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?”

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”

Why Does Government Deny Social Security Disability Benefits

Kiplinger’s recent article entitled “3 Main Reasons Why the Government Denies Social Security Disability Benefits” says three main issues are the primary contributors to the high denial rates and prolonged appeals process:

Applicants fail to satisfy work history requirements. Anyone who pays FICA payroll taxes long enough, is typically insured for SSDI. However, that doesn’t mean they’re eligible for benefits. To meet the SSA definition of disability, one must have physical or mental impairments that prevent them from being unable to perform any substantial gainful activity (SGA) for at least 12 months or have a terminal diagnosis. SGA encompasses work performed for pay or profit, and for 2022, the monthly benefit one would receive after qualification is set at $1,350 a month, or $2,260 if you are blind.
Applicants provide incomplete documentation. Detailed medical evidence is required to document a disability and its impact on the person’s ability to perform SGA—it’s a crucial part of the SSDI application. This should include diagnoses, medical tests and results, treatment history, prescription drugs, surgeries, ER and doctor visits and other relevant medical details to show not just that you have a problem, but also that you’ve been receiving regular medical treatment for your issue. This, along with details about how a disability influences your activities of daily living, is especially significant if you have an invisible disability, such as mental disorders, neurological conditions or cognitive dysfunctions caused by injury or disease. Regular monthly treatments and drug therapies with specialists and mental health professionals are an important part of your claim.
Applicants not knowing they have the right to an SSDI representative. The SSA doesn’t tell initial applicants they have the right to retain a representative to assist them. As a result, most people try to navigate the complicated program on their own. You need an advocate to tell the story of your disability and its impact on you and your family. Less than 30% of applicants have an SSDI representative to help them apply. Those individuals are 23% more likely to get their application approved. It also means getting benefits in six months compared with a year or two!

Representatives are taking on more SSDI cases resulting from long COVID symptoms that have exacerbated physical and mental impairments. Long COVID may affect up to 30% of COVID patients, or an estimated 25 million people in the United States, especially those with respiratory disease, diabetes and cognitive issues.

Reference: Kiplinger (July 16, 2022) “3 Main Reasons Why the Government Denies Social Security Disability Benefits”

Can Traveling Help Seniors’ Mental Health?

A study to be published in the October 2022 edition of Tourism Management presents the thoughts of a cross-disciplinary team of experts in both dementia and tourism. Medical News Today’s recent article entitled “’Travel therapy’ may offer treatment for dementia and benefit mental health” reports that the research hasn’t yet been peer-reviewed, but experts think there may be significant benefits of travel for people with dementia, particularly in the areas of mental health and well-being.

Dementia currently has no cure, but some medications and treatments may help control symptoms.

Care is often supportive, including helping those with dementia do as much as they can on their own and helping them have a better quality of life.

Researchers are still working on how to best help those with dementia. One area of interest is how traveling may benefit people with dementia.

The researchers say that the potential benefits of tourism in treating people with dementia are called “travel therapy.” One definition of tourism the researchers used was “visiting places outside one’s everyday environment for no longer than a full year.” They note that the experience of tourism has four main components to it:

Affective Experience: how it impacts feelings, emotions and mood
Cognitive Experience: how it affects thoughts and memories
Conative Experience: how it impacts behavior; and
Sensorial Experience: how it impacts the senses.

The authors concluded that tourism may have a potentially positive impact on well-being and quality of life through a variety of components. However, the literature supporting this in the treatment of dementia is limited.

The study authors also noted that focusing on components of positive psychology, such as what people can do, positive experiences, and well-being may also benefit people with dementia.

They proposed a few options to implement components of tourism to help people with dementia, such as group travel that promotes social interactions or traveling to locations that stimulate the senses.

