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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


Blog posting provided by Society of Certified Senior Advisors

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How to Protect Your Money from Medicaid

Long-term care can decimate an estate unless you protect yourself ahead of time.

Many people are crossing their fingers that they won’t need long-term care (LTC) when they get older. But “someone turning age 65 today has almost a 70 percent chance of needing some type of long-term care services and supports in their remaining years,” according to the U.S. Department of Health and Human Services.

And that care doesn’t come cheap. The cost of a private room in a nursing care facility averages $7,698 per month, or more than $92,000 per year. That amount is “ruinously expensive,” according to the New York State Court of Appeals. Yet few people are aware they have options and rights when it comes to LTC planning and Medicaid.

Medicaid is Payer of Last Resort

Medicare does not cover LTC. Payment for LTC must come from your own pocket, long-term care insurance (if you’ve purchased a policy, kept current on payments and qualify under the policy’s terms) and Medicaid.

Medicaid coverage of nursing home costs is means-tested. Often, by the time people qualify for Medicaid, their assets are depleted. Any inheritance they hoped to leave loved ones is gone, and they are without financial security if they end up moving out of the care facility.

As an example, New York has a relatively generous income allowance for Medicaid. Those 65 and older may have no more than $15,150 in assets (some other states put this limit at $2,000 or less). Income may also factor in. The annual income limit in New York for an older adult is $10,100.

There’s an important catch regarding assets. Medicaid has a look-back provision which lets the government review transfers of assets for up to five years before the Medicaid application. If it finds a transfer that was not exempt, the applicant may become ineligible for Medicaid for a defined penalty period.

Asset Protection Trusts

To qualify for Medicaid, you may place assets, such as your home, in an irrevocable trust. These assets legally no longer belong to you, but are controlled by an independent trustee. You can designate a spouse or other loved ones to inherit the assets of the trust upon your death. While you lose control of the trust’s principal, you can use assets in the trust during your lifetime.

This method of asset transferal has benefits compared to simply giving the assets away with strings attached, such as specific conditions. For starters, you don’t have to rely on an individual’s trustworthiness (such as hoping that person won’t turn around and kick you out of the home). You won’t be left in the cold by having your home taken away if an individual incurs a debt or liability that exposes that person’s assets to debt collection. There won’t be complications over who owns the house or whether or not you can stay in it because an individual got divorced or predeceased you. And the individuals will receive a step-up in basis for assets like a house when it is placed in a trust, meaning they won’t have to pay capital gains on the difference between what you paid for it and what it is worth when you die.

Also, if your home in such a trust is sold while you’re still alive, the proceeds will not count toward your Medicaid eligibility. Be aware that a revocable, or “living” trust, does not offer this protection. Assets in a revocable trust are still considered to be your property.

Further, irrevocable trusts are subject to the five-year Medicaid look-back period.

Finding a Medicaid Facility

Medicaid traditionally pays only for nursing home care, not assisted living, unless a state has a waiver for that option. At any rate, your biggest hurdle may not be asset protection but finding a facility with openings that also accepts Medicaid. Facilities that pass inspection may choose to designate a small percentage of beds for Medicaid patients. Other facilities may elect to take only private payers.

Many facilities are requiring a period of private pay, typically from 18 months to four years, before accepting Medicaid payments from residents. Thus, residents must have enough assets to be able to make it through this spend-down period before they can rely on Medicaid to cover their LTC costs.

The Medicaid contract typically offers payment that is considerably lower than (sometimes less than half) the private pay rate. Thus, nursing homes are disincentivized to accept Medicaid residents. It’s not uncommon for families to place dozens of calls in an attempt to find a care provider for their loved one.

The Medicare site has a feature that can tell you if a nursing home accepts Medicaid.

Income Trusts

When you apply for Medicaid, an income limit is enforced. If your income exceeds this amount, the excess has to be managed appropriately in order for you to get and keep Medicaid eligibility.

Qualified Income Trusts (QITs), also referred to as Miller Trusts, are useful in states where an income cap does not allow spend down on your own care to comply with Medicaid limits. QITs are irrevocable trusts designed to hold excess income with disbursements managed by a trustee.

