OHIO ELDER LAW BLAWG

Some Signs of Dementia may be B-12 Deficiency Instead

The NY Times today had a piece which described a woman's cognitive declines.  Her daughter noticed her becoming more and more confused.  When Aricept (a common Alzheimers' disease treatment) was prescribed, the woman became more confused. 

When blood work was done her B-12 level was well below normal.  When she recieved B-12 injections, she recovered. Now 87, the woman still lives alone in Manhattan and feels well enough to refuse outside assistance.

The link to the article is below.  It discusses not only the story, but information about B-12. 

http://www.nytimes.com/2011/11/29/health/vitamin-b12-deficiency-can-cause-symptoms-that-mimic-aging.html?src=me&ref=general

Tsunami has Especially Severe Consequences for the Elderly and Ill

 

I spent a little time this morning wondering how the elderly and disabled were doing after the Tsunami.  It appears as though hospitals were in its path, one hospital's first floor was ruined, and unfortunately the first floor kept all of the food and many supplies.

One article I read noted that "Much of the concern is focusing on of the elderly. At Shintona, about 90% of the victims were described as old, suggesting this might become a defining characteristic of the disaster."  The article noted that some elderly in nursing homes were dead or missing.  The care manager, Kiyoko Kawanami, of one of Miyagi Japan's first old people's homes she was able to confirm only 20 of the 90 residents were safe. "We don't know what happened to them. The tsunami hit while we were trying to organize an evacuation," she said.

There are already a number of articles engaging in hand-wringing over what could have been learned and was not in the aftermath of the the 2004 Tsunami, which hit Thailand with incredible devistation.  I guess there is always room for improvement, but it is hard to see how much of this devastation could have been fully avoided after such an incredible natural disaster.

Among a few interesting ways people can donate, Apple is accepting Red Cross donations through iTunes.  

A few links to articles:

http://www.newser.com/article/d9lutaro0/sick-elderly-face-double-misery-after-japanese-tsunami-destroys-hospitals-along-the-coast.html

http://www.guardian.co.uk/world/2011/mar/13/japan-earthquake-tsunami-survivors-grief

 

Global Aging is Changing Rules of Retirement

The entire world, not just the US, is seeing a revolution in the way we are spending retirment years, including not retiring at all.  The reasons can be because of personal choice, as well as necessity.  The Christian Science Monitor surveys this issue in an article published today.

Article

Health Benefits of Walking May Include Protection of Brain Size and Memory

The benefits of walking are probably more than just helping to remain fit and healthy. We know walking results in a reduced risk of disability in the elderly population, as well as it lowers chances of developing cancer in men. According to a recent study, walking at least six miles per week protects brain size and preserves memory in old age.

The study was initiated on 299 individuals who showed no signs of dementia. During the study, participants had to record the number of blocks walked each week. Nine years later brain scans were taken in order to measure brain size of the subjects. Having completed four more years, authors conducted a test for ascertaining the presence of cognitive impairment or dementia. People walking at least 72 blocks a week, (six to nine miles) may have greater gray matter volume than people who didn’t walk that much. The results were measured at the nine-year time point after recording activity.

Kirk I. Erickson, PhD, with the University of Pittsburgh in Pittsburgh and the study author explained, “Brain size shrinks in late adulthood, which can cause memory problems. Our results should encourage well-designed trials of physical exercise in older adults as a promising approach for preventing dementia and Alzheimer’s disease.”

       Gray matter volume did not seem to boost any further in those walking more than 72 blocks. After four years, 116 volunteers comprising 40 percent were apparently diagnosed with either cognitive impairment or dementia. Walking possibly lowers chances of developing memory problems. Experts presume that while regular exercose enhances brain health in midlife, thinking and memory is improved in later life.

The study was published in the October 13, 2010, online issue of Neurology, the medical journal of the American Academy of Neurology.  Excerpts of this article were taken from healthjockey.com.

Trusts are Good and Trusts are Bad

Like anything in life, there is a good and a bad side.

Last week when the market went down 1000 points, that seemed like bad news. However, some lucky soul out there was probably buying Accenture for 1 cent a share, and it bounced back up to its pre-crash status of some $40.  So, it was bad, yes, but it also was good, wasn't it?

When planning for nursing home eligibility under Medicaid, trusts can be...well, good or bad.

