Estate Planning Blog Articles

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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”

The Biggest Health Mistakes Seniors Make

We all can improve the chances of a longer, more healthful life by just avoiding these deadly health mistakes that people tend to make after age 50, according to Money Talks News’ recent article entitled “7 Fatal Health Mistakes People Make After Age 50.”

  1. Failing to stay social. Research shows that isolation may double a person’s risk of dying of cardiovascular disease. Social isolation is also linked to increased risks of depression, cognitive decline, obesity and a weakened immune system. Keep those connections with friends and family as you move through your golden years.
  2. Continuing to eat high-sodium foods. Roughly 90% of the sodium we consume comes from salt. In addition, 90% of Americans consume too much sodium. Reduce your sodium intake, and your blood pressure should fall within a couple of weeks, helping to lower your risk of deadly heart disease and stroke.
  3. Postponing colorectal cancer screening. All adults 50 to 75 should have a colorectal cancer screening. This test can find precancerous polyps, which are the main source of colorectal cancer. Screening also can find the disease itself in its early stages, when it is most treatable.
  4. Not taking a daily aspirin. Not everyone over 50 should take an aspirin every day. However, it may be good for those with certain potentially life-threatening health conditions. The U.S. Preventive Services Task Force recommends daily aspirin therapy if you’re age 50 to 59 and not at increased bleeding risk, and you have an increased risk of heart attack or stroke of 10% or greater over the next decade. However, their new recommendations suggest there is no net benefit to starting an aspirin regimen at age 60 or older.
  5. Avoiding the weight room. As we get older, the risk of the bone disease osteoporosis increases. Women are especially at risk for osteoporosis. In fact, one in two women will break a bone due to osteoporosis — which occurs more often in women than a heart attack, stroke and breast cancer combined. The key to preventing osteoporosis is getting enough calcium and vitamin D, along with weight-bearing exercise.
  6. Avoiding water intake. Children and seniors are most at risk for the most devastating consequences of dehydration. Older adults carry a lower volume of water in their bodies. They’re also more likely to take medications that boost the risk of dehydration. Their sense of thirst is also less acute, making it easy for them to forget the need to drink.
  7. Smoking cigarettes. Kicking the nicotine habit pays off at any age so quit now. The improvements can be nearly immediate: your heart rate and blood pressure drop 20 minutes after quitting. Carbon monoxide in your blood drops to normal a few days after quitting, and circulation and lung function improve shortly after quitting.

Just remember to talk to your doctor before undertaking these practices.

Reference: Money Talks News (May 19, 2022) “7 Fatal Health Mistakes People Make After Age 50”

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:

  1. 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.
  2. 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.
  3. 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 My Pet Help Me in Old Age?

Seniors who own a pet may slow their rate of cognitive decline, according to a preliminary study recently presented at the American Academy of Neurology’s 74th Annual Meeting.

Money Talks News’ recent article entitled “Sharp Mind in Old Age? Thank Your Pet” reports that the positive effect appears to be particularly pronounced for those who own a pet for at least five years.

The study looked at data from 1,369 older adults with an average age of 65.

All had normal cognitive skills at the outset of the study. Of the adults in the study, 53% owned pets, with 32% having had their pet for five years or longer.

After examining cognitive test data, the researchers found that after six years, long-term pet owners had a cognitive composite score that was 1.2 points higher compared than those who did not own pets.

In a press release, study author Dr. Tiffany Braley of the University of Michigan Medical Center in Ann Arbor remarked that the positive impact of pets may stem in part from the animals’ ability to reduce our levels of stress:

“As stress can negatively affect cognitive function, the potential stress-buffering effects of pet ownership could provide a plausible reason for our findings. A companion animal can also increase physical activity, which could benefit cognitive health.”

However, Braley — who also is a member of the American Academy of Neurology — said more research is needed to both confirm the results and identify underlying mechanisms that may be responsible for the link.

Earlier studies have found that the presence of pets can help reduce their owners’ levels of stress and even lower their blood pressure.

Reference: : Money Talks News (May 5, 2022) “Sharp Mind in Old Age? Thank Your Pet”

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”

What Do I Need to ‘Age in Place’?

Home modification is the official term (from the Americans with Disabilities Act) for renovations and remodels aimed for use by the elderly or the impaired. It means physically changing your home, removing potential hazards and making it more accessible, so you can continue living in it independently.

Bankrate’s recent article entitled “The best home modifications for aging in place” reports that home modifications can be pricey—typically ranging from $3,000 to $15,000, with the average national spend being $9,500. However, it can be a worthwhile investment. You can save money by doing the right home modifications. That is because the longer you can safely live in your home, the less you will need to pay for assisted living care.

The best aging-in-place home modifications align with “universal design,” an architectural term for features that are easy for all to use and adaptable, as needs dictate. This includes additions and changes to the exterior and interior of a home. Some of the simplest home modifications include DIY jobs:

  • Adding easy-grip knobs and pulls, swapping knobs for levers
  • Installing adjustable handheld shower heads
  • Rearranging furniture for better movement
  • Removing trip hazards; and
  • Installing mats and non-slip floor coverings.