Period Income Trusts (PITs) are similar to QITs, but for disabled individuals whose surplus income is pooled and managed by a nonprofit. The nonprofit organization functions as the trustee. PITs are not for estate planning. Funds that aren’t used will stay with the trust for charitable use.

Private Annuities and Promissory Notes

Many times, older adults unexpectedly require long-term care when they have either transferred assets within the look-back period or still hold meaningful assets. Divesting these assets within the look-back period automatically triggers a penalty. The penalty time period is the number of months someone is ineligible for Medicaid. The penalty is calculated by dividing the value of assets by Medicaid’s regional monthly rate for nursing home care.

A 2006 law allows you to preserve some assets while still qualifying for Medicaid by using a private annuity or promissory note to pay the nursing home over a shorter penalty period. It’s a bit confusing, so an example will help demonstrate how it works.

Jane has a bank balance of $300,000 when she suddenly needs nursing home care. She’d like to pass some of those assets on to her daughter, Susan, but she doesn’t think she can because she is way past the look-back period. She figures all she can do is spend down her assets before applying for Medicaid to cover her care.

Jane is correct in thinking that if she gives the $300,000 to Susan, she will be penalized by Medicaid. If the average cost of a nursing home room in her area is $5,000 a month, then that would make Jane ineligible for the full five year look-back period. All of her assets would be spent on her care, and none would go to Susan.

However, if Jane gives Susan $150,000, the penalty period changes to 30 months. With her remaining $150,000, Jane can buy a private annuity or promissory note that will provide a monthly income of $5,000. She can use this income, combined with her Social Security check, to pay for nursing home care during the shortened penalty period. When 30 months have passed, she’ll be in the nursing home with Medicaid coverage and Susan will be able to keep $150,000.

It may not be as good as what could be achieved if Jane had planned ahead, but it’s a great strategy to pass along some assets in a pinch.

Caregiver Agreement

This strategy can work well in a situation where you want or need extra services above and beyond what a nursing home provides and Medicaid covers. A family member or friend can get income this way, and you can get care from someone you know and trust. Payment for these services removes that amount from your countable resources.

To pay a caregiver in advance, you must have a pre-determined agreement in place that adheres to specific rules.

  • The agreement defines the services that the caregiver will provide and the hours she or he will work. 
  • You have figured the payment using a reasonable life expectancy and valid market rate for services.
  • The caregiver has to keep a daily log of services provided and hours worked, as well as written invoices.
  • When the patient dies, the caregiver must pay back unearned funds to Medicaid in an amount up to that which Medicaid paid for the patient’s care. 

Spousal Transfers and Refusals

Between spouses, Medicaid allows transfers that are not subject to a look-back period or any penalty. Thus, a classic strategy is to place assets that are in the name of the spouse who needs care into the name of the well spouse.

Some states allow spousal refusal. In this case, the well spouse refuses to provide financial support for the spouse who needs care, enabling that spouse to qualify for Medicaid. However, when Medicaid begins providing services it will pursue contributions from the well spouse. Sometimes, Medicaid does not seek its rights, and in others, it will settle at a discount. Reimbursement to Medicaid will always be lower than paying the inflated private pay rate that would have been charged.

Elder Law Attorney Critical

The final step is to contact an elder law attorney who specializes in Medicaid. While it is important to familiarize yourself with various strategies for asset protection, only a specialist can ensure your plan is the best available option for your situation.

To complicate matters, each state has its own system for Medicaid services with unique rules that you must adhere to. It’s critical that a qualified elder law attorney draw up documents that comply with state and federal laws to ensure asset protection.

A good attorney can also prevent a relative with the best of intentions from gifting a Medicaid recipient money that could result in disqualification from the program.

Also, Medicaid rules change often. An elder law attorney will be aware of recent modifications and can keep you informed of future changes that may affect your plans.

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


Blog posting provided by Society of Certified Senior Advisors

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As We Age, Healthy Sleep Without Prescription Drugs

Numerous surprising new products help restore and improve slumber for older adults who don’t want to resort to drug therapy.

