software or are using outdated desktop computers without current security upgrades, making them an easier target. They simply may not be able to afford to use the costs of some security programs.

Scammers use simple scare tactics, combined with scripts updated to reflect the latest worries and concerns of seniors. Even smart people get scammed. One 80-year old woman was using her computer when a pop-up ad claiming to be from Microsoft appeared and directed her to call a phone number. When she called, the person said they were Microsoft’s scam department and warned her not to continue the conversation on the phone because the scammers could hear the conversation. They gave her an address in another country and instructions to send money by wire. They also gave her all the answers to questions her bank would ask, like why the money was needed and why it was going to a foreign country. She ultimately gave the scammers $20,000.

Equally dangerous is letting scammers have login information. Once they can get into your electronic devices and steal data, they can take personal information and money without the user’s knowledge.  They can also hack into the computer and deploy ransom software, blocking you from using your own computer until you pay ransom. Even then, there’s no guarantee of retrieving your information.

How can you protect yourself?

  • Legitimate companies will not call to tell you there’s a problem with your computer.
  • A real tech company won’t send a popup ad to your computer and ask for a phone call.
  • Anything that must be done fast should be considered a scam.
  • Legitimate companies don’t ask for wire transfers, gift cards or bank account information.
  • Never, ever, click on a link in an email. Other people’s systems get spoofed (taken over), and their email lists are often used to send out fraudulent emails.
  • Keep your computer up to date with the latest in security and updating browsers and operating systems regularly.

Reference: Kiplinger (Aug. 5, 2022) “Tech Support Fraud Targets Seniors”

Scammers Try to Take Senior for a Ride

An 80-year-old woman figured out she was being scammed before going to the bank, after receiving an email from fraudsters who hired an Uber to take her there.

However, the story is a stark reminder of the extent to which thieves will go to scam the elderly, says Krebs on Security’s recent article entitled “Scammers Sent Uber to Take Elderly Lady to the Bank.”

Travis Hardaway said his mother last month replied to an email she received regarding an appliance installation from BestBuy. He said the timing of the scam email couldn’t have been worse, since his mom’s dishwasher had just died. She’d paid to have a new one delivered and installed.

“I think that’s where she got confused, because she thought the email was about her dishwasher installation,” Hardaway said.

Hardaway said his mom initiated a call to the phone number listed in the phony BestBuy email. The scammers told her she owed $160 for the installation, which seemed about right. However, they then asked her to install remote administration software on her computer, so that they could control the machine from afar and assist her in making the payment.

After she logged into her bank and savings accounts with scammers watching her screen, the fraudster on the phone claimed that instead of pulling $160 out of her account, they accidentally transferred $160,000 to her account. They said they needed her help to make sure the money was “returned.”

“They took control of her screen and said they had accidentally transferred $160,000 into her account,” Hardaway said. “The person on the phone told her he was going to lose his job over this transfer error, that he didn’t know what to do. So, they sent her some information about where to wire the money and asked her to go to the bank. However, she told them, ‘I don’t drive,’ and they told her, “No problem, we’re sending an Uber to come help you to the bank.’”

Her son was out of town when this happened. Thankfully, his mom eventually grew exasperated and gave up trying to help the scammers.

“They told her they were sending an Uber to pick her up and that it was on its way,” Hardaway said. “I don’t know if the Uber ever got there. However, my mom went over to the neighbor’s house and they saw it for what it was — a scam.”

Hardaway said he has since wiped her computer, reinstalled the operating system and changed her passwords. However, he says the incident has left his mom rattled.

“She’s really second-guessing herself now,” Hardaway said. “She’s not computer-savvy, and just moved down here from Boston during COVID to be near us, but she’s living by herself and feeling isolated and vulnerable, and stuff like this doesn’t help.”

According to the FBI, seniors are often the targets of scams because they tend to be trusting and polite. They also usually have financial savings, own a home and have good credit—all of which make them attractive to scammers.

“Additionally, seniors may be less inclined to report fraud because they don’t know how, or they may be too ashamed of having been scammed,” the FBI warned in May. “They might also be concerned that their relatives will lose confidence in their abilities to manage their own financial affairs. And when an elderly victim does report a crime, they may be unable to supply detailed information to investigators.”

Reference: Krebs on Security (Aug. 4, 2022) “Scammers Sent Uber to Take Elderly Lady to the Bank”

Wayward Senior Tracked by Bluetooth Technology

The Hernando County Sheriff’s Office recently received a report of a missing adult in the Hernando Beach area.

