Many Kidney Failure Patients Lack Advance Directives Near the End of Life

• Among nursing home residents in the last year of life, patients with kidney failure were far less likely to have advance directives that put limitations on treatments and designated surrogate decision makers compared with other nursing home residents with serious illnesses.
• Advance directives with these components were associated with a lower use of intensive interventions at the end of life.
• Nearly all kidney failure patients with an advance directive putting limitations on treatment received end-of-life care that was concordant with their preferences.

More than 80,000 Americans die each year while receiving dialysis therapy for end-stage renal disease.

Newswise, February 3, 2017— A new study indicates that many nursing home residents receiving dialysis do not have advance directives that sufficiently address end-of-life treatment decisions.

Those with advance directives that put limitations on treatments and designated surrogate decision makers had fewer hospitalizations, intensive procedures, and inpatient deaths, and they were more likely to use hospice and discontinue dialysis prior to death.

The study, which appears in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN), found that nearly all patients with an advance directive requesting treatment limitations received end-of-life care that was in line with their preferences.

Advance directives outlining individuals’ preferences related to end-of-life care are often promoted for patients with serious illnesses such as kidney failure as a means to avoid interventions that are unwanted or of limited benefit.

Little is known about the relation between the content of advance directives and later treatment decisions among kidney failure patients, however.

To investigate, Manjula Kurella Tamura, MD, MPH (VA Palo Alto Health Care System and Stanford University) and her colleagues examined the prevalence and content of advance directives among 30,716 nursing home residents with end-stage renal disease (ESRD), and30,825 nursing home residents with other serious illnesses during the year before death.

The investigators also linked the content of advance directives to Medicare claims to determine which treatments ESRD patients received in the last month of life.

In the last year of life, 47% of patients with ESRD vs. 59%-70% of patients with other serious illnesses had any form of advance directive. In addition, 36% of nursing home residents with ESRD had a treatment-limiting directive, 22% had a surrogate decision maker, and 13% had both.

These estimates were 13%-27%, 5%-11%, and 6%-13% lower, respectively, than for patients with other serious illnesses. For patients with ESRD who had both a treatment limiting directive and surrogate decision maker, the frequencies of hospitalization, intensive care unit admission, intensive procedures, and inpatient death were lower by 13%, 17%, 13% and 14%, respectively, and hospice use and dialysis discontinuation were 5% and 7% higher compared with patients with ESRD who lacked both components.

“We found that advance directives indicating treatment limitations and/or documenting surrogate decision makers were associated with less intensive end-of-life care among nursing home residents with ESRD, but these were in place much less often than for nursing home residents with other serious illnesses,” said Dr. Tamura.

“Because the vast majority of patients with a treatment limiting directive received care that was consistent with their advance directive, our findings suggest that efforts to increase engagement in advance care planning and expand the use of advance directives among patients receiving dialysis may offer untapped opportunities to better align end-of-life care with patient preferences and values.”

Study co-authors include Maria Montez-Rath, PhD, Yoshio Hall, MD, MS, Ronit Katz, DPhil, and Ann O’Hare, MD, MA.

Disclosures: The authors reported no financial disclosures.

The article, entitled “Advance Directives and End-of-Life Care among Nursing Home Residents Receiving Maintenance Dialysis,” will appear online at http://cjasn.asnjournals.org/ on January 5, 2017, doi: 10.2215/CJN.07510716.

Eldercare Advocate Chris Cooper: Nine Nursing Home Selection Tips

November 30, 2016 /PRNewswire/ -- The holidays are a traditional time for families to discuss if it is time to put a relative in a nursing home. They soon discover that when it comes to eldercare, there is no such thing as being safe at home.

"Selecting the right environment for an elderly person to live is a series of tough decisions that a caregiver or caretaker must negotiate," says Chris Cooper, author of the candid new guide "Eldercare Confidential: Cautionary Tales for Adult Caregivers and Caretakers of Parents and Spouses" (Indie Books International, 2016).

Cooper is a California Licensed Professional Fiduciary who works with seniors, disabled persons, and other individuals who can't manage their affairs on their own, assisting with everything from day-today financial issues to investment and estate management.

"Caregivers and caretakers are often thrust into the role of fiduciary, either by legal appointment or by assuming the role because of their relationship to the elderly person who needs caretaking," says Cooper. "The duties are more than a moral responsibility, they are also a legal obligation."

