Wednesday, June 26, 2019

FDA Overhauls Supplements




For the first time in a quarter century, the feds are reviewing everything from vitamins to herbal tonics.


Four out of five older consumers take dietary supplements, according to the U.S. Food and Drug Administration (FDA), in spite of the fact that they can interact with commonly prescribed medications. You may not know what is actually in the supplements. Some contain drugs that aren’t listed on the label; others make claims that can’t be substantiated.

Recently, the FDA announced an initiative to inform the public more quickly about potential illegal or dangerous ingredients, enact updated enforcement strategies and change the way it evaluates products coming on the market. It’s “one of the most significant modernizations of dietary supplement regulation and oversight in more than 25 years,” FDA Commissioner Scott Gottlieb says.

Industry Growth Inhibited Regulation


The dietary supplements industry has grown from $4 billion dollars and 4,000 products 25 years ago to a worth of more than $40 billion and at least 50,000 unique items today, according to Gottlieb. These products include vitamins, minerals and herbs that many older adults consume daily.

"I’m concerned that changes in the supplement market may have outpaced the evolution of our own policies and our capacity to manage emerging risks," Gottlieb says.

The first move from the feds was to mail warning letters to 17 companies selling products that claim to prevent, treat or cure Alzheimer’s disease, diabetes and cancer. The claims have no basis in fact, and carry an additional danger.

Five Supplements You May Need


While a lot of supplements are falsely advertised or, more likely, simply not needed, there are some that medical professionals agree are worth asking your doctor about. Here are five supplements that may be needed to meet the increased nutrient needs of older adults.
  1. Vitamin D. The use of sunscreen prevents many adults from absorbing the vitamin D they need from the sun. Try exposing arms and legs to sun for a limited time daily to increase your levels. Older adults who don’t spend much time outside or whose bodies don’t absorb vitamin D well may need extra, according to Dr. Nothelle.
  2.  
  3. Calcium. While older adults often need extra calcium, the caveat is that this supplement increases the risk of a heart attack. And calcium doesn’t have to come in a pill or gummy. “Eating plenty of dairy, canned fish with soft bones, and dark, leafy greens like kale may be a safer option,” Dr. Nothelle says.
  4.  
  5. Vitamin B12. “Vitamin B12 needs acid from the stomach to be properly absorbed,” Dr. Nothelle reports. Some older adults might not produce adequate acid, or it can be inhibited by acid reflux medication like Prilosec or blood sugar drugs such as metformin. Ask your doctor to test for adequate B12 in your blood.
  6.  
  7. Vitamin B6. This helps protect nerves and form red blood cells. You can boost Vitamin B6 by eating potatoes, bananas and chicken. 
  8.  
  9. Acetyl-L-Carnitine (ALCAR). Some studies connect ALCAR with the body’s ability to ward off age-related fatigue and cognitive decline. It may be helpful for older adults with mild cognition impairment or Alzheimer’s, according to a study from the NIH Office of Dietary Supplements. 
"Such claims can harm patients by discouraging them from seeking FDA-approved medical products that have been demonstrated to be safe and effective for these medical conditions," Gottlieb says.

The government has struggled to keep up with the explosion of new ingredients on the market that claim to remedy everything from erectile dysfunction to hair loss. The last major regulation of the industry occurred in 1994 with the Dietary Supplement Health and Education Act. Recognizing that they’d fallen behind, the FDA created the Office of Dietary Supplement Programs three years ago.

Sandra Eskin, food safety project director for the Pew Charitable Trusts, says that the new plan is a good start, but much more needs to be done.

"This is a great first step to improving the safety of dietary supplements," she said. "In recent years, there’s been an explosion of products with risky ingredients, and we think it's absolutely critical that the agency address this problem.”

New Tool to Alert Public


As part of its new effort, the FDA is launching a tool to make public ingredients that “appear to be unlawfully marketed in dietary supplements.” Dubbed the Dietary Supplement Ingredient Advisory List, it will be located on the FDA website.  Consumers can sign up to get the most recent updates.

In a press release, the FDA announced that it had already taken action against eight companies for marketing supplements containing DMHA, which it considers “a new dietary ingredient” for which it hasn’t received notification, or an “unsafe food additive.” The FDA also warned three companies for marketing supplements containing phenibut, which does not meet the statutory definition of a dietary ingredient.

The FDA welcomes feedback from consumers while seeking to balance access to lawful supplements and protect the public from unscrupulous marketing. Anyone can submit feedback to support or refute the FDA’s preliminary drug assessments by sending an email to odsp@fda.hhs.gov.

Should You Take Supplements?


Alcohol and Supplements Don’t Mix


Beware of taking supplements and drinking alcohol. Just like combining supplements with prescription drugs, there may be unintended consequences that can be dangerous or even fatal.

For instance, alcohol combined with aspirin can increase the risk of intestinal bleeding. Cold and allergy medicines containing antihistamines mixed with alcohol can make you exceptionally sleepy. Alcohol and acetaminophen may cause irreversible liver damage. Sleeping pills, pain pills or anxiety or anti-depression medication can be deadly when combined with alcohol.

Your friends routinely recommend this supplement or that herbal remedy, swearing that it’s helped whatever the current concern may be. But what supplements do experts recommend seniors take on a regular basis?

None. Not a single one. Surprised?

“I think supplements are seen by many as only having the potential for benefit, but there is real risk of harm,” according to Dr. Stephanie Nothelle, post-doctoral research fellow in general internal medicine at The Johns Hopkins University School of Medicine. Supplements aren’t regulated the same way as drugs, and you can’t be sure of what’s inside the bottle.

