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Health experts are talking about…

January 22, 2017 By Liz Seegert

…aging in place. Most baby boomers haven’t thought much about it and haven’t begun preparing their homes for changing needs as they get older, according to the online, home-improvement marketplace HomeAdvisor. A survey of 289 home-service professionals and 586 consumers over age 55 had some surprising results:

• 61 percent plan to stay in their homes indefinitely, yet few are investing in aging-related improvements.
• 65 percent believe their home layouts are adequate without any aging-related improvement.
• 78 percent have never completed an aging-related renovation.

Many design features can enhance the livability of a home for all ages and possibly even raise the home’s value, according to the report. For example, installing base drawers instead of lower cabinets during a kitchen remodel makes pots and pans more accessible for everyone. Adding a bench seat, grab bars or a handheld sprayer in the shower helps both children and older people.

While most consumers (67 percent) believe smart-home technology can help them age in place, fewer than one in five older homeowners have installed it for this purpose. Smart homes include devices like programmable or voice-activated lighting, thermostats, appliances and security systems.

Home-improvement professionals say that only 20 percent of homeowners contact them before there’s an immediate renovation need. Rather, most only reach out when they or a loved one develop a condition that limits independence, or suffer a hospitalization, a major medical event or fall. 

…diet and brain health. As we age, our brains shrink and lose brain cells, which affects learning and memory. But two recent studies show that diet may have a positive effect on our brains.

Those who follow a Mediterranean diet retain more brain volume than those who don’t follow this type of eating plan as closely, say researchers in Scotland. The Mediterranean diet includes a lot of fruit, vegetables, legumes and cereals, with olive oil as the primary source of fat, in addition to moderate consumption of fish, low-to-moderate amounts of dairy and wine (accompanying meals) and low consumption of red meat and poultry.

The Scottish study followed a group of 967 people with an average age of 70 for several years. Over half (582) had a brain scan at age 73, which measured overall brain volume and other markers of brain health. Three years later, 401 people from that group returned for a second scan. Measurements were compared to how closely participants followed the Mediterranean program.

Those who didn’t follow the eating plan as closely lost more brain volume than those who did, even after factoring in age, education or high blood pressure. Contrary to previous studies, researchers did not find fish and meat consumption affected brain changes, so it’s possible that other components of the diet were responsible for the results.

Then there’s the MIND diet—a cross between the Mediterranean and Dietary Approaches to Stop Hypertension (DASH) programs. Not only does each plan individually lower the risk of heart disease, but researchers at Rush University in Chicago found that, combined, they may reduce the risk of Alzheimer's by as much as 53 percent in those who observe the diet rigorously, and by about 35 percent among those who follow it moderately well.

MIND emphasizes “healthy brain” foods: whole grains, leafy green vegetables, poultry, beans, berries (especially blueberries), fish and nuts, along with a glass of wine most days. It limits intake of red meat, butter, cheese, sweets and fried/fast food.

Martha Clare Morris, PhD, a Rush nutritional epidemiologist who developed the diet, said participants liked the MIND plan for its wider choices and greater flexibility than the Mediterranean diet. Morris and her team are gearing up for a more thorough study, which will randomly assign participants to follow a particular diet over three years. Randomized trials provide the most rigorous scientific evidence for disease prevention.

… older moms. Older women are mentally sharper if they had their last baby after age 35, say researchers at the University of Southern California (USC). In a study of 830 healthy, postmenopausal women, they found a positive connection between later-age pregnancy and better verbal memory (the ability to remember something written or spoken that was previously learned, such as a poem). The study also concluded that women who have their first pregnancy after age 24 have better executive function, which includes attention control, working memory, reasoning and problem solving.

Previous research has associated estrogen with better brain chemistry, function and structure, while progesterone has been linked with growth and development of brain tissue. In the USC study, scientists also reported their findings on additional reproductive events with potential impact on late-life cognition: women who start menstruating before age 13 perform better on executive function tests, and those using hormonal contraceptives for more than 10 years fare better with verbal memory and critical thinking. Researchers think it’s because oral contraceptives help stabilize levels of female sex hormones in the body, while earlier menstruation and later pregnancy keep them there longer. 

…new Medicare payment rules. The way Medicare pays doctors is changing, which should mean better quality care for patients. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rewards physicians who do a good job of managing care, especially for patients with multiple chronic conditions, and penalizes those who don’t. These Alternative Payment Models (APMs) are strategies developed in partnership with the clinician community to provide added financial encouragement for delivering high-quality and cost-effective care while improving results.

Essentially, APMs hold physicians and other care providers more accountable for the results of the care they provide. Most consumer advocacy groups think it’s a good idea. Many doctors, however, are taking a wait-and-see approach. You can learn more here about how these changes will affect patients.

…an annual medication checkup. Experts at St. Louis University in Missouri advise starting the new year off by reviewing all prescription and over-the-counter medications with your doctor to make sure that they’re all still necessary and work well together. This includes common dietary supplements and other nonprescription medications, which are often less rigorously regulated than prescription medications and are a major cause of dangerous drug interactions in older patients, according to Milta Little, DO, an associate professor of geriatrics at the university. She recently wrote an article on overmedication in older adults for the Journal of Post Acute and Long Term Care Medicine.

Polypharmacy and drug interactions are more common with age since we often develop more chronic illnesses, and because older bodies don’t process medication as efficiently as younger adults’ bodies do, Little said. Ask your doctor:

• Whether the medication is still necessary. Something prescribed 10 years ago may or may not be appropriate now.
• If the dosage is still right. As we age, our bodies change. A smaller dose in an older patient may work just as effectively as a higher dose does in a younger person.
• About possible side effects and whether they could be caused by certain medications or combinations of them. For instance, antidepressants can cause frequent urination, which can lead to incontinence. Statins and blood thinners worsen frailty, which makes a patient vulnerable to more medical problems. An antidiuretic for blood pressure can worsen symptoms of gout, which is a form of arthritis.
• Whether all of the medications play well with each other. For example, acid reflux medication can reduce the effectiveness of blood thinners because of the way the medicines are broken down in the liver. The Food and Drug Administration advises that even common, over-the-counter medications like pain relievers, antacids, cold medicines, laxatives—and even certain foods, like grapefruit—can cause potential problems when combined with prescription medications. Be sure to inform your health provider about any dietary supplements, vitamins or herbal remedies you may be taking and topical medicines you may be using.

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