Here are nine tips from the book to guide you in evaluating potential nursing homes:

• The best time to tour a nursing home is on a Saturday evening. Because administrative and marketing staff won't be around at that time, you'll get a truer picture of what life is really like at the facility.
• Make sure you visit when a meal is being served. You'll get a chance to see the quality (and quantity) of food firsthand. Make sure every resident gets enough to eat and that staff are available to help those who need assistance.
• Find out how often the nursing home brings in nurses from a staffing agency. It's not unusual or a bad thing for a nursing home to occasionally have to turn to an agency to shore up its staff—after all, you want an adequate number of medical personnel on hand at all times. But if the nursing home is always bringing in new staff who aren't familiar with the facility or the patients, that could result in a lower quality of care for your loved one.
• Consider long-term care. Medicare offers very limited coverage for nursing home stays. That's why many people purchase long-term-care insurance or set aside money so they can pay for care out of their own pocket.
• Consistency of caregivers matters. In some facilities, a patient's caregivers may change from day to day. That can be unsettling and confusing for patients. Try to find a nursing home where the same caregiver sees the patient on most days.
• You need to be proactive to make sure your loved one gets the care they need.Often, it helps to designate a single family member to serve as the representative who will take charge of the patient's care and deal with the nursing home.
• Your loved one probably won't be able to choose their doctor. Instead, they'll be limited to whatever doctor(s) work with the nursing home. The facility's doctor may also be responsible for numerous patients. Nursing home doctors may visit the facility just once a week to make quick visits with patients.
• You should make your family member's room feel as much like home as possible. Bring personal objects and pictures so the place is familiar and comforting to them.
• Theft can be a problem. If your loved one has valuable items (like jewelry) make sure that they aren't left out anywhere where they could easily disappear. If possible, mark valuable items with your loved one's name.
•  

Cooper advises it is important to check with Medicare, Medicaid, and any private insurance provider to find out their current rules about covering the costs of long-term care.

When thinking about nursing home costs, keep in mind that you can have extra out-of-pocket charges for some supplies or personal care—for instance, hair appointments, laundry, and services that are outside routine care.

The rules about programs and benefits for nursing homes can change. Visit www.medicare.gov for information about different care options. To learn more about the Medicaid program, see www.medicaid.gov.

Cooper is a passionate advocate for those trying to meet the crushing costs of medical care. More tips are available on his website www.chriscooper.com.

About Indie Books International

Indie Books International (www.indiebooksintl.com) was founded in 2014 in Oceanside, California by two best-selling business authors. Similar to indie film companies and indie music labels, the mission of Indie Books International is to serve as an independent publishing alternative for consultants, executive coaches and business thought leaders.

Smartwatch Interface Could Improve Communication, Help Prevent Falls at Nursing Homes

Newswise, August 3, 2016 – Poor communication systems at nursing homes can lead to serious injury for residents who are not tended to in a timely manner. 

A new smartwatch app being developed at Binghamton University could help certified nursing assistants (CNAs) respond to alerts more quickly and help prevent falls.

Binghamton University researchers Assistant Professor of Systems Science and Industrial Engineering Huiyang Li and PhD candidate Haneen Ali are developing a smartwatch application to improve communication and notification systems for nursing homes, which are often faulty and inefficient.

The proposed design integrates all of the existing safety systems at nursing homes—e.g., call lights, chair and bed alarms, wander guards, calling-for-help functions—and provides alerts to users.

Through a process of iterative design and evaluation with prospective users, a final design was well received by nursing experts in geriatric care, and at local nursing homes. An on-going evaluation study shows that using this system reduces staff response time to alarms.

“The problem associated with not responding in time is that residents tend to stand up or go to the bathroom by themselves. If they’re not strong enough, they can’t support the weight. And if they have to wait, they will just get up and go. And that leads to falls,” said Li.

“We wanted to design a better system that improves notification and also, potentially, communication in nursing homes. The improvement of notification will potentially help staff to do a better job and, eventually, improve patient safety. Whenever residents need help, they have a way to call for help, and messages will be delivered to staff in an effective way.”

Most nursing homes use a call light system, where residents push a button inside of their room to send an alert, and bed and chair pads with pressure sensors that send an alert when a resident sits or stands up. When nurses are working down the hallway, they might not hear or see these alerts.

“With our system, we provide an informative and customized message for different alarms. The message contains the resident’s name, the type of alarm, the room number and the CNA who is responsible.

“The smartwatch will be on the CNA’s wrist, so it’s accessible all the time. They can see the message, hear the alarm, and feel the vibration, whether they are working down the hallway or inside the rooms,” said Li.

Every CNA who uses the app sees a different display, as it is personalized to the user’s specific task assignment. When CNAs start their shift, they will sign in and add their assigned residents.

 When a resident triggers an alert, a message will pop up on everyone’s screen indicating who the resident is, their room number, and the type of alert (e.g., an exit from a chair).

“The alert message is more informative than the existing system and, at the same time, it will help nurses to prioritize. We will mark or highight alarms from residents who are actually assigned to whoever is using the app,” said Li.

“The CNAs are exited about this idea and they are interested in this device. They would like to see the adoption of new technologies in their working environment because all of the problems in their current situation,” said Ali.

Li and Ali hope to test the system in the future using a high-fidelity prototype at real nursing homes.

While buying a smartwatch for every employee would be an added expense to nursing homes, the researchers believe that the benefits of this app would far outweigh the cost, particularly with the increasing availability of low-cost smartwatches.