As for vitamins, they’re more readily absorbed from foods than pills. “For a healthy older adult, I do not routinely recommend any supplements,” says Dr. Nothelle, a specialist in the health care of older adults. “The best form of vitamins is from the foods we eat. I recommend that all older adults eat a balanced diet of minimally processed foods.”

The National Institute of Health’s National Institute on Aging concurs. “Most, if not all, of your daily vitamins and minerals should come from food.”


Sources:

https://www.cnbc.com/2019/02/11/fda-plans-to-strengthen-regulation-of-dietary-supplements-create-rapid-response-tool.html
https://www.healio.com/family-medicine/pharmacology/news/online/%7Baef542ba-ff12-40a7-a4bf-7313bfcccbb1%7D/fda-proposes-overhaul-of-dietary-supplement-industry
https://www.usatoday.com/story/money/2019/02/11/dietary-supplements-grow-safer-first-fda-overhaul-25-years/2835763002/
https://www.fda.gov/newsevents/newsroom/pressannouncements/default.htm
https://www.silversneakers.com/blog/supplements-older-adults-need-know/
https://www.livestrong.com/article/375909-what-are-the-effects-of-alcohol-in-vitamins-minerals/
https://www.nia.nih.gov/health/alcohol-and-medicines?utm_source=NIA+Main&utm_campaign=2c2547dee4-20190401_alcohol&utm_medium=email&utm_term=0_ffe42fdac3-2c2547dee4-7425877



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Monday, June 24, 2019

Understanding RMD Withdrawals




It’s critical to have a firm grasp of required minimum distributions and some related tax strategies that won’t run afoul of the IRS.


Tax-deferred retirement accounts are a great place to tuck away money for your later years. Your dollars can grow without having to pay Uncle Sam, and the power of compounding works to your advantage. But don’t forget that the tax man cometh, and the IRS will be looking for its share of your retirement pot once you turn 70 1/2.

How Soon RMDs Start


Required minimum distributions (RMDs) are the federal government’s way of getting their share of your tax-deferred investment vehicle. Whether you have a traditional individual retirement account (IRA), simplified employee pension (SEP) account or a SIMPLE IRA, you must begin required withdrawals according to the IRS schedule or face stiff penalties. The distribution counts as income for the tax year in which it is taken.

To simplify, we’ll refer only to your traditional IRA in this article. (You paid taxes on your Roth IRA when you put money in the account, so there are no RMDs on a Roth). Check out this publication for IRS rules on all tax-deferred investments.

You have a choice of taking your first withdrawal during the year you turn 70 1/2, or waiting until April 1 of the following year. Then, you must take a specified distribution annually. Some people like to wait until the following year, because they have just retired and their income is substantially reduced the next year. But not everyone should wait until the last possible date for their first withdrawal.

The tax implications could be significant. If you wait to take your first distribution the next year, you will have another withdrawal to make for that year. Taking out two RMDs in one year could kick you into a higher tax bracket, and may create or increase taxation of your Social Security payment. See the sidebar “Your Birthday Determines When RMDs Begin” for further clarification.

Rollovers


You should also note that the first money out of your tax-deferred retirement account in any given year is considered to be the RMD, and it cannot be rolled over. You may choose to take out additional funds after you take your RMD, but whether they are for a 60-day rollover payable to you, a Roth conversion, or any distribution from an employer plan such as a 401(k), 403(b) or a pension, your RMD must be paid out before moving any other funds out of your IRA.

So, if you have funds in your employer’s 401(k) plan, you would have to first take your RMD from the 401(k) before moving the balance to an IRA. 

Your Birthday Determines When RMDs Begin


The month you were born sets the date for your first RMD.

  • Those born in the first six months of the year, from January through June, will usually begin RMDs the year they become 70 years old.
  •  
  • Those born in the last six months of the year, from July through December, will generally start taking RMDs the year they turn 71 years old.

However, it’s not quite that simple. The government allows you to wait to take your first RMD up until April 1 of the year after you turn 70 1/2. But the downside is that you’ll be required to take two RMDs that year, your first RMD and the RMD for that year. 

For example, if Diane turns 70 on February 21, 2019, she will be 70 1/2 on August 21. Diane must take her first RMD in 2019, but she can wait as late as April 1, 2020 to remove the initial amount. However, she will also need to take her second RMD in 2020, and it must be taken by December 31. Both amounts count as income in the year they were taken out of her IRA.

As another example, Tom turns 70 on September 7, 2019. He will be 70 1/2 on March 7, 2020. He will be required to take his first RMD in 2020 but could wait as late as April 1, 2021. However, he will also have to take a second RMD for 2021 by December 31 of that year.

Rollovers


You should also note that the first money out of your tax-deferred retirement account in any given year is considered to be the RMD, and it cannot be rolled over. You may choose to take out additional funds after you take your RMD, but whether they are for a 60-day rollover payable to you, a Roth conversion, or any distribution from an employer plan such as a 401(k), 403(b) or a pension, your RMD must be paid out before moving any other funds out of your IRA.

So, if you have funds in your employer’s 401(k) plan, you would have to first take your RMD from the 401(k) before moving the balance to an IRA.

How to Calculate Your RMD
The IRS RMD Worksheet will work for most account owners. Your married status is determined on January 1 of each year. The worksheet uses the Uniform Lifetime Table to figure out how much you must remove.

If your spouse is the sole account beneficiary and is more than 10 years younger than you, you will make slightly lower RMDs by using the required Joint Life and Last Survivor Expectancy Table. You can use the IRS RMD Worksheet that applies to your special situation.