Many seniors have trouble getting to sleep or staying asleep. As we age, insomnia increases due to various factors, including the use of caffeine, tobacco and alcohol; poor sleep habits; medications; and disease.

Particularly as we enter our 50s and beyond, the amount of slow-wave sleep we get decreases. This occurs even if we are still getting a good eight hours of sleep a night. Slow-wave sleep is also called “deep sleep.” It’s considered to be important for memory consolidation and processing. Studies of sleep deprivation with human volunteers suggest that the most important function of slow-wave sleep is brain recovery from the daily stress of mental activity.

Insomnia is the inability to experience restorative sleep, and it’s a problem for about half of adults over the age of 60 in the U.S. Insomnia may result from an inability to fall asleep, or multiple episodes of wakefulness during the night. It can even happen if you wake too early and are unable to get back to sleep. Whatever the cause, insomnia leads to a feeling of exhaustion and “brain fog” the next day.

Primary insomnia is a condition that arises independently, but older adults often tack on secondary insomnia due to medical conditions or the side effects of prescription medications.
Sleeplessness should not be taken lightly. The condition has been linked to depression, anxiety and other psychiatric disorders. New research even points to sleeplessness as a cause of cognitive dysfunction, diabetes and Alzheimer’s. Researchers have found that the protein deposits that are characteristic of this cognitive disease may clear during deep sleep.

Try This First

You may be able to modify your habits and/or environment to get a better night’s rest without resorting to drugs or technical sleep aids. Altering even one of these may be the key to improved rest, so make sure you can tick off each item before you give up. Even if you need further adjustments, you will have created a solid foundation.

Behavioral modifications:

  • Don’t nap during the day.
  • Don’t use your bed for activities like reading or watching TV.
  • Exercise every day.
  • Avoid alcohol, tobacco and caffeine, especially within four hours of bedtime.

Environmental modifications:

  • Keep the bedroom very dark at night.
  • Keep the bedroom quiet.
  • Make sure the temperature and humidity are conducive to sleep.
  • Use comfortable bedding.
  • Get plenty of light exposure during the day.

What About Marijuana

More and more people of all ages are beginning to consider marijuana for various health issues. Of course, your doctor should approve any drug before you try it. Cannabis has a reputation for helping users fall asleep. Two of the main components of marijuana are cannabinoids and terpenes, both of which affect slumber.

Cannabinoids, including CBD, are being studied for their beneficial effects on depression, anxiety, Alzheimer’s and Parkinson’s, among others. They also appear to help induce sleep. THC, the product that gives the “high” associated with marijuana, has sedative effects. Recently, it’s been found to improve breathing during sleep (potentially helpful for sleep apnea). Studies also seem to show that THC increases time spent in slow-wave sleep.

Terpenes are the tiny molecules in marijuana that create its distinctive smell and taste. They also occur in many other plants, fruits and flowers. Among the many terpenes, several have been shown to have sedative effects. Some terpenes improve mood by elevating serotonin levels, and others reduce anxiety and stress, or ward off depression.

For a more complete discussion of marijuana and sleep, see a blog on the topic by Dr. Michael Breus.

Alternative Answers for Better Sleep

There is a plethora of pills that doctors prescribe to help induce or extend sleep. Check this list of pharmaceutical sleep aids. However, many older adults want a better solution because they don’t want to risk unwanted drug interactions with medications they are already taking. Others simply don’t want the risk of side effects from prescription drugs, and are looking for an alternative. Indeed, there are several recent developments to counter sleep-onset insomnia that look appealing.

Ebb Insomnia Therapy.  Created by a doctor, this device “gently cools the forehead” to a temperature within a therapeutic range to reduce abnormal elevations in frontal cortex metabolism that can inhibit sleep. It’s FDA-cleared for primary insomnia, and can calm “racing minds” that prevent restful slumber. A randomized, placebo-controlled study of 106 adults showed significantly reduced time to get to both Stage 1 and Stage 2 sleep (the two stages of light sleep). A licensed physician or nurse practitioner has to write a prescription for a patient to get the device.