“Falls, skin problems—these kind of facility acquired conditions can cost a hospital a lot of money. If the system can actually reduce falls, reduce adverse events, improve patient safety, and also improve quality of care, hospitals will save money.”

The paper, “Designing a Smart Watch Interface for a Notification and Communication System for Nursing Homes,” was presented at the Human-Computer Interaction International Conference 2016.

Derailed Train of Thought? Brain’s Stopping System May Be at Fault

Newswise, April 21, 2016 — Have you had the experience of being just on the verge of saying something when the phone rang? Did you then forget what it is you were going to say? A study of the brain’s electrical activity offers a new explanation of how that happens.

Published in Nature Communications, the study comes from the lab of neuroscientist Adam Aron at the University of California San Diego, together with collaborators at Oxford University in the UK, and was led by first author Jan Wessel, while a post-doctoral scholar in the Aron Lab.

The researchers suggest that the same brain system that is involved in interrupting, or stopping, movement in our bodies also interrupts cognition – which, in the example of the phone ringing, derails your train of thought.

The findings may give insights into Parkinson’s disease, said Aron, a professor of psychology in the UC San Diego Division of Social Sciences, and Wessel, now an assistant professor of psychology and neurology at the University of Iowa.

The disease can cause muscle tremors as well as slowed-down movement and facial expression. Parkinson’s patients may also present as the “opposite of distractible,” often with a thought stream so stable that it can seem hard to interrupt. The same brain system that is implicated in “over-stopping” motor activity in these patients, Aron said, might also be keeping them over-focused. 

The current study focuses particularly on one part of the brain’s stopping system – the subthalamic nucleus (STN). This is a small lens-shaped cluster of densely packed neurons in the midbrain and is part of the basal ganglia system.

Earlier research by Aron and colleagues had shown that the STN is engaged when action stopping is required. Specifically, it may be important, Aron said, for a “broad stop.”

 A broad stop is the sort of whole-body jolt we experience when, for example, we’re just about to exit an elevator and suddenly see that there’s another person standing right there on the other side of the doors.

The study analyzes signals from the scalp in 20 healthy subjects as well as signals from electrode implants in the STN of seven people with Parkinson’s disease. (The STN is the main target for therapeutic deep brain stimulation in Parkinson’s disease.)

All the volunteers were given a working memory task. On each trial, they were asked to hold in mind a string of letters, and then tested for recall. Most of the time, while they were maintaining the letters in mind, and before the recall test, they were played a simple, single-frequency tone.

On a minority of trials, this sound was replaced by a birdsong segment – which is not startling like a “bang!” but is unexpected and surprising, like a cell phone chirping suddenly. The volunteers’ brain activity was recorded, as well as their accuracy in recalling the letters they’d been shown.

The results show, the researchers write, that unexpected events manifest the same brain signature as outright stopping of the body.

They also recruit the STN. And the more the STN was engaged – or the more that part of the brain responded to the unexpected sound – the more it affected the subjects’ working memory and the more they lost hold of what they were trying to keep in mind.

“For now,” said Wessel, “we’ve shown that unexpected, or surprising, events recruit the same brain system we use to actively stop our actions, which, in turn, appears to influence the degree to which such surprising events affect our ongoing trains of thought.”

A role for the STN in stopping the body and interrupting working memory does fit anatomical models of how the nucleus is situated within circuitry in the brain.

Yet more research is needed, the researchers write, to determine if there’s a causal link between the activity observed in the STN and the loss in working memory.

“An unexpected event appears to clear out what you were thinking,” Aron said. “The radically new idea is that just as the brain’s stopping mechanism is involved in stopping what we’re doing with our bodies it might also be responsible for interrupting and flushing out our thoughts.”

A possible future line of investigation, Aron said, is to see if the STN and associated circuitry plays a role in conditions characterized by distractibility, like Attention Deficit Hyperactivity Disorder. “This is highly speculative,” he said, “but it could be fruitful to explore if the STN is more readily triggered in ADHD.”

Wessel added: “It might also be potentially interesting to see if this system could be engaged deliberately – and actively used to interrupt intrusive thoughts or unwanted memories.”

If further research bears out the connection suggested by the current study, between the STN and losing your train of thought following an unexpected event, the researchers say it might be that it is an adaptive feature of the brain, something we evolved long ago as a way to clear our cognition and re-focus on something new.

Aron suggests this example: You’re walking along one morning on the African Savannah, going to gather firewood. You’re daydreaming about the meal you’re going to prepare when you hear a rustle in the grass. You make a sudden stop – and all thoughts of dinner are gone as you shift your focus to figure out what might be in the grass. In this case, it’s a good thing to forget what you had been thinking about.

Aron and Wessel’s co-authors on the paper are: Ned Jenkinson of John Radcliffe Hospital at the University of Oxford, as well as the University of Birmingham (UK) and John-Stuart Brittain, Sarah H.E.M. Voets and Tipu Z. Aziz, also of Radcliffe Hospital at Oxford.