Use this handy RMD calculator to compute your mandatory minimum distribution from a traditional IRA. Combine the balances of all your traditional IRA accounts on December 31, 2018, but leave out any Roth IRAs. The calculator asks for your primary beneficiary and date of that person’s birth to automatically use the correct table.

As a service to their clients, financial advisors and brokers commonly calculate and even automatically distribute RMDs from their client’s account.

Tip: Remember that the beneficiary or beneficiaries listed on your account(s) supersede a will. If your ex-husband is still the beneficiary on your IRA, he’ll inherit the money. It’s the same for life insurance, so make sure your intended recipient is the one listed on your account.

Penalties and Payments


Should RMDs Start Later?


In the fall of 2018, President Trump asked the Treasury Department to review the rules surrounding RMDs. Updating the life expectancy tables, which was last done 16 years ago when Americans lived on average more than a year less than today, makes sense, although Congress is required to make the change. But few older adults would benefit much from slowing the amount they must withdraw from their IRAs and 401(k)s.

Current RMD requirements combine the life expectancy of the account owner with that of an imaginary beneficiary 10 years younger. This makes for generous assumptions. The life expectancy of someone who is 70 is more than 27 years; that’s far longer than the reality.

The relatively few people with large defined contribution assets used as estate planning vehicles would come out well from such changes. Many are not so fortunate. To meet their living expenses, a lot of retirees with small accounts already withdraw more than the IRS requires. They wouldn’t see any benefit.

Almost half of retirees report less than $100,000 in retirement savings. If 1.6 years are added to life expectancy tables, someone with $137,000 in retirement funds and in the 10 percent income bracket would save $27.60 annually. Hardly a windfall.

At around the same time, the House considered eliminating RMDs on employer retirement plans with balances under $50,000. It seems like a worthy idea, but it wouldn’t make much difference for most account holders. RMDs on that size of account are fairly modest to begin with, and are often depleted to pay for living expenses.


The IRS has waited, sometimes decades, for money from your tax-deferred account. When RMDs are due, the tax agency will make sure you comply by making the penalty so onerous that you dare not do otherwise. If you fail to take distributions, or if the distributions you do take are not enough, you will owe a 50 percent flat rate excise tax on the difference. Ouch.

To take an RMD, you can remove money from any of your traditional IRA accounts in any way you like, as long as it adds up to your RMD. You can take equal percentages from several accounts, or a large amount from one, less from another, and nothing at all from remaining accounts. The IRS doesn’t care, as long as the correct amount is taken. You are also free to take more than the RMD in any year.

Tax Strategies


Many retirees need the money from their RMD for living expenses. However, some individuals with higher net worth or a high proportion of funds in a traditional IRA may not need the entire RMD amount. For these people, it’s important to strategize to keep taxes on the withdrawals as low as possible. Here are some options to discuss with your accountant.

  • You must use all of your traditional IRA accounts, including rollover IRAs, SEP IRAs and SIMPLE IRAs, to calculate your RMD. But you have the option to take the money out of any one or a combination of the accounts. You can choose to remove the money from the IRA that has the highest fees, limited investing options or a concentration in a single stock. You can also trim from accounts to re-balance and maintain your desired allocation.
  •  
  • RMDs in traditional IRAs and 401(k) plans are calculated and withdrawn separately. Each 401(k) RMD must be taken separately as well. If you’re still working when your first RMDs become due, you may be able to wait until April 1 of the year after you quit working to take the RMD from your current employer’s 401(k). If your current employer allows it, you may be able to roll over funds in your other 401(k)s and existing IRA Rollover accounts to your current plan, thus putting off RMD withdrawals.
  •  
  • Make sure your administrator doesn’t automatically withdraw RMDs proportionately from each of your investments. Doing so could cause stocks or funds to be sold at a loss. Usually, you can elect to take your RMDs from cash, and the administrator will send you an alert ahead of time if you need to liquefy assets. 
  •  
  • You can transfer up to $100,000 of income tax-free directly from your IRA to charity each year after you turn 70 1/2. This is called a qualified charitable distribution (QCD) and it counts toward your RMD. The transfer must be made directly from your IRA to the tax-qualified charity. Instead of the IRS taking a share in the form of taxes, the charity gets 100 percent of your money. This includes any church contributions.
  •  
  • Any money you’ve previously rolled over from a traditional IRA to a Roth avoids future RMDs, although you must pay taxes in the year of the rollover. If you roll over a traditional IRA after age 70 1/2, you must take the RMD for that year first.
  •  
  • Money invested in a qualified longevity annuity contract (QLAC) is removed from your RMD calculation. You may invest the lesser of up to a quarter of the balance in your traditional IRA accounts or $130,000. Although it can be done at any age, most invest in their 50s or 60s, and choose to begin receiving payments in their 70s or 80s (but no later than 85). However, if you die before payouts start, you won’t receive a dime, unless you’ve opted for a version. This type of contract offers smaller payouts for you but includes a sum for your heirs if you pass away before your payouts reach your initial investment.
  •  
  • In-kind transfers are permitted to satisfy the RMD. If you have investments in your retirement account that may be difficult to sell, consider transferring them in-kind to a non-retirement account. You will still owe the taxes on the distribution but this option allows you to stay invested in the security. And because you paid taxes, the cost basis on the investment in the taxable account will be reset on the day of the transfer.
  •  
  • If any of your IRA contributions were made with non-deductible contributions, a portion of your withdrawal will be tax-free. You are required to keep track of your tax basis on IRS Form 8606
  •  