Reference: Medical News Today (June 30, 2022) “’Travel therapy’ may offer treatment for dementia and benefit mental health”

Medicare’s Coverage of New Controversial and Expensive Alzheimer’s Drug Is Limited

The final decision, which comes after a proposed policy released in January, will have significant consequences for millions of Alzheimer’s patients and tens of millions of Medicare enrollees. It’s the latest step in the drug’s contentious path to market, reports CNN’s recent article entitled “Medicare limits coverage of controversial Alzheimer’s drug to those in clinical trials.”

The policy is expected to restrict the number of people who can receive the medication. This coverage policy would also apply to other drugs in this class, such as monoclonal antibodies that target amyloid, or plaque, for the treatment of Alzheimer’s disease, that the FDA may approve in the future.

Biogen, the maker of Aduhelm, called CMS’ decision unprecedented and said it will deny all Medicare enrollees access to the drug and may limit coverage for treatments approved in the future.

“When additional data from this new class of treatments become available, Biogen urges CMS to reconsider today’s decision for all FDA-approved amyloid-beta targeting therapies,” the company said in a statement, noting that it is considering its options.

The CMS made this decision based on evidence and analysis of public feedback, CMS Administrator Chiquita Brooks-LaSure said in a statement. More than 10,000 comments on the proposed policy were submitted.

“CMS has a responsibility to ensure that people with Medicare have equitable and appropriate access to therapies that are reasonable and necessary for use in the Medicare population,” she said. “Through this decision, we are creating a pathway for people with Medicare to quickly access drugs the FDA determines have shown a clinical benefit and encourages manufacturers and trial administrators to ensure that the clinical trials recruit racially diverse participants.”

The agency examined the potential for patient benefits against the significance of serious unknown factors that could result in harm, Dr. Lee Fleisher, CMS chief medical officer, said in a statement.

“There is the potential for promise with this treatment; however, there is not currently enough evidence of demonstrating improved health outcomes to say that it is reasonable and necessary for people with Medicare, which is a key consideration for CMS when making national coverage determinations,” Fleisher said.

CNN says that Medicare has never required enrollees to participate in a clinical trial for a drug already approved by the FDA that is being used for its intended purpose.

The FDA’s approval of Aduhelm last June brought about questions and concerns about the process, the drug’s efficacy, as well as its annual cost. Biogen initially priced it at about $56,000 a year. The approval was also a big motivator for a huge increase in Medicare Part B premiums for 2022. The standard monthly payment increased to $170.10, up from $148.50 last year, for the more than 63 million enrollees.

Roughly $10 of the premium spike is due to Aduhelm, a CMS official told CNN. The remainder is from a general increase in health care prices and usage, as well as from congressional action that limited the rise in Part B premiums for 2021 amid the coronavirus pandemic.

Reference: CNN (April 7, 2022) “Medicare limits coverage of controversial Alzheimer’s drug to those in clinical trials”

Can a Teddy Bear Help Elderly with Dementia to Communicate?

This cuddly bear engages with individuals with memory disorders.

WGAL’s article entitled “Talking teddy bear gives patients with dementia a new way to connect” reports that Cue Teddy is the brainchild of Dr. Roger Nelson.

Dr. Nelson is a retired physical therapist whose family dealt with dementia. He saw a need that was not being met.

“They lacked this ability of being able to talk and to think and then to connect with other people,” he said.

Dr. Nelson, therefore, teamed up with Rod Tosten, the vice president of IT at Gettysburg College, to bring the bear to life.

“Cue Teddy cues the individual to move and to stay active,” Tosten said.

The bear goes through a series of questions and commands, tapping into three areas of the brain: thought, motion and touch.

“One of the things we’re testing is what colors work well and what kind of fabric works well,” Tosten said.

But why a teddy bear?

“Everybody kind of remembers their first teddy bear they ever got and the name of the teddy bear,” Nelson said.

In addition, making people remember is part of the goal.

“I hope that a lot of people adopt it and use it because it’s a valuable tool,” Nelson said.

“To be able to help other people is just amazing. I just love working on this,” Tosten said.

Cue Teddy is currently in the early stages of development. When it is ready, the two creators will be looking for a partner to mass produce it.