Nightingale. If troublesome noises are a problem, Cambridge Sound’s Nightingale may be the answer, even if you’ve tried other noise machines. Dual units work in tandem to create a sound curve, immersing the room to mask disruptive noises. Because there are two speakers, the brain can’t locate the source of the sound, making it more effective than traditional machines that mask noises. Nightingale is not regulated by the FDA, nor is it reimbursable as therapy. It is available without a prescription.

Kortex. This general wellness device combines virtual reality (VR) with neurostimulation that “stimulates the brain to produce serotonin and melatonin while lowering cortisol” to enhance sleep. Born from the Fisher Wallace Simulator medical device, the Kortex is designed for the everyday consumer who needs help getting to sleep. Less than 1 percent of patients were found to suffer any side effects in trials, and these were minor, such as temporary headaches and dizziness. There are also no contraindications with medicine, and you don’t need a prescription to get one.

2breathe. Leveraging the known benefits of slow breathing and soothing music, this smart device and app pair guided breathing with a wireless respiration sensor and realtime coaching technology. Personalized, adaptive guiding tones from the user’s breathing have been shown to reduce neural sympathetic activity within minutes — with absolutely no training. Research on device-guided breathing technology has demonstrated stress reduction for cardiovascular therapy, and now for mitigating insomnia. It is not FDA-regulated but comes with unlimited customer support.

Dreampad. As the Dreampad plays music through vibration that travels to the listener’s inner ear, it triggers a relaxation response. The music is specifically designed for sleep, helping release the listener from anxiety-based circular thoughts. Supported by research with adults and children, it works for those with minor sleep issues as well as people who have tried cognitive behavioral therapy without success. In a Columbia University Medical study, the Dreampad notably achieved statistically significant results in the areas of nighttime awakenings and deep sleep. As a relaxation tool rather than a medical device, it is not FDA approved but may be reimbursable.

Meditate Yourself to Sleep

If technical gadgets don’t interest you, try mindfulness meditation. A study on mindfulness meditation to enhance slumber in the Journal of the American Medical Association revealed that meditating was more helpful for middle-aged and older adults than learning better sleep habits. It turns out that meditation evokes a relaxation response, making it easier to get to sleep.

“Mindfulness meditation is just one of a smorgasbord of techniques that evoke the relaxa-tion response,” says Dr. Herbert Benson, director emeritus of the Harvard-affiliated Benson-Henry Institute for Mind Body Medicine. The opposite of the stress response, learning the relaxation response can help overcome depression, pain and high blood pressure. Dr. Benson notes that many sleep disorders are linked to stress.

Mindfulness meditation involves concentrating on your breathing to pull your mind away from racing thoughts and into the present moment, evoking the relaxation response. The study found that 20 minutes of meditation every day achieved results. It should be done sitting up or moving (such as with yoga) to avoid nodding off! And it’s easy to learn.

First, choose a calming focus. This can be your breath, a sound, a short prayer or word. If you picked a sound, say it aloud or silently as you exhale. Second, don’t worry about how well you are meditating. Your mind will wander, especially when you are first learning to meditate. When you notice thoughts coming in, take a deep breath, repeat your calming focus, and pull your attention back to the focus.

Older adults may have more challenges getting to sleep and staying that way, but there are plenty of alternatives to prescription drugs that may help reduce or eliminate the problem. Whether you choose to change your sleep environment, add in meditation or embrace a technological sleep aid, a good night’s rest may not be far away.

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


Blog posting provided by Society of Certified Senior Advisors

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The VA Serves Up Apple

Apple takes another bite of the personal health market by linking up with the nation’s largest integrated health care system.

Tech giant Apple has more up its sleeve than a smartwatch. The company is partnering with the U.S. Department of Veterans Affairs (VA) to provide personal health records to veterans. This summer, the more than 9 million VA users will be able to see their health care records on their iPhone with a few quick clicks.