The study was supported by funding from the National Institutes of Health, grant nos.
R21NS085543 and DA026452, and the James S McDonnell Foundation, grant no. 220020375.

Strength Training Helps Older Adults Live Longer

Newswise, April 21, 2016 — Older adults who met twice-weekly strength training guidelines had lower odds of dying in a new analysis by researchers at Penn State College of Medicine, Penn State Health Milton S. Hershey Medical Center and Columbia University.

The study is the first to demonstrate the association in a large, nationally representative sample over an extended time period, particularly in an older population.

Many studies have previously found that older adults who are physically active have better quality of life and a lower risk of mortality. Regular exercise is associated with health benefits, including preventing early death, cardiovascular disease, diabetes and some cancers.

But although the health rewards of physical activity and aerobic exercise are well established, less data has been collected on strength training.

Over the past decade, researchers have begun to demonstrate benefits of strength training on strength, muscle mass and physical function, as well as improvements in chronic conditions such as diabetes, osteoporosis, low back pain and obesity. Small studies have observed that greater amounts of muscle strength are associated with lower risks of death.

One reason for this lack of data could be that strength training guidelines are newer than recommendations for aerobic activity. Although the American College of Sports Medicine first issued aerobic exercise guidelines decades ago, it was not until 2007 that the organization and the American Heart Association released a joint guideline recommending that all adults strength train at least twice a week.

"This doesn't mean that strength training wasn't a part of what people had been doing for a long time as exercise, but it wasn't until recently that it was solidified in this way as a recommendation," said Dr. Jennifer L. Kraschnewski, assistant professor of medicine and public health sciences, Penn State College of Medicine.

To examine the mortality effects on older adults who meet strength training guidelines, Kraschnewski examined data from the 1997-2001 National Health Interview Survey (NHIS) linked to death certificate data through 2011. Researchers published their results in Preventive Medicine.

The NHIS collects overall health, disease and disability data of the U.S. population from a nationally representative sampling of all 50 states and the District of Columbia. The 1997-2001 survey included more than 30,000 adults age 65 and older.

During the survey period, more than 9 percent of older adults reported strength training at least twice a week.

"That's only a small fraction of the population, but it's actually higher than we had anticipated," Kraschnewski said.

The researchers followed the respondents for 15 years through death certificate data from the National Center for Health Statistics National Death Index. About a third of respondents had died by 2011.

Older adults who strength trained at least twice a week had 46 percent lower odds of death for any reason than those who did not. They also had 41 percent lower odds of cardiac death and 19 percent lower odds of dying from cancer.

Older adults who met strength training guidelines were, on average, slightly younger, and were more likely to be married white males with higher levels of education. They were also more likely to have normal body weight, to engage in aerobic exercise and to abstain from alcohol and tobacco.

When the researchers adjusted for demographic variables, health behaviors and health conditions, a statistically significant effect on mortality remained. Although the effects on cardiac and cancer mortality were no longer statistically significant, the data still pointed to a benefit.

Importantly, after the researchers controlled for physical activity level, people who reported strength exercises appeared to see a greater mortality benefit than those who reported physical activity alone.

The study is strong evidence that strength training in older adults is beneficial beyond improving muscle strength and physical function, the researchers said.

"We need to identify more ways that we can help get people engaged in strength training so we can increase the number from just under 10 percent to a much higher percentage of our older adults who are engaged in these activities," Kraschnewski said.

Other researchers on this project were Christopher N. Sciamanna and Lisa S. Rovniak, Department of Medicine and Department of Public Health Sciences; Jennifer M. Poger, Amanda B. Cooper and Noel H. Ballentine, Department of Medicine; and Erik B. Lehman, Department of Public Health Sciences, all of Penn State College of Medicine/Penn State Health Milton S. Hershey Medical Center; and Joseph T. Ciccolo, Columbia University.

About Penn State College of Medicine
Located on the campus of Penn State Health Milton S. Hershey Medical Center in Hershey, Pa., Penn State College of Medicine boasts a portfolio of nearly $82 million in funded research. Projects range from the development of artificial organs and advanced diagnostics to groundbreaking cancer treatments and understanding the fundamental causes of disease. Enrolling its first students in 1967, the College of Medicine has more than 1,600 students and trainees in medicine, nursing, the health professions and biomedical research on its campus.

Is a Popular Painkiller Hampering Our Ability to Notice Errors?

Newswise, April 14, 2016 — It's been known for more than a century that acetaminophen is an effective painkiller, but according to a new U of T study it could also be impeding error-detection in the brain.

The research, authored by a team including postdoctoral fellow Dan Randles and researchers from the University of British Columbia, is the first neurological study to look at how acetaminophen could be inhibiting the brain response associated with making errors.