Sources:

https://www.barrons.com/articles/ira-mandatory-withdrawal-rules-51552058882
https://www.kiplinger.com/slideshow/retirement/T032-S002-11-strategies-for-ira-withdrawals/index.html?rid=EML-today&rmrecid=3620693347
https://www.fool.com/retirement/iras/2018/09/09/2018-ira-rmd-table-how-much-do-i-have-to-withdraw.aspx
https://www.kiplinger.com/tool/retirement/T032-S000-minimum-ira-distribution-calculator-what-is-my-min/index.php
https://www.investopedia.com/articles/retirement/081916/rmd-strategies-how-avoid-drawing-down-money.asp
https://maestrowealth.com/2017/10/27/birth-month-determines-rmds/
https://www.kitces.com/blog/proposal-reduce-rmd-obligation-update-life-expectancy-eliminate-age-limit-50000-threshold/
https://www.forbes.com/sites/howardgleckman/2018/09/07/treasury-should-review-ira-minimum-distribution-tables-but-changes-would-help-few-seniors/#7d5364ec1d33




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Friday, June 21, 2019

The Power of Art




Creative engagement for older adults has positive psychological, social, cognitive and physiological impacts.


One way to improve the health of older adults is to get them involved with art. Studies continue to show a correlation between the artistic engagement of seniors and improved outcomes for their physical and mental health.

Art Improves Health


Self-reported data from the 2014 Health and Retirement Study demonstrates how the arts can combat hypertension, as well as cognitive and physical decline. Study participants also reported that engaging in artistic pursuits helped them increase socialization with family and friends while improving their level of activity and engagement in the community.

The socialization aspect of making art is profound when you consider that isolation often increases as we age, leading to loneliness and depression — which is now understood to be a public health crisis. Loneliness is as lethal as smoking 15 cigarettes a day, according to the Foundation for Art and Healing.

Participation in any form of art — including painting, pottery, dance, music, poetry, drama or oral history — has positive implications on older adults’ health. These are the findings of the Creativity and Aging Study led by Dr. Gene Cohen. His research confirmed that older adults who engaged in the arts improved their physical health, had fewer visits to their doctor, required less medication and reported fewer falls than those who didn’t.

More than 60,000 older adults have participated in the History Alive and Legacy Art Work programs since 2005. National Taiwan University Professor Peishan Yang reports that participants have shown decreased rates of loneliness and depression, improved mood and confidence, higher morale, and greater hand dexterity, all of which translated into improvements in many areas of their lives.

The Benefits of Expressing Yourself Through Art


A recent article in Geriatric Monthly  by Barbara Bagan, Ph.D., ATR-BC, details  positive outcomes, in addition to improved physical health, that artistic outlets can provide for older adults. She explains that art can:

  • Aid in relaxation, anxiety and depression
  • Give feelings of control
  • Improve communication and socialization (which are very important)
  • Encourage humor and playfulness
  • Improve cognition
  • Offer sensory stimulation
  • Foster a strong sense of identity
  • Bolster self-esteem
  • Nurture faith
  • Reduce boredom

Dementia Barriers Crossed Through Art
The process of making art can be a powerful antidote to the walls that dementia often builds. When verbal communication becomes difficult or impossible, art can provide a pathway that speech no longer travels.

Art Therapist Dr. Raquel Stephenson, program coordinator for Art Therapy at Lesley University, has seen this with her own eyes many times. A non-verbal student in one of her painting classes may suddenly become intensely engaged as they touch, smell and feel the paint. “Where Alzheimer’s disease slammed shut the door of communication, art therapy opened up a new window,” she says.

It’s the process that matters, according to Stephenson, who has founded several national and international art therapy programs. “When people take the risk of making art with others, it builds community, which is therapeutic,” she says. “Making art allows this community-building to happen quickly and more powerfully.”

Anne, 91, moved to a small group home after being diagnosed with Alzheimer’s. Her daughter hired an art therapist to visit, and the therapist and Anne listened to music, painted and laughed together as Anne found the sense of playfulness her dementia had stolen. She was able to complete four paintings before she died, humorously entitling one, “Yellow, Yellow Catch a Fellow.”

Hidden Talent 


A rural Alabama saw miller, Lester Potts became a respected watercolor artist after joining an art therapy program at a local daycare center. Potts had never shown any artistic talent before being diagnosed with Alzheimer’s in his later years.

“Two Friends Photo” by Lester E. Potts. Works available here. Proceeds benefit art therapy charity.

“Dad’s creativity had profound positive effects on him and our family,” says his son, Dr. Daniel C. Potts, who founded Cognitive Dynamics after his father’s death “to bring these therapeutic opportunities to others in like circumstances. The mission of the organization is to improve quality of life for those with cognitive impairment and their caregivers through the expressive arts and storytelling.”

Barriers to Participation


In spite of all the documented benefits of art in the lives of older adults, age brings a host of roadblocks to participation. Common problems include the lack of a program nearby, difficulties in getting to a venue, poor physical health, and the absence of a friend or partner with whom to participate. 

Various groups are stepping in to fill the gap. Local organizations in urban communities, such as New York City’s Elders Share the Arts (ESTA), provide programs for thousands of people. 

Many more participate through outreach programs originating in institutions. The Art Institute of Chicago’s Art Insights program offers visits to retirement communities, bringing the arts to older adults who can’t visit the museum itself. 

The institute also partners with Well Connected and Telephone Topics, using a telephone to reach even the most isolated senior. You can find telephone programs for older adults, including programs in Spanish, through DOROT’s University Without Walls.