The Health Records app will provide information on allergies, conditions, immunizations, lab results, medications, procedures and vital signs. It will include statistics from wearables such as the Apple Watch, as well as data from providers who have agreed to share information. After a visit to the VA, the veteran’s health record will update in a mere 24 hours.

Push the Blue Button

Conceived in 2010, the Blue Button concept was “aimed at enabling more direct consumer access to personal health information by adding a ‘Download My Data’ button to VA patient portal systems.” The concept is a collaboration among the Centers for Medicare and Medicaid Services, the U.S. Department of Defense, and the Markle Foundation’s Consumer Engagement Workgroup. The available data combines self-entered statistics, electronic health records and military service information all in one place.

Frustration from the country’s fragmented electronic medical records system is legendary. One doctor said that when a patient with a complex medical history comes under his care, “It’s like opening a book to page 200 and being asked to write page 201.” Patients undergo duplicate procedures or fail to have them at all because their medical histories are missing critical information. Some experts say that health information technology that is both consistent and comprehensive could save billions of dollars annually.

Apple may begin to fill these critical needs, and our nation’s veterans deserve the best the country has to offer.

Apple Health Records Successful 

Launched in 2018, Apple Health Records took over where efforts abandoned by Google and Microsoft left off. The VA’s questionable history of patient service may have some wondering if this new push will be as beneficial as hoped. However, an early study was overwhelmingly positive.

More than 90 percent of respondents in an early trial of Apple Health Records at UC San Diego reported that it enhanced information sharing and understanding of their health. As a result, the UC Health system gave Apple Health Records access to all 5 million of its patients.

“By building upon the Veterans Health API, we’re raising the bar in collaborating with private sector organizations to create and deploy innovative digital products for veterans,” VA Secretary Robert Wilkie said.

The initiative is part of the Blue Button push to allow veterans increased control of their health and medical information. The thinking is that third-party developers can innovate with applications to use the data more effectively.

“When patients have better access to their health information, they have more productive conversations with their physicians,” Apple Chief Operating Officer Jeff Williams said in a statement. “By bringing Health Records on iPhone to VA patients, we hope veterans will experience improved health care that will enhance their lives.”

Apple Dominates Health Care

Readers may think that’s fine and dandy, but what about those who don’t have an iPhone or Apple Watch? The VA is reaching out to other potential partners to expand services on other mobile platforms. However, Apple is becoming a dominant force in the health care industry.

Apple stock was recently upgraded by Morgan Stanley, where analysts cited the company’s emergence as “a leader in consumer-centric health care” and the company’s image “as a steward of data privacy.” Apple is moving away from a saturated smartphone market toward a novel health care ecosystem. The investment bank lauded the company’s move toward digital disruption in U.S. health care as Apple’s products can already track a user’s heart rate and administer electrocardiograms. A partnership with medical institutions and Johnson & Johnson is making strides toward stroke prevention, better atrial fibrillation outcomes and medication adherence.

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


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Coffee Break - Older Adults: Best Food for Your Pet

Many older adults dote on their dog or cat, but that doesn’t always mean the animal is getting the nutrition it needs.

Older adults love their pets, and an increasing number of seniors are pet owners. While a decade ago just 34 percent of those age 70 and over had a pet, this number rose to 40 percent in a recent report  on pet ownership trends in the U.S. With so much changing information around pet care and the increasing tendency to treat our four-legged companions as family, it’s worth taking a look at what experts say about optimal feeding.

Dog and Cat Nutrition

We all want to feed our pets well, but sometimes the limited budgets of seniors can get in the way. Another common barrier is confusion regarding exactly what a good diet contains. There are so many confusing ingredients in pet food that it’s impossible to tell which is better than another. And how is it possible to know if your pet has an allergy?

Take an old leather belt, some used motor oil and a portion of sawdust. Grind them up, mix them together and let them dry. Send the result to a food testing laboratory for an analysis. It will be rejected, right? Wrong. This uninviting mix contains:

  • 32 percent protein
  • 18 percent fat
  • 3 percent fiber

That’s comparable to the ratios listed on the bags of many pet foods. Leather contains protein, motor oil is a source of fat and the sawdust provides fiber. That illustrates how important it is to find the source of all those ingredients in your pet’s food. While we don’t know of any food that uses those ingredients, there is a big difference in sources that sound like similar products.