Trusts can be great tools for controlling assets after your death, estate tax savings, privacy, and wealth preservation.  However, when a revocable living trust (a trust that you can terminate or change at will) holds assets and you apply for Medicaid, certain strange things can happen. 

Things that normally are NOT counted for medicaid purposes suddenly ARE counted.  For instance, if you put your house in a trust, Medicaid will count it as an asset whether you are living in it or not.  However, if it is OUT of a trust, and you or a spouse are living in the house, Medicaid will NOT count the house as an asset. 

Is this bad, or is this good?  Well, it all depends. 

With a married couple, usually we want a great deal of countable assets when you first go into a facility, but very few assets after that.  Why?  Because generally a spouse who goes to a nursing home has to somehow use 1/2 of the assets he and his wife have collectively on the first date he went into institutional care. 

So, if you and your spouse have $100,000 in cash, and you own a house worth $100,000 that is titled in your joint names, the house is not counted, and you will have $100,000 in countable resources and you will have to spend $50,000 (half of the $100,000 you have) before the spouse in the nursing home can get Medicaid to pay. 

But what if you have the house in a trust before you go into a nursing home?

Now you have $200,000 alltogether: $100,000 in cash, and $100,000 in a house.  The house is counted as an asset because it is in the trust!  So Medicaid says, you have $200,000 and you need to get rid of $100,000 before you are eligible for Medicaid! That becomes easy. If we remove the house from the trust and put it in your name, viola!  You have $100,000 in cash, and Medicaid can no longer count the house as an asset because its now in your name.

On the other hand, some people apply for Medicaid with the house in trust, and don't realize that it will be counted, and may end up getting their Medicaid application denied.

So, that's kinda bad.

So there you are, trusts are good and trusts are bad. Either way, it pays to have someone experienced review the situation if you or a loved one is either going into a nursing home, or has been diagnosed with a condition that may cause a stay in a long term care facility.

-Todd

Increasing Social Security Benefits: When to Elect

Lynn Brenner wrote an article on Monday, May 10, 2010 in which she collected some thoughtful scenarios which I think are worth repeating.  The whole article is here.

When to start collecting your benefits is an important decision.  This post is an excerpt from Ms. Brenner's article which I think nicely illustrates how waiting can sometimes help your long term financial situation.  

There are other techniques that have been discussed on this blog.  Search under Social Security if you are interested!

Todd

Doubling Social Security: The Case for Waiting

To see the long-term benefits of waiting [to start Social Security], consider

this example from T. Rowe Price senior financial planner Christine Fahlund. A man born on January 2, 1948, who earns $80,200, he can expect a $2,157 a month from Social Security at his normal full retirement age of 66. But if he retires this year, at 62, he'll receive just $1,458 a month, about a third less. Using Social Security's assumptions, by waiting until 70, his checks will start at $3,303 — more than double what he'd get at 62.

True, he must pass up eight years' worth of checks — in this example, that's a total of $149,517 in inflation-adjusted benefits from age 62 through 69. But if he starts taking benefits at age 70, the bigger checks will let him make up that $149,517 in a little over six years, or by the time he's 77. From then on, he'll be ahead of the game.Through age 85, he'll have collected $786,450, or$219,462 more than if he had started benefits at 62. Postponing meant eight years of tax-free, government guaranteed growth.

Postponing your benefits can also help you avoid the Social Security earnings penalty if you work in retirement. In 2010, if you receive Social Security checks before the full retirement age, you must temporarily forfeit $1 of your benefits for each $2 you earn over $14,160 (you can't collect any benefits if you earn more than $42,960). If you reach your full retirement age in 2010, Social Security holds back one dollar for every $3 earned over $37,680. After you've reached full retirement age, the earnings penalty disappears.

Weighing the Numbers

To determine when you should tell Social Security to start sending the checks, run some what-if scenarios.

Start by finding out how much Social Security is likely to pay you. The agency's web site has a table listing the normal retirement age based on the year you were born and the penalty for collecting benefits early. If you start at age 62, you'll get 25 percent to 30 percent less than at your full retirement age.

For a pretty good idea what your actual benefits will look like based on what you've earned (your checks are based on the average of your 35 highest-paying years), use Social Security's retirement estimator calculator.