Successful Aging


In the book “Successful Aging,” the authors discuss the three supports of a good life in later years: low risk of disease, high mental and physical functioning, and being actively engaged in life. Art activities can help skew each of these in a positive fashion. Current research repeatedly supports the inclusion and enhancement of art involvement for older adults. The prescription for good health ought to include artistic endeavors.


Sources:


Blog posting provided by Society of Certified Senior Advisors

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Tuesday, June 18, 2019

Designing for Older Adults




Older adults who weren’t a part of the technological revolution in their youth may need design adaptations to encourage tech adoption.


More than 59 percent of older Americans use the internet, and 78 percent have a cellphone. Surveys show that they want to engage with technology and enjoy its benefits. But rarely are products designed with older adults in mind.

Tech adoption among older adults is concentrated in those with the most education and income. With 10,000 baby boomers entering the 65-and-up category every day, it’s an unparalleled marketing opportunity. However, developers need to keep in mind that 80 percent of those over 65 have chronic conditions, and age often affects vision, fine motor skills and cognition.

Health, Aging in Place Top Desires


Older Americans identify a pair of areas that they feel would be made better with technological innovation: health and aging in place.

On the health care front, there are already a bevy of products to assist seniors. Smart pillboxes alert the user when it’s time to take medications, and medical alert systems are standard in care facilities. Fall detection has taken a giant leap forward with Apple’s iWatch. Remote patient monitoring devices abound, and health tracking apps and devices have become routine.

It’s no secret that older adults prefer to stay in their homes as long as possible. Technology is increasingly able to help support that goal through personal response systems, smart doorbells and motion-sensor lights that provide added security. Keyless locks, smart thermostats and smart detection devices eliminate the need for constant monitoring of the home environment.

Web Accessibility Guidelines


However, all of these products are generally designed by younger generations, often for younger generations. When it comes to designing for older adults, the web is ahead of the game.

In June 2018, the latest Web Content Accessibility Guidelines (WCAG) were officially recommended by the World Wide Web Consortium (W3C) to make web content more accessible, primarily for those with disabilities but including all users and devices, such as smartphones.

There are four essential principles in the latest guidelines:
  • Perceivable. Information and interface components must be presentable to users in ways they can perceive.
  •  
  • Operable. User interface components and navigation must be operable.
  •  
  • Understandable. Information and the operation of the user interface must be understandable.
  •  
  • Robust. Content must be robust enough that it can be interpreted reliably by a wide variety of user agents, including assistive technologies.
Professionals who work with older adults would do well to check if their own websites are easy for seniors to find and navigate.

Start at the Beginning


Thankfully, recent years have brought many best practices to the web. Developers are sharing what they’ve learned about designing for an older cohort with less exposure to tech overall and numerous physical limitations. While not everyone will grow hard of hearing or become crippled with arthritis, the trick is to create a design that meets the needs of as broad a group as possible. 

One designer writes that her first hurdle was to avoid assumptions. She detailed what she learned on UX Planet, a dot organization (.org) “resource for everything related to user experience.” 

She writes that designers need to realize seniors “may not understand things like scrolling or search functionality.” They may also fail to recognize common abbreviations and acronyms. Icons and symbols won’t be as clear, so always pair them with text on a plain background. A good practice is to involve older adults from the beginning to test design and function. Their feedback can be much more useful than what a designer thinks is optimal.

For instance,  a hamburger menu can be confusing. Say what? Wikipedia explains that a “hamburger menu” is the same as a “hamburger button, so named for its unintentional resemblance to a hamburger.” Its function is to toggle a menu or navigation bar collapsed behind the button with what appears on the screen. It’s better to use clear signposts to return along your route, and to include a prominent home button.

Fonts and Color


Many designers stress the need to use a sans serif typeface (one that lacks the tiny flourishes at the ends of letters such as L [serif] vs. L [sans serif]). This page is typed in Calibri, a sans serif typeface. Avoid using multiple fonts (style, size and weight of typeface).

As we age, our lenses may become hard and allow less light to enter the eye. Cataracts or macular degeneration may worsen vision. Blues become harder to distinguish and should be avoided for important elements. Color should not be used to convey a message. Check designs with online visual impairment simulators and convert designs to gray scale to check for legibility.

Designs can also offer personal adaptations. Many older adults like to be able to increase the font size. Some with certain visual impairments can benefit by changing a page from black letters on a white background to yellow letters on a blue background.

Navigation


Simplification can be vital for many seniors. It’s easier to slowly make changes on a site to allow users to adapt, and to make the information on each page cover a defined set of information that doesn’t require scrolling. 

Older users can have a hard time seeing and touching the correct button when they’re small or placed close together. It can happen to anyone. (How many times have you accidentally hit the wrong button and deleted something?!). 

Computer “breadcrumbs” are useful. Just like Hansel and Gretel, electronic breadcrumbs can help us find our way home.

Adaptations for Dementia Help All


While designing a site for Dementia Diaries, a project detailed in this month’s Coffee Break section of Senior Spirit, designers aimed for the highest accessibility on a tight budget. Users and contributors would have every stage of dementia, which is more likely as people age. 

Web developer Rory Gilchrist built a site where people with dementia could record their own stories and read the stories of others. What he learned has implications that reach far beyond this population. 

Gilchrist found key lessons covering:
  • Content
  • Layout and navigation
  • Colors and contrasts
  • Text and fonts
  • Images
  • Multimedia use
  •  
Extensive points on each of these topics are available in an article in Smashing magazine, which is well worth reading in its entirety. 

As a final note, Gilchrist reminds developers not to shy from announcing that a website has made every attempt to be dementia (or senior) friendly. It can be a welcome relief to find a resource that is simple to navigate and easy to read!