Reference: WGAL (Feb. 14, 2022) “Talking teddy bear gives patients with dementia a new way to connect

Does Lack of Clutter Help with Dementia?

Researchers in Great Britain looked at whether people with dementia were better able to carry out tasks, such as making a cup of tea, at home surrounded by their usual clutter or in a clutter-free environment. The researchers were surprised to find that participants with moderate dementia performed better when surrounded by their usual clutter.

News Medical Life Sciences’ recent article entitled “People with dementia may not benefit from a clutter-free environment” also noted that the different environments made no difference to those with mild and severe dementia. These patients were able to perform at the same level in both settings.

Professor Eneida Mioshi, from the University of East Anglia’s School of Health Sciences, said: “The majority of people with dementia live in their own home and usually want to remain living at home for as long as possible. So it’s really important to know how people with dementia can be best supported at home – one possible route would be by adapting the physical environment to best suit their needs.”

He also noted that as dementia progresses, seniors will gradually lose their ability to carry out daily tasks due to changes in their cognitive, perceptual and physical abilities. The professor went on to say that participation in daily tasks could then be improved, by adapting the individual’s environment.

“To this end, we wanted to investigate the role of clutter in activity participation, given the potential to use de-cluttering to support people with dementia to continue to be independent,” Professor Mioshi explained. “Environmental clutter has been defined as the presence of an excessive number of objects on a surface or the presence of items that are not required for a task.”

Mioshi also said it’s generally assumed that an individual suffering from dementia will be better-able to carry out daily tasks, when their home space is tidy and clutter free. However, he noted that there’s been very little research on this hypothesis.

Occupational therapist and PhD student Julieta Camino carried out the study with 65 participants who were grouped into those with mild, moderate and severe dementia. The participants were asked to carry out daily tasks, including making a cup of tea and making a simple meal, both at their own home and at UEA’s specially designed NEAT research bungalow – a fully furnished research facility that feels just like a domestic living space.

The researchers looked at their performance of activities in both settings, and also measured the amount of clutter in the participants’ homes. The NEAT home setting, however, was completely clutter free. They believed the complete absence of clutter in the research facility would play a beneficial role in helping people with dementia with daily living activities. However, we were wrong. Overall, those with moderate dementia, in particular, performed daily tasks better at home, despite the fact their homes were much more cluttered than the research bungalow.

Moreover, it didn’t seem to make any difference how cluttered the participant’s home was. The only factor that contributed to how well they could carry out tasks at home was their level of cognition – with those with severe dementia encountering the same difficulties to perform the tasks at home and in the research facility.

Sian Gregory, Research Information Manager at Alzheimer’s Society, said: “We can sometimes make assumptions about what might help someone with dementia who’s living at home, like de-cluttering so they can concentrate on tasks like making a cup of tea. But, as this study shows, our ideas might not always be right.

“Challenging assumptions is so important for careers to understand how to help someone with dementia to live well in their environment. That’s why the Alzheimer’s Society funds a variety of studies like this one to evaluate what actually works for people living with dementia today, as well as finding treatments for the future.”

Reference: News Medical Life Sciences (Nov. 26, 2021) “People with dementia may not benefit from a clutter-free environment”

How Do I Hire an Elder Law Attorney?

Elder law attorneys are lawyers who assist the elderly and their family members, and caregivers with legal questions and planning related to aging.

These attorneys frequently are called upon to assist with tax planning, disability planning, probate and the administration of an estate, nursing home placement, as well as a host of other legal issues, says Forbes’ recent article entitled “Hiring An Elder Law Attorney.”

In addition, there are some elder law attorneys who have the designation of Certified Elder Law Attorney (CELA), a certification issued by the National Elder Law Foundation. A Certified Elder Law Attorney must meet licensing and other requirements, including specific experience in elder law matters and continuing education in elder law. However, note that an elder law attorney does not need to have the CELA certification to be an experienced elder law attorney.