Also, consider these three factors before you start the clock on Social Security:

Your health. If you have a serious illness or family history of short life expectancies, taking benefits as soon as you can makes sense. "But for most people, delaying benefits until their normal retirement age or later is best," says Vernon, "because, on average, Americans in their 50s and 60s will live until their mid-80s." You can use the calculators at livingto100.com and bluezones.com to estimate your life expectancy based on your health, family history and lifestyle.

Your marital status. If you're married, delaying your checks will not only boost your benefit, it will mean a larger survivor benefit for your spouse — extra money that will last for the rest of his or her life. There's an 81 percent chance that one or both members of a 65-year-old couple will live to 85, a 58 percent chance that one or both will make it to 90.

Your plans. Of course advice here can't take into account your personal needs: You may want to start taking Social Security late because you plan to keep working into your late 60s and don't need the government checks. Conversely, you may want to receive the money early so you can write the Great American Novel.

The Math for Marriage

If you're married, running the numbers is, as Meryl Streep might say, complicated. MoneyWatch blogger Larry Swedroe wrote a helpful four-part series on Social Security strategies for couples that demystifies the math. Here are the four basic rules:

1.You can claim a Social Security benefit based on your work record or your spouse's work record. The maximum spousal benefit is 50 percent of what your husband or wife will receive.

2. A widow or widower who starts collecting survivor benefits at the normal retirement age or older generally earns 100 percent of the deceased spouse's benefit. But the amount shrinks to 71 to 99 percent if you begin getting survivor benefits between 60 and your normal retirement age.

3. You can never collect your benefit and your spousal (or survivor's) benefit at the same time. If you're entitled to both benefits and are under the full retirement age, you will always receive the larger of the two.

4. You can't apply for a spousal benefit until your husband or wife has filed for Social Security.

How Couples Can Collect Early

Married couples who can't afford postponing Social Security altogether can use a technique known as the "62/70 Strategy" to maximize benefits over the long term. With this system, the lower-earning spouse files for Social Security at age 62 and the higher earner delays until age 70. "No matter which spouse dies first, the smaller benefit will die off too," says James Mahaney, vice president of Prudential Retirement and co-author of a report on how to maximize Social Security benefits.

Here's how T. Rowe Price's Fahlund says 62/70 could work: Assume John's full benefit will be $2,157 a month. His wife Jane's full retirement benefit will be $1,081 a month; at 62, she'd receive $721 a month. Jane applies for her $721 benefit at 62, and John delays claiming his checks until 70, when he'll collect $3,303. If John dies at 82, his monthly benefit will have grown to $4,601 because he had waited until 70 to start collecting. That $4,601 then becomes Jane's survivor benefit, and it will be 88 percent more than Jane would have received if John had begun collecting at age 62.

Couples should also take advantage of the little-known rules to boost retirement income.

Let's go back to John and Jane. Although John is waiting until 70 to start receiving his benefits, at 66 he can apply for a spousal benefit based on Jane's work record while his own benefit keeps growing. (If he was younger than 66, he couldn't do that.) Because he has reached his full retirement age, John qualifies for the maximum spousal benefit: $541 a month, or 50 percent of Jane's $1,081 benefit. When John hits 70, he'll drop the spousal benefit and start collecting his own larger benefit.

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Does this Soda Make Me Look Old?

Is America's love affair with the soda killing us off early, and if so, why?

You might be surprised to learn that a new study indicates it may not be the sugar, aspartame, or splenda, but added phosphorous that is causing some major health problems. 

Science Daily has published an article which indicates the increase in use of phosphorous in processed food leads to premature aging, may "increase the prevalence and severity of age-related complications, such as chronic kidney disease and cardiovascular calcification, and can also induce severe muscle and skin atrophy."

The studies were done on mice, not humans. I am thinking this needs a bit more study. Read the full article here.

Those Who Know, Know Longer?

A recent study in the Journal of the International Neuropsychological Society seems to indicate that people who are aware they are developing mild memory problems as they age develop Alzheimer’s disease at a slower rate than those who do are not aware that their memory is failing.

The study compared a group of people with Mild Cognitive Impairment (MCI) to a group of healthy older adults.  All were given neuropsychological tests and were required to perform tasks during functional magnetic resonance imaging (fMRI) testing.  The results indicated that the cortical midline area of the brain showed activity during self-assessment exercises and that MCI participants with less insight into their impairment had considerably less brain activity than those who were aware of their mental difficulties. 