     

Sources:






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Sunday, June 16, 2019

Coffee Break - Dementia Diaries




A groundbreaking project records the experiences of people with dementia, promoting the voices of those who live with the disease.


We need to educate society that dementia touches many people in many different ways. We need to dispel the myths. Dementia is everyone’s business. —Anne MacDonald

Dementia Diaries is a project recording the voices of people across the United Kingdom who are living with dementia. Anyone can read or listen to current posts by clicking on the photo of the desired diarist, making it seem almost as though you’re sitting across from the person at home, listening to a piece of conversation. In fact, there’s a page where you can meet the current diarists and Listen to archived audio diaries.

Volunteer to Transcribe


Anyone can assist in the Dementia Diaries project by helping to transcribe audio diaries. You don’t even have to sign up! Simply navigate to the volunteer page and follow the simple instructions.

You can do one conversation, or as many as you like. You don’t need to commit to further transcriptions, but can simply return to the site to help out whenever you feel like it. There is a tab at the top for audio diaries that need transcribing.
Everyone from activists to artists have joined the project to contribute their views. While many people seek to provide the best experience for a spouse or patient experiencing dementia, this site is different in that it is exclusively available to those who have been diagnosed with the disease. Although people in the United States are unable to contribute, any English speaker can access the site and offer feedback and reflections, available at the end of each post.

Dementia Content is Diverse


Diarists are not limited in subject matter, so readers can find snippets on a variety of topics. Some recent posts covered death and dying with dementia (should a person be able to choose when to die?), how dementia affects one contributor’s ability to support others and a compilation of gardens in celebration of National Gardening Week.

A range of emotions are exposed as contributors argue for consistency of care, express gratitude for small acts of kindness or ruminate on daily difficulties. Naturally, there are posts that tend toward despair (Carol’s “This last month has been dreadful for me!”) but you don’t have to look far to find a wide range of themes.

Navigate to the Key Themes page to find topics of interest, such as family and friends, diagnosis, memories and daily challenges. All of the headings listed apply to those living with dementia in the U.S. Even the health and social care listing has relevant concerns, despite socialized health care in the U.K. Readers have only to browse entries such as “Dory educates her taxi driver” or “Can people with dementia self-manage?” to realize that there are a plethora of universal themes across the pond.

Readers have the choice of following one contributor, or pecking through posts from a variety of diarists. Someone with dementia may want to take their journey with a contributor who shares a similar age, sex and viewpoint, for example.

About the Project


Because it can become difficult to master technologies as dementia progresses, contributors can use their own mobile or land line phones. 3-D printed handsets that are intentionally as simple to use as possible are also available.

“Our shared aim is that by opening up our lives to the public we will improve understanding of the diverse experiences of living with dementia and how communities and services can best offer support,” according to information on the site.

The project is an arm of the Dementia Engagement and Empowerment Project (DEEP) and designed by non-profit communications agency On Our Radar. The effort is currently funded jointly by the BIG Lottery Fund and Comic Relief.

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Friday, June 14, 2019

Famous and 65

Look who's turning 65 this month

June 15 - James Belushi, comedian and actor


James Belushi, the younger brother of famed actor and Blues Brother John Belushi, earned his comic and acting chops on his own right. He played the title role in the sitcom According to Jim, after an early start on the iconic Saturday Night Live from 1983 to 1985. Belushi acted in a wide variety of films from the 80s to now, including About Last Night, The Principal, Red Heat, K9, Curly Sue, Once Upon A Crime, Last Action Hero, Jingle All The Way, Wag The Dog, and Less Than Perfect.

Belushi was born in Chicago to an Albanian immigrant father and a mother who was the daughter of Albanian immigrants from the same small town. He got a degree in theater and arts, then followed his older brother to The Second City theater group in their hometown. He joined Saturday Night Live in 1983 and got a breakthrough with The Man with One Red Shoe in 1985.

Belushi is also a talented musician. In 2003, he paired with Dan Aykroyd on the album Have Love, Will Travel, which spawned a tour. He continues to appear nationwide as Zee Blues in current version of the famed Blues Brothers. He also released a book in 2006 entitled, Real Men Don’t Apologize.


June 15 - Paul Rusesabagina, Rwandan hotel manager and humanitarian


Paul Rusesabagina’s selfless actions saved more than a thousand people and inspired the movie Hotel Rwanda.

One of nine children born to a Tutsi mother and a Hutu father, Rusesabagina’s first ambition was to become a minister. He married in 1967 and moved to Cameroon to study at a seminary. A friend asked him to apply for an opening at a local hotel, leading Rusesabagina to promotions and trips to Europe to study hospitality management.

In 1992, he was given the job of assistant manager at the Diplomates Hotel. April, 1994 saw the explosion of tension between ethnic Tutsis and Hutus in Rwanda. It began as a political division, and was fully inflamed with the assassination of the prime minister and other powerful government figures. Hutus and Tutsis hunted each other down, committing genocide.

Rusesabagina fled to a sister hotel, where he sheltered his family and hid 1,200 Hutu and Tutsi refugees. This was no small feat; more than a million Rwandans died in the fighting. Four of his eight siblings were still alive at the end of the combat, and this was considered relatively lucky.
Rusesabagina and his family now live in Texas and maintain a home in Belgium. He is a humanitarian activist on a global scale and has won many awards for his work.


June 19 - Kathleen Turner, actress

Maybe you first saw her in the movie Body Heat, or it could have been in Romancing the Stone or Prizzi’s Honor, both of which earned Kathleen Turner a Golden Globe Award for Best Actress. Besides her numerous film credits, Turner was twice nominated for a Tony Award for Broadway roles as Maggie in Cat on a Hot Tin Roof and Martha in Who’s Afraid of Virginia Woolf?

