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Aging Well CONSUMER REPORTS INSIGHTS You can help keep your wits about you Aging is inevitable; losing your mental acuity is not.


That’s the implication of the latest brain research, which is discovering that the choices we make throughout our life- time about work, play, diet, social interaction, relaxation and even spirituality have a significant effect on our ability to remain sharp well into old age. A 2009 study sponsored by the National Institutes of


Health, for example, found that while most older people experience some cognitive decline as they age, nearly a third don’t. And what sets that minority apart from others are factors that can be controlled.


 Build a mental reserve. Au- topsy studies reveal that some people who had a brain filled with the plaque deposits that mark Alzheimer’s disease none- theless lived with few if any no- ticeable cognitive deficits. That was possible because of some- thing called cognitive reserve, a buffer of extra brain structures and networks built by a lifetime of stimulating experiences. Education and intellectual in- quisitiveness help build cogni- tive reserve. And a 2009 report from the Bronx Aging Study, which is following men and women in their 70s and 80s, found that the type of leisure ac- tivities they pursued as they aged was just as important as their education early in life. The researchers found that the more the participants engaged in mentally stimulating activities — reading, writing, working crossword puzzles, playing board or card games, participat- ing in group discussions, or play- ing music — the longer they de- layed the onset of rapid memory decline.  Don’t quit your day job. One way to keep the mental juices flowing is to work, especially if your job involves critical think- ing and social interactions. A re-


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New law provides free preventive care for many seniors INSURING YOUR HEALTH


Michelle Andrews


get older. Many of the major cancers that can be screened for —such as breast and colorectal cancer — are typically diagnosed at about age 70. After age 55, people have a 90 percent chance of developing high blood pressure, putting them at higher risk for heart disease and stroke. “The payoff in terms of


P


prevention in geriatrics is more upfront and more immediate,” says geriatrician Peter Hollmann, chairman of the public policy committee for the American Geriatrics Society. Starting in January, the new health-care law will make it easier and cheaper for seniors to get preventive care. Medicare beneficiaries will be able to receive for free all preventive services and screenings that receive an A or B recommendation for seniors from the U.S. Preventive Services Task Force, an independent panel of experts in primary care and prevention. These measures include mammograms and


reventive health care is important at any age, but never more so than as we


colorectal cancer screening, bone mass measurement and nutritional counseling for people at risk for diet-related chronic diseases such as diabetes. Medicare beneficiaries will


also get a free annual wellness visit under the new law. The visit will cover a number of services, including a health risk assessment and a review of the person’s functional and cognitive abilities. The goal is to identify and to address declines in physical or mental capacity early on, say experts — before someone takes a fall, for example, or starts to forget to pay his bills. Currently, seniors in


traditional Medicare pay 20 percent of the cost for most covered preventive services. The new requirements for free preventive coverage don’t apply to enrollees in Medicare Advantage plans, although many of those plans already offer free preventive services.


Cost can be a big stumbling block to getting preventive care. A co-payment of just $12 for a


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mammogram in Medicare’s managed-care plans resulted in screening rates that were 8 to 11 percentage points lower than those for women in plans that didn’t require a co-payment, according to a 2008 study published in the New England Journal of Medicine. Another study found that an increase of $10 in a co-payment for physician office visits led to a 20


opportunity to educate people about community activities like healthy eating or falls-prevention programs,” says Nancy Whitelaw, a senior vice president at the National Council on Aging. Some insurance plans offer their own programs that encourage “healthy aging.” Eight years ago, Tom Cajski joined the Kaiser Permanente Senior


“It’s awfully nice to see Medicare catch up to where the rest of the world has been for some time.”


— Peter Hollmann, American Geriatrics Society


percent decline in appointments among elderly patients. “A lot of these screenings


aren’t something somebody wakes up and says, ‘Wow, I’m going to have a flexible sigmoidoscopy today,’ ” says Cheryl Matheis, senior vice president for health strategy at AARP. To encourage seniors to get


that test, one of a number of approved screenings for colorectal cancer, and other important preventive services, “we have to educate people about the value and then eliminate the cost and make it convenient,” she says. The new law envisions the free annual wellness visit as an opportunity for seniors to develop a “personalized prevention plan” with their physician and plot out appropriate services and screenings for the next five to 10 years. There hasn’t been much research on people in their 80s or older, so it’s hard to calculate the risk/benefit ratio of preventive tests and screenings in this group, say experts. “It gets a little murky when people get older,” says Hollmann. Among other things, “you have to consider their practical life expectancy.” Many people who work with seniors hope the annual wellness visit will provide an opening to also discuss preventive activities not covered by Medicare. “We can use it as an