The very first thing to look for on a pet food label is the statement that the food it contains is “complete and balanced.” This is not meaningless jargon, but guarantees the food follows strict dietary requirements dictated by the Association of American Feed Control Officials (AAFCO). The food must contain all necessary nutrients in the guaranteed analysis, which lists minimum amounts of crude protein and fat, as well as maximum percentages of water and crude fiber. You can always call a specific company to ask about the food it makes. Here’s a list of questions to ask company representatives. The list, from the World Small Animal Veterinary Association, contains a lot of helpful information on what answers you might expect.


Meat is a surprisingly confusing ingredient. Many dogs are allergic to beef. Whole meats have a high percentage of water weight, meaning that the percentage of meat can appear lower after processing. Meat meal may not sound very appetizing, but it contains no water to alter the calculation.

Take a look at the product name. You might think that “Beef,” “Beef Dinner” and “Beef Flavor” are roughly equivalent, but you’d be mistaken. If the name says “beef,” that ingredient must make up at least 70 percent of the product. Move to “beef entree,” “beef dinner” or “beef platter,” though, and the requirement is for a mere 10 percent of beef in the offering. If it says “with beef,” then beef may be as little as three percent of the total, and “beef flavor” only needs to be enough to make the product taste beefy. The same holds true for any other protein.

Cat owners should be aware that their pets are what is known as “obligate carnivores” because they must eat meat to live. They have lost the ability to make certain amino acids and vitamins in their bodies like herbivores and omnivores do. Even their digestive tracts are quite short compared to other mammals. Raw meat is highly digestible.

In fact, meat is highly digestible for dogs, too. It can be broken down into small particles and transported in the bloodstream quicker than other sources.

Protein requirements of pets can vary according to the stage of life and species. Cats need more protein than dogs do. Growing puppies and kittens need more than adults. Generally, adult dogs need a minimum of 18 percent, and adult cats require at least 26 percent protein, according to AAFCO. Higher levels may be needed for very active animals, or those which are ill.

The ingredient list that is mandatory on every cat or dog food label can do more to confuse owners than clarify matters. Fortunately, Skaer Veterinary Clinic offers this exhaustive list of pet food ingredients with descriptions for every entry. Consult it to learn about everything from animal digest to yucca schidegera.

The Top 7 Dog Nutrition Myths

There’s a lot of information — and misinformation — floating around the internet. It can cause even the most diligent researcher to throw up their hands in despair. It helps to know the most common myths that are circulating, and the truth behind them. The American Kennel Club has produced a helpful fact sheet so you can tell truth from fiction.

  1. Never feed your dog pork. Why do so few commercial dog foods contain pork? Apart from a lot of hogwash regarding pork’s high fat content (about one-third that of beef), toxicity (the exact element is never identified), and tendency for pigs to eat bugs (like chickens), the answer seems to be that humans eat just about every part of a pig, from snout to tail, leaving very little for the pet food industry. According to veterinarian Al Townshend, “Pork is a highly digestible animal protein, an excellent source of amino acids,” and it’s less likely to cause an allergic reaction than some other protein sources. 
  2. Lamb is hypoallergenic. Lamb was initially used in hypoallergenic dog food (a diet that doesn’t trigger allergies and their potential adverse effects) because so few canines had been exposed to it, and were therefore unlikely to have developed an allergy to the meat. With lamb a more common ingredient nowadays, you’ll see exotics such as duck and bison in hypoallergenic foods. 
  3. High-protein diets cause kidney failure. Some say that you shouldn’t tax kidney health by feeding too much protein. However, this hasn’t been proven and in fact bodybuilders, rats and other study subjects fed high levels of protein have shown no such ill effects. The myth evidently arose from an admonition to avoid high protein levels with dogs that have kidney failure. However, this advice is currently under consideration. What is true is that a dog fed too little protein will draw on its own source, its muscles, causing harm. The current recommendation is to feed a moderate level of high-quality protein. 
  4. Meat is better than meat meal. Is it better to have one or the other come first on a list of ingredients? If you want the most meat nutrients, choose meat meal. Ingredients appear in order of descending weight, and there’s less water in meat meal. Keep in mind that if several meat sources are listed, it is their value together that comprises protein from meat sources.
  5. Grain is bad for dogs.  While it’s true that some dogs are allergic to some grains (they can also be allergic to particular meats), grain is fine for most and may even be more nutritious than ingredients used to replace it in grain-free diets.
  6. Raw eggs will make a shiny coat. There are no studies to show this is true. However, eggs contain protein, fat and vitamins, including biotin, which is widely accepted to be helpful for human hair. Diets high in fat have proven to result in glossier, softer coats, whatever the source. 
  7. Dogs don’t like variety. This is a great claim by dog food makers to keep you buying the same product. In fact, dogs raised on the same diet are hesitant to accept new foods. But dogs that have choice prefer variety, and will seek out food that contain nutrients its current diet lacks.