Brought up in a strictly conservative Christian household, Turner’s acting ambitions were roundly discouraged by both parents, but especially her father. Known for her husky voice that could beckon or boss around, the Missouri phenomenon attended the American School in London due to her father’s job in the foreign service.

Her father died the same year she graduated from the London school, and Turner wound up at the University of Maryland, where she studied theater and received a bachelor’s degree in fine arts. She entered her professional career on the soap opera The Doctors, landing her first film role just three years later.

Turner had a brilliant career until the early 90s, when pain from rheumatoid arthritis left her barely able to walk. Just as her age started to work against her, medication for the arthritis robbed her of her trademark good looks and caused her to put on weight. She says she started getting offers to play “mothers and grandmothers” in her forties.

Turner has championed Planned Parenthood since the age of 19, and continues to support various charitable causes.


June 19 - “Taz” Tasmanian devil cartoon character

Animated cartoon character “Taz” appeared in five shorts before Warner Bros. Cartoons boarded up shop in 1964. Voracious and surly, it has been suggested that the character was inspired by movie idol Errol Flynn. The real Australian marsupial looks nothing like Taz and walks on four legs, but it is ferocious and a hearty eater.

Taz first appeared in 1954’s Devil May Hare, where he stalks Bugs Bunny. With an IQ on the level of Bugs’s other nemesis, Elmer Fudd, Taz is more of an irritation than a threat. His character mostly growls and grunts, rarely speaking, yet is able to read and write. An oft-repeated gag portrayed Bugs looking up “Tazmanian devil” in a dictionary to see what it eats, and being relieved that rabbits aren’t listed, only to have Taz enter and find rabbits in the book, or write “rabbits” on the list himself.

The character nearly met an early death. The head of Warner Bros. animation studio ordered Taz to the cutting room floor after his film debut, thinking parents would frown on his violent nature. But when no new shorts came out, the studio head asked what was going on with the character, saying he had “boxes and boxes” of letters from people waiting to see more of Taz. More shorts were soon made.

Taz has had a resurgence in the last 20 years, appearing on television and in marketing schemes.


June 22 - Freddie Prinze, comedian and actor

Born Frederick Karl Pruetzel, Prinz changed his name to become the “prince” of comedy since Alan King already had the superior title. He starred in the successful sitcom Chico and the Man from 1974 until his death three years later.

Prinze made the rounds at clubs in New York City, where he grew up. He made it onto Jack Paar Tonite, but got his big break in 1971 on The Tonight Show. He was the first young comedian Johnny Carson picked to have a chat during his first appearance on the show. Prinze would later guest-host the show several times.

Prinze could also sing, and counted Tony Orlando as one of his best friends. He roasted greats such as Muhammad Ali and Sammy Davis Jr., and in 1975 he released his own comedy album, Looking Good. A few months before he died, Prinze had penned a $6 million contract for five more years with NBC.

Sources:

https://www.wikipedia.org

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Wednesday, May 29, 2019

The Shingles Vaccine Controversy





Reactions to the Zostavax shingles vaccine inspired dozens of lawsuits, and now the CDC recommends rival Shingrix. But should you get it?


Shingles is a painful viral infection that causes a rash, usually as a mass of blisters wrapping around the right or left side of the torso. A million cases of the disease occur in the U.S. every year, and the risk rises with age. Shingles is caused by the same varicella-zoster virus that triggers chickenpox. Once you’ve had chickenpox, the virus remains dormant in nerve tissue and can reactivate in the form of shingles years later. Anyone who has ever had chickenpox can come down with shingles. Many experts anticipate that half the population over age 80 will develop shingles.

Approved by the U.S. Food and Drug Administration (FDA) in 2006, Zostavax shingles vaccine was recommended to those 60 and older. The live vaccine is given as a single injection in the upper arm. But many who got the shot say it gave them shingles, or non-shingles related injuries, due to the live virus in Zostavax. Hundreds of product liability claims are pending against drug maker Merck & Co. from those who got the vaccine. Plaintiffs allege that the vaccine caused them to develop a more severe, painful and less treatable form of shingles than the one they were trying to avoid, as well as other auto-immune disorders. 

Chickenpox Exposure Affects Shingles


Before children were routinely vaccinated for chickenpox, exposure to the disease helped protect adults who had already had it from developing shingles. Many countries have previously avoided universal vaccination against chickenpox in childhood because of a belief that the rise in shingles cases would outbalance the dip in chickenpox disease. This is one argument against vaccinating children for chickenpox. 

In the U.S., Gary Goldman, Ph.D., served as a research analyst for the Varicella Active Surveillance Project in a cooperative project with the CDC from 1995 to 2002. He believed having chickenpox in a population protected against shingles. In his resignation letter, he stated that “When research data concerning a vaccine used in human populations is being suppressed and/or misrepresented, this is very disturbing and goes against all scientific norms and compromises professional ethics.” In 2005, Goldman published a paper giving evidence that shingles is suppressed naturally in human populations by repeated exposure to naturally occurring chickenpox. 

However, while experts used to think this asymptomatic boosting lasted up to 20 years, a recent study by researchers from the Universities of Antwerp and Hasselt (Belgium) shows the protection only endures for two years. The only age group that appears to show an uptick in shingles cases when a population vaccinates children against chickenpox is 31 to 40-year-olds. Therefore, scientists have concluded that the benefits of the chickenpox vaccine for children outweigh the risks. 