Summit program at a clinic near his home in Kailua, on the island of Oahu in Hawaii. Among other things, the program aims to stay in touch with seniors who are relatively healthy and don’t visit clinics often to make sure they’re getting the preventive care they need, says Sandi Brekke, who runs the program. Every month, members attend


lectures or demonstrations on health topics from foot care to acupuncture. Twice a year they get physical evaluations to test their strength, flexibility and balance, among other things. Cajski, 73, says he thinks the


program helps him take better care of his health. “I’m surrounded by people who give me health hints and keep me thinking about something that would otherwise recede,” he says. Advocates for seniors say the


new law’s provisions make it clear that prevention is important at any age. And about time, too. “It’s awfully nice to see


Medicare catch up to where the rest of the world has been for some time,” says Hollmann.


This column is produced through a collaboration between The Post and Kaiser Health News. KHN, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health-care-policy organization that is not affiliated with Kaiser Permanente. E-mail: questions@kaiserhealthnews.org.


cent analysis of about 400 Brit- ish men, for example, suggests that working later in life wards off cognitive decline. Every year they continued to work was as- sociated with a delay of almost seven weeks in the onset of Alz- heimer’s symptoms.  Mind your heart. Exercise boosts short-term brain function and wards off cognitive decline, according to two recent studies published in the Archives of In- ternal Medicine. In the first, Ger- man researchers found that bi- cycling, gardening, swimming or walking at least once a week for two years helped prevent cogni- tive decline in 3,903 people who were middle-aged and older. The second study, a year-long trial of 155 women age 65 to 75, found that strength training boosted executive function: that is, the ability to plan, make decisions and navigate new situations.  What you eat matters, too. An April 2010 study that fol- lowed 2,148 older adults for about four years found that those whose diet was high in fish, nuts, poultry and certain fruits and vegetables but low in high-fat dairy products and red meat were less likely than the others to develop Alzheimer’s disease.


The Checkup 6voices.washingtonpost.com/checkup


B vitamins show no value after stroke The supposed benefits of vitamins have suffered another


blow. In this case it’s B vitamins, which do not appear to protect stroke patients from subsequent heart attacks or strokes, according to the biggest, best study to examine the issue. Previous research has suggested that people with elevated blood levels of an amino acid known as homocysteine are at increased risk for heart attacks and strokes. (B vitamins can reduce homocysteine levels.) To test this hypothesis, researchers in Australia launched


the new study, which involved giving 8,164 patients who had suffered a stroke in the previous seven months either a placebo or a combination of the B vitamins folic acid, vitamin B6


and vitamin B12 . In the September issue of the British journal the Lancet


Neurology, the researchers report that those who took the B vitamins had lower homocysteine levels. But they were not significantly less likely to suffer a stroke or heart attack or to die from any cause during the 3.4-year study. Despite the findings, Peter Sandercock of the Western


General Hospital in Edinburgh, Scotland, argues that more research is needed to continue to explore the hypothesis, especially given the previous findings and the fact that B vitamins appear to be very safe.


— Rob Stein COPYRIGHT CORBIS


 Quiet your mind. To begin with, you are sharper when rest- ed. Shave even one or two hours off the optimal seven or eight hours of nightly sleep and you’ll probably lower your response time and have more difficulty with complex tasks. In addition, rest gives your brain time to make connections to new infor- mation and shuttle it into long- term memory. Also, give yourself time each day to meditate, pray or simply tune out the demands clamoring for your attention.  Find good company. Your brain thrives in a social environ- ment. Harvard researchers found that scores on standard memory tests dropped twice as fast among people 50 and older


who had the fewest social con- nections.  Check eyes and ears. Re- search suggests that simply pro- viding older hospitalized pa- tients with glasses, hearing aids or other devices helps to keep them sharp, attentive and aware of their surroundings. And re- searchers at the University of Michigan who followed 625 old- er men and women for 81


⁄2 years


found that those with poorer vi- sion who did not go to an oph- thalmologist had a risk of devel- oping Alzheimer’s disease that was nearly 10 times greater than similar people who did see a vi- sion specialist.