According to the agency, the elderly man, who suffers from dementia, was reported missing by his wife at about 7:30 in the morning.

Units were dispatched within minutes, reports WTSP.com, in the article entitled “’Technology is one of the best tools…’: Missing elderly man found through Bluetooth tracking device.”

The sheriff’s office said this wasn’t the first time the man has been reported missing.

This time, his wife was prepared: she attached a Bluetooth tracking device to her husband’s belt.

Bluetooth is a type of wireless technology that allows the exchange of data between different devices, such as two cellphones.

Because she planted the device, she was able to give deputies a location to where to find her husband.

Law enforcement was able to locate the man by 7:54 a.m.

He was returned safely home to his family.

“With the high heat index this time of year and the multiple access points to water in the area, we are thankful for this assistance of technology in order to locate this individual within 18 minutes,” the sheriff’s office wrote in a statement.

The sheriff’s office says tracking devices like the one used in this incident can give families peace of mind when caring for a senior with mental health issues, by being able to monitor their location.

“Whether it is a child with special needs or a senior who is forgetful, there are usually warning signs that a person is prone to wandering,” Sheriff Al Nienhuis said in a statement.

“Technology is one of the best tools family members can use to alert them when that individual has unexpectedly left the house.”

“It also provides invaluable tools to increase the likelihood the person will be returned safely. We strongly encourage families to research what technology is right for their situation.”

Reference: WTSP.com (August 8, 2022) “’Technology is one of the best tools…’: Missing elderly man found through Bluetooth tracking device”

What’s Going on with Marvel Comics Creator Stan Lee’s Estate?

According to a court document filed recently, comic book icon Stan Lee’s estate moved to dismiss claims against Lee’s former business manager, Jerardo “Jerry” Olivarez. Terms of the deal weren’t disclosed. The settlement doesn’t include claims against Lee’s former attorney, Uvi Litvak.

The Hollywood Reporter’s recent article entitled “Stan Lee’s Estate Settles Elder Abuse Suit Against Ex-Business Manager” explains that the four-year legal saga, sparked by The Hollywood Reporter‘s investigation detailing accusations of elder abuse, centers on a fight over Lee’s estate. The battle includes his daughter, J.C., and people who allegedly manipulated her in efforts to exploit her famous father. Lee accused J.C., his only child and heir to his estate, of verbally abusing him.

J.C.’s outbursts turned physical at some points in conflicts over money, reports say.

The executive vice president and publisher of Marvel Comics, Stan Lee sued Olivarez and Litvak in 2018, calling them “unscrupulous businessmen, sycophants and opportunists” seeking to take advantage of him following the death of his wife, Joan Lee. Olivarez joined Stan’s inner circle as a consultant to J.C. and Joan’s various business endeavors before ending up with power of attorney over Lee after Joan’s death. He was given the title of “senior adviser,” handling caregiving duties for Lee.

“Jerry Olivarez and JC Lee, Stan and Joan Lee’s only daughter and Trustee of the Lee Family Trust, are happy to announce the resolution of their Court dispute,” said Olivarez’s attorney Donald Randolph in a statement. “The genesis of this dispute was the unfortunate manipulation of Stan Lee and his family undertaken by certain individuals — not named in the lawsuit — which was intended to unfairly malign Jerry Olivarez. These individuals exerted undue influence on the Lee family to accuse Jerry Olivarez of harmful acts which he did not do.”

According to the complaint, Olivarez fired Stan Lee’s banker of 26 years along with his lawyers and transferred roughly $4.6 million out of his bank account without authorization. After convincing Lee to sign a power of attorney to give him authority, Olivarez allegedly appointed his own lawyer, Livtak, as Lee’s lawyer without disclosing the conflict of interest.

Prior to his death, Lee alleged fraud, financial abuse of an elder and misappropriation of name and likeness, among other claims.

“Olivarez abused his relationship of trust with Lee and JC Lee, knowledge of Lee’s and JC Lee’s confidential business and estate planning operations, and ability to mislead Lee due to his advanced age all in a covert and intentional effort to dupe Lee into a host of schemes and financial missteps that benefited Olivarez and disenfranchised Lee,” reads the complaint.

Reference: The Hollywood Reporter (July 27, 2022) “Stan Lee’s Estate Settles Elder Abuse Suit Against Ex-Business Manager”

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