Next, are some more complex home modifications. These probably would need a professional contractor, especially if you want them up to code standards:

  • Installing handrails
  • Adding automatic outdoor lighting
  • Installing automatic push-button doors
  • Leveling flooring; and
  • Installing doorway ramps

There are also home modifications that can be done by room:

  • In the bathroom, installing grab bars and railing, a roll- or walk-in shower/tub, or a shower bench
  • In the kitchen: adding higher countertops, lever or touchless faucets and cabinet pull-out shelves
  • For the bedroom, use a less-high bed, non-slip floor, walk-in closets and motion-activated lights
  • Outside, you can add ramps, a porch or stair lifts, and automatic push button doors.

Finally, throughout the house, keep things well-lit and widen hallways and doorways; add a first-level master suite, elevators or chair lifts, “smart” window shades/thermostats/lighting and simpler windows.

Note that some home modifications may qualify as medical expenses. As a result, they are eligible for an itemized deduction on your income tax return. A home modification may be tax-deductible as a medical expense, if it has made to accommodate the disabilities (preferably documented by a physician or other health care provider) of someone who lives in the home, according to the IRS.

Reference: Bankrate (March 30, 2022) “The best home modifications for aging in place”

Is Advance Care Planning a Benefit to Seniors?

Advance care planning (ACP) is an ongoing discussion that involves shared decision-making to clarify and document an individual’s wishes, preferences and goals regarding their medical care. This is extremely important to making certain that they get the medical care they want, if they become incapacitated and unable to make their own decisions. Despite the importance of ACP, most Americans don’t have their medical wishes documented, according to Medical Life Sciences News’ recent article entitled “Comprehensive approach may promote Advance Care Planning for elderly adults.”

In the pandemic, too many families exhausted themselves attempting to address this issue, agonizing over what their loved one might have chosen for their care if they had been given the chance.

Dr. Angelo Volandes, MD, MPH, physician and researcher, Division of General Internal Medicine at Massachusetts General Hospital, and colleagues started the Advance Care Planning: Communicating with Outpatients for Vital Informed Decisions (ACP-COVID) pragmatic trial. This experiment was designed to see if ACP participation during the pandemic would increase following implementation of video decision aids and clinician communication skills training. They also looked at how these interventions would affect ACP documentation among patients from ethnic and racial minority groups, specifically African Americans and Hispanics.

The trial included a large, diverse patient population aged 65+ from 22 outpatient clinics at Northwell Health, the largest healthcare system in New York State. ACP documentation from three six-month time periods was compared:

  1. Pre-COVID-19
  2. The first wave of COVID-19; and
  3. An intervention period.

The findings showed that ACP documentation was significantly greater among all groups during the intervention period, with African American and Hispanic patients showing the most significant increases.

“The stark disparity in COVID-related outcomes for African American and Hispanic patients highlights a reality already known by many: our healthcare system routinely fails to meet the needs of minority patients. No one intervention or initiative is going to correct all those failings though advance care planning, through engaging and empowering patients, is one of the most effective, immediate ways to address disparities in care,” adds Volandes, who is also an Associate Professor of Medicine at Harvard Medical School.

“Fundamentally, advance care planning aims to empower patients. The results of our study demonstrate the importance of meeting patients where they are,” adds Volandes. “Whether that means providing information in their native language or sharing educational material via text rather than a patient portal, if advance care planning is to be about the patient and we need to find ways to ensure that they feel they have the knowledge and ability to make decisions alongside their clinicians when they deem the time is right. COVID-19 has made ACP more important than ever, and especially in communities that have been hardest hit by the pandemic.”

Reference: Medical Life Sciences News (Feb. 28, 2022) “Comprehensive approach may promote Advance Care Planning for elderly adults”

What Did I Hear about Over-the-Counter Hearing Aids?

The proposed rule comes four years after Congress passed a law mandating that the FDA to establish a category of over-the-counter hearing aids. The agency ran through its August 2020 deadline for doing so, but now has finalized it after a 90-day public commentary period. The FDA’s updated guidelines will create a new category of devices requiring neither a prescription nor a fitting by an audiologist. These will be sold online and at retail stores for adults with mild to moderate hearing loss.

AARP’s recent article entitled “FDA Clears Way for Over-the-Counter Hearing Aids” reports that right now those seeking hearing aids usually must see a health care professional for testing and fitting — a process that can be both costly and lengthy.

“Hearing loss has a profound impact on daily communication, social interaction and the overall health and quality of life for millions of Americans,” Acting FDA Commissioner Janet Woodcock, M.D., said in a statement. “The FDA’s proposed rule represents a significant step toward helping ensure that adults with mild to moderate hearing loss have improved access to more affordable and innovative product options.”

About 15% of U.S. adults (37.5 million) report trouble hearing, according to the National Institute on Deafness and Other Communication Disorders, and fewer than 1 in 3 adults aged 70 and older with hearing loss who could benefit from hearing aids have ever used them. The reason most often cited is the cost. Hearing aids currently cost between $2,000 and $6,000 a pair and are not covered by Medicare or most insurance. The proposed rule is expected to lead to lower prices for consumers, by lowering barriers to entry for hearing aid makers.

The only over-the-counter options now available have been personal sound-amplification products (PSAPs), which increase the volume of all the sounds in a given environment, and which typically cost a hundred dollars a pair.

“Reducing health care costs for everyone in America is a top priority,” Health and Human Services Secretary Xavier Becerra said in a statement. “Today’s move by FDA takes us one step closer to the goal of making hearing aids more accessible and affordable for the tens of millions of people who experience mild to moderate hearing loss.”

Reference: AARP (Oct. 19, 2021) “FDA Clears Way for Over-the-Counter Hearing Aids”