There are many elder law attorneys who specialize in Medicaid planning to help protect a senior’s financial assets, if they suffer from dementia or another debilitating illness that may require long-term care. Elder law attorneys also prepare estate documents, such as a durable power of attorney for health and medical needs and a living will. As you age, the legal issues that you, your spouse, and/or your family caregivers must address can also change.

If you are a senior, then you should have durable powers of attorney for financial and health needs, in the event that you or your spouse becomes incapacitated. You might also need an elder law attorney to help you transfer assets if you or your spouse move into a nursing home to avoid spending your life savings on long-term care.

Healthy people over 65 are in the best spot to do more than having estate planning documents prepared. That’s because they have the opportunity to develop a holistic strategy beyond the legal documents. This can give assurances that the family members and professionals they’ve assembled understand the principle of supported decision-making and how it will be implemented.

For example, an elder law attorney may focus on finding the least restrictive residential environment and making other health care and financial choices. An elder law attorney can also protect seniors with diminished capacity, who are being victimized by personal and financial exploitation.

An initial consultation with an elder law attorney will help determine the types of legal services they can offer, and the fees associated with these services.

Reference: Forbes (Oct. 4, 2021) “Hiring an Elder Law Attorney”

Is a Cup of Joe Help Healthy for Seniors?

Nutrition experts and medical researchers are finding all kinds of reasons to recommend indulging in a cup of joe— most based on the fact that coffee is the single greatest contributor to total antioxidant intake, says AARP’s article entitled “Five Surprising Health Benefits of Coffee.”

“Coffee is abundant in bioactive compounds that promote health,” says Kristin Kirkpatrick, a registered dietitian at Cleveland Clinic. As she explains, research published in The New England Journal of Medicine shows that these compounds may improve the gut microbiome (made up of healthy bacteria that aid in digestion and boost immunity) and reduce what’s called oxidative stress, which occurs when free radicals outnumber antioxidants in a way that leads to disease-causing cellular damage in the body. “The beans also have a deep rich hue, and we know that the deeper the color of a plant, the more benefits we can expect for health.”

However, moderation is the key. Three to five eight-ounce cups of coffee — or up to 400 mg of caffeine — per day can be part of a healthy diet. That is plain black coffee, not cappuccinos, lattes and macchiatos. Those are high in calories, sugar and fat. Let’s look at five health benefits of coffee that give you even more reason to enjoy your next cup.

Lowers Your Risk of Type 2 Diabetes. A large review of studies published in Nutrition Reviews found that your risk of developing type 2 diabetes drops by 6% for each cup you drink per day. That’s because coffee is packed with phytochemicals that may act as antioxidants, anti-inflammatory compounds, insulin-sensitivity boosters and more. The same goes for decaffeinated brews. A study published in the Journal of Internal Medicine found that those who drank two to three cups of filtered coffee a day — as opposed to unfiltered coffee (made with a pod, an espresso machine, or a French press) had a 60% lower risk of developing type 2 diabetes than people who drank less than one cup of filtered coffee a day. Those drinking unfiltered coffee didn’t see such a reduction in risk.
Heart Protection. A review of three major studies published recently in Circulation: Heart Failure found that drinking one or more cups of plain caffeinated coffee a day may reduce your risk for heart failure. (Decaf didn’t yield the same benefits.) Among those without diagnosed heart disease, researchers found that drinking up to three cups of coffee a day was associated with a lower risk of stroke, death from cardiovascular disease and death from any cause.

If possible, though, drink filtered coffee because unfiltered coffee contains two compounds that raise LDL cholesterol in some people, and high levels of LDL cholesterol increase your risk for heart disease and stroke.