"Past research tells us physical pain and social rejection share a neural process that we experience as distress, and both have been traced to same part of the brain," says Randles.

Recent research has begun to show how exactly acetaminophen inhibits pain, while behavioural studies suggest it may also inhibit evaluative responses more generally. Randles own past research has found that people are less reactive to uncertain situations when under the effect of acetaminophen.

"The core idea of our study is that we don't fully understand how acetaminophen affects the brain," says Randles. "While there's been recent behavioural research on the effects of acetaminophen, we wanted to have a sense of what's happening neurologically."

To test the idea two groups of 30 were given a target-detection task called the Go or No Go. Participants were asked to hit a Go button every time the letter F flashed on a screen but refrain from hitting the button if an E flashed on the screen.

"The trick is you're supposed to move very quickly capturing all the GOs, but hold back when you see a No Go," says Randles.

Each participant was hooked up to an electroencephalogram (EEG), which measures electrical activity in the brain. The researchers were looking for a particular wave called Error Related Negativity (ERN) and Error Related Positivity (Pe). Essentially what happens is that when people are hooked up to an EEG and make an error in the task there is a robust increase in ERN and Pe.

One group, which was given 1,000 mg of acetaminophen - the equivalent of a normal maximum dose - showed a smaller Pe when making mistakes than those who didn't receive a dose, suggesting that acetaminophen inhibits our conscious awareness of the error.

"It looks like acetaminophen makes it harder to recognize an error, which may have implications for cognitive control in daily life," says Randles.

Cognitive control is an important neurological function because people are constantly doing cognitive tasks that flow automatically like reading, walking or talking. These tasks require very little cognitive control because they are well mapped out neurological processes, notes Randles.

"Sometimes you need to interrupt your normal processes or they'll lead to a mistake, like when you're talking to a friend while crossing the street, you should still be ready to react to an erratic driver," explains Randles.

"The task we designed is meant to capture that since most of the stimuli were Go, so you end up getting into a routine of automatically hitting the Go button. When you see a No Go, that requires cognitive control because you need to interrupt the process."

The study was double blind, so neither the researcher running the study nor the participant knew whether they had been given a placebo or acetaminophen.

An unexpected and surprise finding that Randles plans to explore more closely is that those who received an acetaminophen dose appeared to miss more of the Go stimuli than they should have.

He plans on expanding on the error detection aspect of the research to see whether acetaminophen is possibly causing people to "mind wander" and become distracted.

"An obvious question is if people aren't detecting these errors, are they also making errors more often when taking acetaminophen? This is the first study to address this question, so we need more work and ideally with tasks more closely related to normal daily behaviour."

The research is published in the current edition of the journal Social Cognitive and Affective Neuroscience.

Feeling Older Increases Risk of Hospitalization, Study Says

Disease, depression could help explain association

Newswise,  February 13, 2016-- People who feel older than their peers are more likely to be hospitalized as they age, regardless of their actual age or other demographic factors, according to research published by the American Psychological Association.

“How old you feel matters. Previous research has shown it can affect your well-being and other health-related factors and, now we know it can predict your likelihood of ending up in the hospital,” said the study’s lead author, Yannick Stephan, PhD, of the University of Montpellier in France.

The research, which comprised more than 10,000 adults across the U.S., was published in the journal Health Psychology.

Despite previous studies showing an association between health-related issues and subjective age, this is the first study to test whether feeling older is linked to a higher risk of hospitalization, according to the article.

Stephan and co-authors Angelina R. Sutin, PhD, and Antonio Terracciano, PhD, of Florida State University, analyzed data from three longitudinal studies conducted from 1995 to 2013 with participants ranging in age from 24 to 102.

They found that those who reported feeling older than their actual age had a 10 to 25 percent increased likelihood of being hospitalized over the next two to 10 years when controlling for age, gender, race and education. The findings replicated across the three samples.

Further analysis showed that having more depressive symptoms and poorer health helped explain the link between feeling older and being hospitalized.

“Feeling older is associated with poorer physical and mental health, but also with physiological impairments that may result in illness and health service use over time,” said Sutin.

Participants were drawn from the Midlife in the United States Survey, the Health and Retirement Study and the National Health and Aging Trends Study.

In each sample, the participant’s subjective age was assessed by asking each participant how old he or she felt at the beginning of the study. Researchers also asked them to provide information about previously diagnosed health conditions (i.e., high blood pressure, diabetes, cancer, lung disease, heart condition, stroke, osteoporosis or arthritis).

Participants also answered a questionnaire designed to assess symptoms of depression. At the beginning and at various follow-up periods, subjects reported if they had been hospitalized for any reason, either over the last year in two samples or over the last two years for the other.

“In addition, individuals with an older subjective age are more likely to be sedentary and to experience faster cognitive decline, all of which may precipitate a hospital stay” said Terracciano. 

“Taken as a whole, this study suggests that subjective age, along with demographic, cognitive, behavioral and health-related factors, could be a valuable tool to help identify individuals at risk of future hospitalization,” said Stephan.