Human Food for Pets

Finally, we all like to hand Scruffy the last bit of our peanut butter sandwich, or give Bitsy a piece of turkey drenched in drippings. They lick their chops and get so excited, who can resist? But where is the line between helpful and hurtful? Many veterinarians recommend no more than a quarter of your pet’s food comes from your own plate in order to maintain the proper ratios of ingredients, and a healthy amount of minerals and vitamins. It’s also important to familiarize yourself with people foods that can kill your pet.  Tasty foods such as avocados may seem harmless, but they can be deadly for your best friend.

Kibble vs. Canned Food

Both dry dog food and wet have their pros and cons. Canned foods usually contain less grain and carbohydrates. Kibble adds up to 50 percent of these so the food can go through the machinery needed to form it into pieces. As a result, canned foods typically have more fat and meat protein than kibble.

Canned food also offers a “cleaner” product that contains fewer chemical additives. The canning process acts to preserve the food without additives. You probably know that you can’t leave canned food out for long without it spoiling, and it has a short refrigerator life. However, you are less likely to find artificial flavors and colors in canned food.

The liquid content of canned food is high, around 75 to 82 percent. This makes it easier to digest and less of a strain on an animal’s kidneys. But it also means you have to feed more of it to achieve the same mass as a similar weight of kibble food.

Now the downsides of canned food. A number of thickening agents may be used, among them carrageenan, which has been associated with inflammatory bowel disease, acid reflux and intestinal ulcers. The cans are often lined with BPA, a substance that Canada, the E.U. and the U.S. have recently banned in baby bottles as a toxin.

Canned food is also more expensive than kibble, especially if you have a large dog. And the cans weigh a lot more and are more difficult to carry around than a bag of dry food. The answer for many people is to buy a higher quality kibble than is typically available in the grocery store. Here’s one list of the best dog foods of all types to consider for your pet. Feline Living offers this similar list of top cat foods. Although there is much debate, some sites provide list of the worst dog food and worst cat food. You might be startled to see familiar brands listed.

What About Freeze Dried?

Freeze-dried raw food is all the rage, and there are plenty of reasons to sing its praises. The low  (three to five percent) moisture content makes it easy to store in an unopened package at room temperature. Dogs love the taste when rehydrated, whether it’s because of minimal processing or the delicious flavor. Many old or ill dogs will eat freeze-dried food when nothing else is appealing.

And the ingredients in most freeze-dried dog food are some of the best money can buy. Most companies are targeting the top end of the market and take care to source top-quality ingredients, such as organic, grass-fed beef and free range chicken. You are also going to pay a pretty penny, no, make that a LOT of pretty pennies, for top quality food. It may not matter if you have an unlimited budget, a small dog or a cat, or if you prefer to use freeze-dried food for convenience when traveling with your pet. Check here for more information on raw, freeze-dried dog food and recommended brands. Check here for raw, freeze-dried cat food recommendations.

