Estate Planning Blog Articles

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

What Is ‘Food Insecurity’?

“The pandemic has exacerbated existing trends in food insecurity,” Cindy Leung, ScD, MPH, assistant professor of public health nutrition at the Harvard T.H. Chan School of Public Health, in Boston, said in an email. “People who were already experiencing food insecurity found themselves at more severe levels, and other people were experiencing food insecurity for the first time. Older adults were no exception, on top of a higher risk of COVID-related disease burden and hospitalizations.”

MedPage Today’s recent article entitled “Food Insecurity Among Older Adults Remains a Problem” explains that food insecurity, which is defined as a lack of access to a sufficient amount of nutritious foods, was an issue in the U.S. even before the pandemic started.

Leung and her then-colleagues at the University of Michigan conducted a survey of about 2,000 older adults in 2020 that found that 14% of those ages 50-80 had experienced food insecurity in 2019. This appeared to be connected to worse physical and mental health, the researchers reported.

“Nearly half of adults aged 50-80 who were food insecure rated their physical health as fair or poor (45%), compared to 14% of those who were food secure,” while “almost a quarter of those who were food insecure reported fair or poor mental health (24%) compared to 5% of those who were food secure.”

The researchers also found that about 54% of food-insecure respondents had multiple (two or more) chronic conditions, compared to 41% of food-secure individuals. Food-insecure individuals were more likely than food-secure individuals to report having these conditions than food-secure respondents:

  • Asthma
  • Chronic bronchitis or chronic obstructive pulmonary disease
  • Chronic pain; diabetes
  • Kidney disease; or
  • A sleep disorder.

There were no significant differences in cancer, heart disease, high blood pressure, high cholesterol, or non-alcoholic fatty liver disease by food security status, however, they noted.

“Food insecurity is actually a really big problem among older adults,” Nicole Heckman, vice president of benefits access at the AARP Foundation, said in a phone interview at which a press person was present. “Nearly 9.5 million adults ages 50 and older are food insecure.”

Heckman gave several reasons for the problem. “One is obviously a lack of income,” she said. “Those that are at or below the poverty line struggle to afford the food they need, especially when we think about the inflation and just the crazy food prices and how much they have gone up over the last 2 years.”

The federal government addressed the general issue of food insecurity during the pandemic in part by expanding access to food programs like the Supplemental Nutrition Assistance Program (SNAP), as well as expanding the dollar value of available benefits. However, Heckman said, “many older adults aren’t actually aware of the programs and benefits to help them put food on their table. Research shows there are over three million older adults that missed out on more than $200 a month in SNAP benefits” during the pandemic.

Reference: MedPage Today (Jan. 10, 2023) “Food Insecurity Among Older Adults Remains a Problem”

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 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?”

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”

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”

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”

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”

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”