“People who feel older may benefit from standard health treatments -- for example through physical activity and exercise programs, which may reduce their risk of depression and chronic disease, and ultimately their hospitalization risk.”
________________________________________
Article: “Feeling Older and Risk of Hospitalization: Evidence From Three Longitudinal Cohorts,” by Yannick Stephan, PhD, University of Montpellier; and Angelina R. Sutin, PhD, and Antonio Terracciano, PhD, Florida State University, Health Psychology, published online Feb. 11, 2016.

Full text of the article is available from the APA Public Affairs Office and at www.apa.org/pubs/journals/releases/hea-hea0000335.pdf.

Mature Drivers Favour Checks on Over 70s, New Study Finds

Publisher’s Note:  Although this survey was taken outside the US, we publish it here as the US faces challenges of an Aging Population—including driving and transportation for older persons

Newswise, February 5, 2016 — The majority of older drivers are in favour of tighter rules on checking the health and suitability of over-70s to drive – even if those checks could take them off the road themselves – according to a new report. T

he Institute of Advanced Motorists (IAM) worked with Dr Carol Hawley at Warwick Medical School, the University of Warwick, to survey more than 2,600 drivers and former drivers on their opinions, habits and motoring history.

The first major survey of its kind for two decades, Keeping Older Drivers Safe and Mobile, found more than half of over 70s demonstrate that they self-regulate to stay safe, by avoiding driving in challenging situations like busy traffic, after dark, in rush hour or bad weather.

While mature drivers travel significantly fewer miles than other age groups, 84% of them rated their driving ability as ‘good to excellent’ and only 6% had ever considered giving up driving.

Despite that a very high proportion of respondents were in favour of measures to increase their safety on the roads. Dr Hawley said: “Almost 60% of those questioned said drivers should retake the driving test every five years after age 70, 85% said drivers should pass an eyesight test every five years once they have reached 70, and more than half said that drivers aged around 70 should be required to have a medical examination.”

Dr Hawley worked with Professor Elizabeth Maylor in the University’s Psychology Department who provided access to the Warwick University research volunteer panel which provided nearly all of the respondents. Of those questioned 94% agreed that GPs should be required to inform patients if their medical condition may affect their fitness to drive and half agreed that a flexible licensing system should be introduced which could restrict types of roads and conditions for some older drivers.

The IAM’s survey found respondents wanted some rules to extend further than older drivers – 84% agreed that all drivers should pass an eyesight test every 10 years after first passing, regardless of their age.

The report also found just how important driving is to this group. Some 82% said that driving was very or extremely important to them, a figure that increases for women. Independence and convenience were cited as the main reasons for wanting to continue driving.

The number of drivers over the age of 70 is set to double over the next 20 years and with more than one million licence holders over the age of 80, there is a pressing need for enlightened policies and practical actions to help them keep safe and competently mobile for as long as possible.

Sarah Sillars, IAM chief executive officer, said: “Driving is about so much more than getting from A to B and nowhere is this more apparent than in this age group. It helps maintain self-esteem and freedom and is essential for combatting social isolation.

“There are certain issues that affect mature drivers more so than other groups however, such as reductions in mobility and a slowdown in reaction times. The great news from this survey is that mature drivers themselves are aware of the risks and support action to review their safety.

“Voluntary self-assessment and better education via GPs are important techniques for helping drivers understand how long they can continue to drive safely for. And for those needing a confidence boost or a little extra reassurance on today’s busy roads, the IAM’s Mature Driver Assessment could be something to think about.”

Yoga for Heart Health

Yoga practitioners have been touting yoga’s psychological and physical benefits for more than 5,000 years. Increasingly, yoga is being recommended for some patients with heart disease

Newswise, February 5, 2016— Yoga practitioners have been touting yoga’s psychological and physical benefits for more than 5,000 years. Increasingly, yoga is being recommended for some patients with heart disease.

Valley Medical Group’s Center for Integrative Medicine, located in Ridgewood, NJ recently introduced a free cardiac yoga program designed to help patients deal with the stress of a diagnosis of heart disease on all levels: physical, mental, emotional, and spiritual. 

The program takes a gentle approach to cardiac rehabilitation and each class includes adaptive yoga poses and sequences, restorative yoga poses, gentle breathing techniques, relaxation and guided meditation.

“Participants in the class experience numerous physical and psychological benefits, which can include decreased levels of stress, reduction in blood pressure, lowering of cholesterol levels and lessening of harmful inflammation,” says cardiologist Benita Burke, M.D. 

In addition to serving as Medical Director of Valley Medical Group’s Heart Care for Women practice, Dr. Burke is a board-certified integrative medicine practitioner.

Valley’s cardiac yoga program is being offered in conjunction with Kula for Karma, a not-for-profit organization that offers therapeutic yoga, meditation and stress management. Loretta Turner, a Senior Program Director with Kula for Karma, explains that their “yoga instructors are specifically trained to work with cardiac patients. 