Boosts brain health. Some research suggests that regular caffeine consumption may offer brain health benefits. In one study of people ages 65 to 84, published in the Journal of Alzheimer’s Disease, those who drank a cup or two of coffee daily had a lower rate of mild cognitive impairment than those who never or rarely consumed coffee. Other studies suggest coffee may also protect against Parkinson’s disease. However, some research shows that having over five or six cups a day may have an adverse health impact on the brain.
Improves your mood. Drinking coffee may reduce your risk of depression by nearly one-third, according to research from Harvard Medical School. The effect may be related to coffee’s anti-inflammatory properties. Coffee also has phytochemicals that feed the good bacteria in our guts. The good bacteria may produce or enhance other compounds that act on the brain and have beneficial effects on mood.
Maximizes workouts. Downing a cup before exercise can make a difference in your workout because coffee improves circulation, endurance and muscular strength. It also may reduce pain, according to a review of research published in 2019 in Sports Medicine. However, it is important to recognize that coffee can also act as a diuretic.

Reference: AARP (Sep. 20, 2021) “Five Surprising Health Benefits of Coffee”

Will Congress Provide more Dollars for Elder Care?

For millions of Americans taking care of elderly or disabled loved ones, resources are very costly. Government assistance is provided through Medicaid, but it’s just for those with the lowest incomes. Many who qualify don’t get the help because many states restrict the number of eligible recipients, resulting in long waiting lists.

NBC News’ recent article entitled “Democrats want billions to pay for elder care. Republicans say the price tag is too high” reports that Democrats have earmarked roughly $300 billion to expand home-based care for seniors and the disabled in the $3.5 trillion spending bill dubbed the American Families Plan. The bill would offer states incentives to lift their income caps to 300 times the poverty level, or about $38,600 per person. Democrats say it would enable an additional 3.2 million people to be eligible for home-based assistance.

However, Republicans are launching an all-out messaging campaign that accuses Democrats of a “reckless tax and spending spree” and saying the American Families Plan would lead to higher inflation and a suffering economy. Democrats say they aren’t afraid of the cost or of Republican claims about inflation. Research shows that the elder care proposal is one of the most popular components of their agenda among likely Democratic voters. Two-thirds of voters said expanding access to home-based care for the elderly and the disabled was important, and 48% strongly favored the expansion.

Progressives have said $3.5 trillion is too little to transform the economy. Moderate Democrats point to the risk of inflation.

U.S. Rep. Katherine Clark (D-MA), who is a member of the House Women’s Caucus, cared for her dad, who suffered a stroke, her mom, who had Alzheimer’s and three young children when she was running for Congress. She said elder care is a priority.

“Even though I had resources and options, it was really, really challenging to me. That story plays out for parents and women across this country every day,” Clark said in an interview. “It is long past time that we recognize how fundamental the care agenda and the care economy is to our economy in general.”

Democrats also would like to pass provisions to guarantee that home health care workers make a living wage through reporting guidelines and by requiring a minimum wage, which would be set by region.

Reference: NBC News (Aug. 21, 2021) “Democrats want billions to pay for elder care. Republicans say the price tag is too high.”

Estate Planning Blog Articles

Estate & Business Planning Law Firm Serving the Providence & Cranston, RI Areas

What Games are Best for Brain Health?

Wayward Senior Tracked by Bluetooth Technology

Can Traveling Help Seniors’ Mental Health?

Medicare’s Coverage of New Controversial and Expensive Alzheimer’s Drug Is Limited

Can a Teddy Bear Help Elderly with Dementia to Communicate?

Does Lack of Clutter Help with Dementia?

How Do I Hire an Elder Law Attorney?

Is a Cup of Joe Help Healthy for Seniors?

Will Congress Provide more Dollars for Elder Care?

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What Games are Best for Brain Health?

Wayward Senior Tracked by Bluetooth Technology

Can Traveling Help Seniors’ Mental Health?

Medicare’s Coverage of New Controversial and Expensive Alzheimer’s Drug Is Limited

Can a Teddy Bear Help Elderly with Dementia to Communicate?

Does Lack of Clutter Help with Dementia?

How Do I Hire an Elder Law Attorney?

Is a Cup of Joe Help Healthy for Seniors?

Will Congress Provide more Dollars for Elder Care?

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