Copyright 2010. Consumers Union of United States Inc.


HEALTH SCAN PATIENT RIGHTS


When it’s good to be bad “THE EMPOWERED PATIENT” (BALLANTINE BOOKS, $15) CNN’s senior medical correspondent,


Elizabeth Cohen, thinks you should be a bad patient. That’s Cohen’s first rule to get- ting better health care, as explained in “The Empowered Patient,” her new book based on her CNN.com feature of the same name. The American medical system can be a frus- trating place, summarized in this witty quote from an “Empowered Patient” online reader: “I barely get to see my doctor, and when I do I wait two hours for ten minutes of rapid discussion about my health. My HEALTH. I spend more time with my auto


mechanic.” The first chapter reveals tips for being a bad pa- tient, such as asking lots of questions, not worrying whether the doctor likes you or not, and firing Dr. Wrong until you find Dr. Right. Cohen includes lots of anecdotes, including one about a high school girl who diagnosed her Crohn’s disease by looking at slides of her own tissue under a microscope in sci- ence class.


MEDICAL TECHNOLOGY


The aesthetics of prosthetics “A HEALING ART,” PBS Next week’s installment of the PBS series P.O.V. includes the


nature documentary “Salt” (not to be confused with the Ange- lina Jolie spy thriller of the same name; it’s about salt flats in Australia) and the short film “A Healing Art.” The latter runs just shy of seven minutes and is about the artists who hand- paint prosthetic eyes. “There’s just an infinite amount of pat- terns and colors,” one says. “For us, as artists and as crafts- men, it’s both a challenge and an honor to be the one that’s trying to duplicate that.” Squeamish folks should watch out for the scenes where health-care workers use suction cups to remove and replace the false eyes. “Salt” and “A Healing Art” air Aug. 17 at 10 p.m.


— Rachel Saslow


KLMNO


V1 V2 V3 V4


TUESDAY, AUGUST 10, 2010


QUICK STUDY DEMENTIA


Consumption of foods with Vitamin E is linked to a lower risk of dementia


THE QUESTION Might a diet rich in antioxidants protect against dementia? THIS STUDY involved 5,395 people, who averaged 68 years old and did not have dementia at the start of the study. Their diets were assessed, and then they were examined pe- riodically for about 10 years. In that time, 465 participants were given a diagnosis of dementia. Those who ate the most foods high in Vitamin E were 25 percent less likely to have de- veloped dementia than were people who took in the least Vi- tamin E. Other antioxidants consumed in foods — Vitamin C, beta carotene and flavonoids — showed no link to dementia. WHO MAY BE AFFECTED? Older people, especially those who eat foods containing antioxidants, which are thought to help prevent and repair cell damage and stave off heart disease and diabetes. Good sources of Vitamin E are leafy green vege- tables, vegetable oils, margarine, nuts and seeds. It also is of- ten added to cereals. Not all older people develop dementia. It is considered a collection of symptoms, including declin- ing memory and language skills, that cause impaired intel- lectual functioning and, in time, can change a person’s per- sonality and behavior and interfere with normal day-to-day activities. CAVEATS Supplement usage was not considered. Partici- pants’ diets were assessed only at the start of the study, and the determination of typical diets was based on their answers to questionnaires. FIND THIS STUDY July issue of Archives of Neurology. LEARN MORE ABOUT Vitamin E at www.ods.od.nih.gov/ factsheets. Learn about dementia at www.ninds.nih.gov/ disorders.


—Linda Searing


The research described in Quick Study comes from credible, peer-reviewed journals. Nonetheless, conclusive evidence about a treatment’s effectiveness is rarely found in a single study. Anyone considering changing or beginning treatment of any kind should consult with a physician.


HEALTH & SCIENCE


Editor: Frances Stead Sellers • Assistant Editors: Margaret Shapiro, Nancy Szokan, Kathryn Tolbert • Art Director: Brad Walters • Editorial Aides: Charity Brown,


Rachel Saslow • To Contact Us: health-science@washpost.com · 202-334-5031 · The Washington Post, Health, 1150 15th St. NW, Washington, D.C. 20071 • Advertising Information: Shawn Mckenna-Deane, 202-334-5750 · mckenna-deanes@washpost.com


Thursday in Local Living


Eat, Drink & Be Healthy offers ideas for nutritious school lunches in the back-to-school issue.


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