Each instructor must complete an advanced teacher training that outlines the physiological considerations when working with this population. The instructors meet each participant at his or her own level and provide self-care tools that often become invaluable both in class and throughout life.”

Allendale resident Linda Parise says that “This is not something I would have considered because I was embarrassed about my level, but there is no judgment here. The instructors are wonderful and concerned about me. I feel a physical change.”

Adds Fair Lawn resident Beth Goldberg, “There is a sense of community in this class—whatever the path was that brought us here—we have a common purpose. The class is not intimidating and it is a welcoming group.”

Valley’s Center for Integrative Medicine also offers specialty yoga classes for patients who are recovering from spinal surgery and patients and survivors of cancer. A physician’s prescription is required to participate.

Valley Medical Group is part of Ridgewood, NJ-based Valley Health System, which also includes The Valley Hospital and Valley Home Care.

AARP Expert Amy Goyer Shares Tips for Caregiving Success in New Book for America's 40 Million Caregivers

ABA/AARP book "Juggling Life, Work, and Caregiving" is now available in time for National Family Caregivers Month

November 11 /PRNewswire/ -- Amy Goyer, AARP family and caregiving expert and author of the new book Juggling Life, Work, and Caregiving, is among 40 million Americans who know the challenges and joys of caring for loved ones. Goyer's personal experience caring for her grandparents, parents and sister helped shape her newest book.

Her 92-year-old father, who has Alzheimer's disease, currently lives with her. Juggling Life, Work, and Caregiving is available just in time for National Family Caregiving Month in November.

"I've been a caregiver my entire adult life and Juggling Life, Work, and Caregiving shares what I've learned from my own hard-earned experience and the resources of the caregiving community," said Goyer. "No matter where you are in your caregiving journey, this book is a quick and easy guide to help you support your loved ones and be a resilient caregiver."

Goyer has more than 30 years of experience in aging and caregiving, including working in adult day services centers and nursing homes, monitoring programs for the Ohio Department of Aging, and leading AARP's intergenerational and grandparent caregiver programs.

Caregiving Book Gives Guidance 

Juggling Life, Work, and Caregiving offers family caregivers useful tips and tools whether they are caregiving day-to-day or periodically, planning for future needs, or experiencing a crisis. The book covers everything from using technology to creating a caregiving team and caring for yourself, to handling housing and medical care, to grieving and life after caregiving. 

Juggling Life, Work, and Caregiving is a companion book to Sally Hurme's book Checklist for Family Caregivers: A Guide to Making It Manageable (ABA/AARP) and the PBS documentary Caring for Mom and Dad. The books from the ABA and AARP are available at online retailers and bookstores.  

AARP members receive 40% off the retail cost of ABA/AARP books when they're purchased online through AARP.org/CaregivingBooks and the ABA purchase option is chosen.

To learn more about caregiving resources, visit the AARP Caregiving Resource Center athttp://www.aarp.org/caregiving.

Research Finds Midlife Fitness Helps Reduce Health Costs After Age 65

Newswise, November 10, 2015 — People with high fitness levels in midlife have significantly lower annual health care costs after age 65 than people with low fitness in midlife, after adjusting for cardiovascular risk factors, according to a study published in the Journal of the American College of Cardiology (JACC).

Vanderbilt cardiologist and first author Justin Bachmann, M.D., MPH, and researchers studied 19,571 healthy individuals who underwent cardiorespiratory fitness assessment at a mean age of 49 and received Medicare coverage about 22 years later, from 1999 to 2009, at an average age of 71.

Cardiorespiratory fitness was estimated by maximal metabolic equivalents (METs) calculated from treadmill time. METs are used to estimate the oxygen cost of activity; for example, sitting equals one MET while running hard on a treadmill on incline equals 15 METS.

The researchers followed healthy individuals in the Cooper Center Longitudinal Study and found that average annual health care costs, obtained from Medicare files, were significantly lower for participants 65 years or older with high midlife fitness than with low midlife fitness in both men ($7,569 vs. $12,811) and women ($6,065 vs. $10,029).

The study also looked at hospitalization rates and found that the low fitness group was hospitalized at a much higher rate than the MET fit group. Mean annual inpatient rates and physician office visits were also significantly higher in the low fitness group.

“No one had previously investigated whether fitness in midlife translates into decreased health care costs 20-30 years later while adjusting for the risk factors,” said Bachmann, instructor in Medicine. “For every metabolic equivalent you are able to achieve, your health care costs decrease by about 7 percent. A lot of exercise machines these days will measure METS, so this is information people can access.”

These findings may have important implications for health policies directed at improving physical fitness, he added

In addition to Bress, Hess, and Muntner, the co-authors are Rikki Tanner and Lisandro Colantonio from the University of Alabama, and Daichi Shimbo from Columbia University.