While MCI is always a precursor to Alzheimer’s disease, people with MCI don’t always develop Alzheimer’s. "[U]nawareness of function loss is beginning to be recognized as an important clinical symptom of MCI, and with studies like this one, we are starting to understand how these symptoms develop,” says Michele Ries, a neuropsychologist and researcher at the the University of Wisconsin Alzheimer’s Disease Research Center.

According to the Alzheimer’s Association, 5.3 million Americans live with the disease.  There will be half a million new cases this year alone.

To me this raises the question of whether honestly and openly discussing memory loss with our friends and family who may have MCI would be of benefit to them, or whether some individuals (or some disease processes) simply cannot have (or allow) insight into their own cognitive limitations.

Maybe further study will reveal the answer to that question.

The Middle Aged Brain Ain't So Addled After All

There are many myths that have developed over the years about aging and brain health, but new studies and the use of technology is showing us that what we once thought about middle age brain health decline are largely incorrect. 

Here are ten myths about the aging brain, which have proven not to be true, excerpted from an article in the Huffington Post this morning.  Link is at the end:

1 MYTH ONE: We lose 30 percent of our brain cells as we age.

For many years, even the most eminent neuroscientists thought that millions of our brain cells simply shriveled up and died as we got aged. But new brain scanning studies show that, as long as we're healthy, we actually keep most of our brain cells for as long as we live.

2. MYTH TWO: Our brains stop developing in our 20s.

It's now known that our brain continue to develop, change and adapt. Growth of white matter and brain connections that we gain through years of experience allow us to recognize patterns faster, make better judgments and find unique solutions to problems. Scientist call these traits cognitive expertise and they reach their peak in middle age.

3. MYTH THREE: Midlife crises are inevitable.

Long-term studies now show that people find middle age the most satisfactory time in their lives. In fact, brain changes in midlife make us more optimistic, not less. And recent research shows that those who have emotional upheavals in midlife have, in many cases, had similar emotional distress at other times in their lives.

4. MYTH FOUR: The empty nest syndrome.

More recent studies of real people -- men and women -- find that our lives, and our moods, often improve when the kids leave home.

5. MYTH FIVE: Our brains operate best in our 20s.

In fact, our brains, in most important areas, reach their peak in midlife. We get better in a whole range of areas, including inductive reasoning, vocabulary, judgment, even the ability to get the "gist'' of an argument and find solutions. There is evidence that we can also become more creative as we age.

MYTH SIX: Our brains start to fade away.

Actually, brains in middle age begin to "power up'' not down. In some cases, we learn to use two parts of our brain instead of one to solve problems. And it is those with the highest cognitive abilities who learn to use their brains this way.

MYTH SEVEN: Dementia is inevitable.

On the contrary. We now have enough people living long enough to show that dementia is not inevitable. There are increasing numbers of what are called "pristine agers,'' whose brains remain largely intact well into their 90s.

MYTH EIGHT: There is nothing we can do to improve our brains.

New research shows that middle age is a time when the brain is "on the cusp,'' and that what we do matters, even what we think matters. There is increasing evidence -- not hype but solid evidence -- that shows that such things as exercise, education and even what we eat does make a difference. Since we now know that we do not lose whole swaths of brain cells, there is a full-tilt effort to find out how to keep those brain cells intact.

Those who research the ingredients in red wine, for instance, are racing to put it in a pill. New studies in animals and humans show that new baby brain cells are born in the brain, with something as simple as aerobic exercise.

And those who research how adults learn have found that one way to keep our brains alive and growing is to actively explore ideas -- and people -- that challenge our view of the world.

This can create what Jack Mezirow, professor emeritus at Columbia Teachers College, has called a "disorienting dilemma'' in our minds that, as another researcher put it, "shakes up the cognitive egg,'' prompting our brain cells to wake up, reconfigure and -- with a little luck -- rejuvenate.

Full article

I heard a story this morning on NPR about this, and it confirms what many of you have read on these pages, that exercise and diet help keep you healthy, brain and body.  In addition, it is becoming clear we can tease our brain into growing by doing new things, looking at things in new ways, and challenging our brain to work hard at something it normally does not do.

Maybe I will try to understand my son's calculus textbook tonight.

Caring for aging parents often means establishing a new relationship, one adult to another.

Nice piece in the Minneapolis Star Tribune about working with aging parents, and that often we need to start establishing a brand new relationship with our parents, as we enter a new phase of the relationship: Child as Caretaker.

Click Here For Full Article