"We were surprised to find that re-exposure to chickenpox is beneficial for so few years and also that the most pronounced effect of vaccination on increasing cases of shingles is in younger adults," says lead author Dr. Benson Ogunjimi. "Our findings should allay some fears about implementing childhood chickenpox vaccination," he says.

Vaccine Hesitancy

Recently, vaccine hesitancy joined air pollution and obesity at the top of global health threats prioritized by the World Health Organization (WHO) in 2019. Vaccine hesitancy, or skepticism, is a novel inclusion. It reflects a growing mistrust of recommended vaccinations, likely spurred by shared media accounts. But scholars like Amesh Adalja at the Johns Hopkins Center for Health Security in the United States say that vaccines are an important control and vaccine hesitancy belongs on the list.

"If you'd done that list 100 years ago it would have been all infectious diseases. The reasons why it's not is because of vaccines,” Adalja says. “People didn't have the luxury of dying from diabetes, obesity, cancer and cardiovascular disease. Vaccines are probably one of the greatest technologies to have impacted on human health.”

A measles outbreak in the U.S. recently highlighted the “anti-vaxxer” phenomenon. Measles is a potentially deadly disease that can cause pneumonia and encephalitis. The respiratory disease is extremely contagious. You can get measles just by being in a room where a person with measles has been, even if that person left up to two hours before.

Some teens are turning to social media site Reddit for advice after parents refused to get them vaccinated as children. The teens are worried about catching a preventable disease, and also don’t want to be responsible for potentially passing that disease along to someone who cannot get vaccinated for health reasons. Fellow users have offered support in the form of everything from links to scientific articles to Go Fund Me campaigns to pay for shots.

As with all health matters, it’s important to seek out reliable sources of information with strong scientific backing when considering vaccinations.

Shingrix Vaccine


In 2017, the FDA approved a new vaccine for shingles, Shingrix, that is 90 percent effective at protecting against the virus. Developed by GlaxoSmithKline, Shingrix is different from most other vaccines, including Zostavax. Shingrix is made from a single protein that comes from the outer shell of the herpes zoster virus, rather than a weakened form of the whole virus. And the vaccine contains something called an adjuvant that helps your body fight the virus.

As people get older, their natural immunity declines, leaving them more susceptible to disease. This is often when the dormant chickenpox virus attacks, causing stabbing pain and flu-like symptoms.

A new study included more than 15,000 people in 18 countries who got two doses of the vaccine, two months apart. Participants were from Europe, North America, Latin America, Asia and Australia.

"The second dose of the vaccine is important to ensure long-term protection," says lead researcher Professor Tony Cunningham from the Westmead Institute for Medical Research. "The efficacy is approximately 90 percent for all age groups, even for those over 70 years of age.

"This is quite remarkable because there are no other vaccines that perform nearly so well for people in their 70s and their 80s. We are seeing results comparable to those of childhood vaccinations. What's particularly exciting, though, is that 90 percent of recipients had an increased immune response sustained across the three-year duration of the study.”

The study authors anticipate that protection will endure “much, much longer” than four years with the addition of the second recommended vaccine dose, given two to six months after the first.

CDC Switches to Shingrix


The Centers for Disease Control and Prevention (CDC) has promoted the use of Zostavax for years in spite of drawbacks. According to the manufacturer product insert, Zostavax “does not result in protection of all vaccine recipients. The duration of protection beyond four years after vaccination with Zostavax is unknown.” Studies found a significant decrease in vaccine effectiveness one year post-vaccination, and by nine years, Zostavax offered no protection. According to the CDC, Zostavax was effective in reducing shingles by about half (51 percent) in adults age 60 and over.

As of 2018, the CDC dubbed Shingrix the preferred vaccine for shingles. Additionally, the longer protection time of Shingrix caused the CDC to change its starting recommendation from age 60 to age 50 for the newer vaccine.

However, Shingrix comes with a downside. It’s more likely to cause unpleasant side effects than Zostavax, according to Dr. Kathleen Dooling, a medical officer in the division of viral diseases at the CDC.

“One of the important things is to go into this vaccination knowing that you’ll probably have some side effects after and be prepared for those,” Dooling says. “The advice we’ve been giving people is that if you plan to get the vaccine, in the day or two afterwards, don’t plan any big, strenuous activities. For example, don’t plan a big gardening project ... don’t plan your big golf game for that period.”

Your arm is likely to be sore in the day or two after vaccination. Eighty percent of people reported injection-site pain, redness or swelling. You may also experience general flu-like symptoms such as tiredness, nausea, headache, shivering, muscle aches and fever. Taking an over-the-counter medication for pain would be “a reasonable thing to do,” Dooling says.

Three percent of “adverse events” related to Shingrix and reported through the Vaccine Adverse Event Reporting System were serious, out of about 3.2 million doses administered in the first eight months of the new vaccine’s use. It’s “not different from what we would expect for any new vaccination,” according to Dooling.

Who Should Get Shingrix Vaccine


People who are in good health age 50 or older should get vaccinated with Shingrix, according to the CDC. While you can’t get shingles if you’ve never had chickenpox, more than 99 percent of Americans over the age of 40 have had the disease. People should get the Shingrix vaccine even if they’ve gotten the Zostavax shot in the past or have already had shingles.

It’s important to get a second dose of Shingrix within two to six months after the first shot. It may trigger another bout of side effects, and those could be different than any you got from the first shot.

Shortages of the vaccine have been reported. If you’re in doubt, visit a vaccine locater website to find a location near you that has the vaccine in stock.

Click below for the other articles in the May 2019 Senior Spirit


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