“Generalizability of results from the Systolic Blood Pressure Intervention Trial (SPRINT) to the US adult population” will be published online in the Journal of the American College of Cardiologists on Nov. 9, 2015

AARP Brain Health Survey Reveals Nearly Half of People Are Not Doing the Most Important Activities to Support Brain Health New Survey Results Released with the Launch of the Global Council on Brain Health

WASHINGTON, Oct. 28 2015 /PRNewswire-USNewswire/ -- In AARP's latest survey on brain health, it found that although virtually every adult age 40 and over (98%) believes it is important to maintain or improve their brain health, only about half (56%) are doing one of the two most important activities to support their brain health—engaging in exercise and eating a healthy diet. 

According to a 2011 study by the Mayo Clinic and a 2010 study published in the Nature Reviews Neuroscience Journal, engaging in aerobic exercise regularly and eating a healthy diet are the two most important activities to maintain and improve brain health. 

To help empower people to maintain and improve their cognitive health, AARP is launching the Global Council on Brain Health (GCBH)—an independent collaborative of scientists, doctors, scholars and policy experts. This collaborative will provide trusted information on what actions people can take to support their brain health through quarterly white papers, scientific reviews and other research.

"It's clear that people want to know how to keep their brains active and healthy as they age, but they need a trusted source that can help them make sense of all the latest developments in brain health science," saidSarah Lock, AARP Senior Vice President, Policy, Research and International Affairs. 

"The Global Council on Brain Health will help people understand what real-life approaches work best and empower them to live brain-healthy lifestyles."

The GCBH is an independent collaborative convened by AARP working together with Age UK—the United Kingdom's largest charity dedicated to helping everyone make the most of later life—that will address a critical social issue and help people live their best lives. 

The collaborative will build on the Institute of Medicine's Cognitive Aging report from April 2015, which provided a basis for understanding the aging brain and described opportunities for actions. 

Members are eminent experts from leading research institutions working in the fields of neuroscience and geriatrics who will address the full range of factors that can impact brain health and examine key priority issue areas—such as physical exercise, mental engagement, stress levels, and medications and supplements.

HomeAdvisor Releases Aging-in-Place Report

Report Underscores Need For More Resources for Professionals to Educate Homeowners

Oct. 18, 2015 /PRNewswire/ -- Today HomeAdvisor, a leading nationwide home services marketplace, released an Aging-in-Place Report that analyzes the trends related to how homeowners modify their homes to ensure they can remain there safely, comfortably, and independently as long as possible. 

The Report was prepared by Marianne Cusato, HomeAdvisor's housing expert and professor of practice at University of Notre Dame's School of Architecture, and is comprised of data submitted to HomeAdvisor.com as well as results from a recent survey* conducted among HomeAdvisor's network of pre-screened home professionals. 

HomeAdvisor released the Aging-in-Place Report in collaboration with the National Aging in Place Council.   

"The U.S. Census Bureau reports the number of residents 65 or older will grow to nearly 73 million in 2030 and at least 90 percent of those homeowners intend to remain permanently in their home," said Cusato. 

"While the report revealed a small number of homeowners are already planning ahead, the majority may benefit from the help of informed home service professionals."

Highlights of the 2015 Aging-in-Place Report:

Over one-half of homeowners who hire a professional for an aging-related home improvement are younger than 65 years old, with 10 percent younger than 50 years old.

When hiring a professional to complete an aging-in-place project, 73 percent of the time homeowners make contact with the professional themselves. The daughter is second mostly likely to contact the professional and does so five times more often than the son.

When technology is installed in the home, more than one-half of homeowners request home automation systems (e.g. security systems, lights, thermostats), 14 percent purchase assistive technology (e.g. automatic countertops and shelves), and 10 percent install in-home health monitoring (e.g. heart rate tracking and fall monitoring).

Seventy four percent of professionals feel prepared to discuss the financial benefits available to homeowners to help them age in place.

"The report shows most professionals are prepared to talk to homeowners about aging-in-place improvements but few are ready with additional resources," said Cusato. 

"Seventy two percent of professionals don't have marketing materials directed towards aging in place, over two-thirds are unfamiliar with the term 'Universal Design', and 83 percent are unaware of Medicare and Medicaid benefits."

The Aging-in-Place Report also uncovered the most common projects related to aging in place. 

The projects most frequently requested include adding grab bars in the home, building a disability ramp, installing a lift on the stairs, and adding a personal alert system.

For the complete Aging-in-Place Report, click here. For more information about HomeAdvisor, visitwww.homeadvisor.com.  

About HomeAdvisor

*Data included in the Aging-in-Place Report is based on the number of service requests submitted to HomeAdvisor.com from August 3, 2014-August 3, 2015; and a survey conducted by Survey Monkey on behalf of HomeAdvisor. The survey was conducted among 237 professionals from August 21, 2015-August 30, 2015, of whom 187 reported completing aging-in-place tasks for homeowners.