Older Pets

We can’t be finished without addressing the unique needs of senior pets. After all, we are certainly aware that our own nutritional needs have changed, and we know how important good nutrition is for overall health. It’s no less critical for our furry family members who are aging with us.

What is an “older” pet? Here are a couple of handy charts to help you figure it out, one for cats and the other for dogs.

Age: Human equivalents for older pets

Cat Years Human Years
7 54
10 63
15 78
20 97

Dog Years Human Years
7 Small - Medium: 44-47
Large - Very Large: 50-56
10 Small - Medium: 56-60
Large - Very Large: 66-78
15 Small - Medium: 76-83
Large - Very Large: 93-115
20 Small - Medium: 96-105
Large - Very Large: 120

From the American Veterinary Medical Association, Senior Pet Care (FAQ)

Geriatric pets need foods that can be digested easily, and that may require a change of diet. It’s quite easy to overfeed them, and weight gain can make issues such as arthritis worse. Exercise is important to control excess weight. In cats, older individuals are more likely to become underweight. Consult your veterinarian to make sure your pet is getting the proper nutrition for their age.

Final Word

Pets can keep us from feeling lonely, listen to our deepest secrets without telling a soul, and give us a reason for getting up in the morning. Having a pet to walk can improve our own health immensely, and give us back so much more than we give. Consider adopting a homeless shelter animal that is looking for stability and a new friend. The “seniors for seniors” pet adoption program is available all over the country, matching an older animal that is likely to be lower-energy with an older owner. Type the program into the search box along with your locality, or simply ask for an older animal at your local shelter. Wherever you find your new best friend, we wish you the best!

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


Blog posting provided by Society of Certified Senior Advisors

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Famous and 65

Look who's turning 65 this month

May 5 - Dave Spector, TV Personality

This foreign TV personality has lived and worked in Japan since 1983, when he moved there to research film clips from the country for use on American TV show Ripley’s Believe It or Not!

His fluency in Japanese has garnered him serious spots discussing foreign events, and he founded Spector Communications, headquartered in Tokyo, in 1988. He is one of the most respected commentators in Japan among all age groups.

Spector starred in TV commercials in America as a child, including one for breakfast food powerhouse Kellogg. An immigrant classmate from Japan got him interested in the country in fifth grade when they became friends. Spector started learning Japanese with weekly classes at his friend’s Sunday Japanese school. Studying with other Japanese students, he wound up class president of their graduating class and amazed the community by becoming the first non-Japanese person to win the Chicago Japanese speech contest. Spector even studied at a University in Tokyo before enrolling at the Institute off Broadcast Arts in the U.S.

May 15 - Robert P. Harrison, Thinker

Born in Turkey, Harrison is a professor of Italian literature at prestigious Stanford University. He has published numerous books, beginning his career in academia as a Dante scholar. His work then expanded to encompass the Western literary and philosophical tradition, with a concentration on people’s place in nature.

In Gardens: An Essay on the Human Condition, he argues that gardens contain “the vocation of care” at the inner core of our humanity. His musings are based on a conception of man’s place in the natural world based on death (perhaps darkly influenced by his early exposure to Dante).

The writer has also contributed a number of essays and articles on subjects ranging from poetry to architecture, John Muir to Nietzsche. And to let loose in his off-hours, Harrison plays lead guitar for cerebral rock band Glass Wave. You can hear him on their 2010 album by the same name.

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May 20 - Guy Hoffman, Musician (Violent Femmes)

Hoffman’s musical career began early, when he started playing drums at the age of nine. However, he became more interested in watercolor painting at the University of Wisconsin Milwaukee where he majored in fine arts while playing gigs with local bands around the state. Always drawn to the punk scene, Hoffman was an original member of BoDeans, a Milwaukee enterprise.

In 1993, Hoffman became a member of the Violent Femmes, where he drummed on “Blister in the Sun” and in film concerts such as “Woodstock ’94.” As the band gained fame, Hoffman went on late-night talk shows around the world as well as appearing in a number of music videos. He also used his old graphic arts degree to design the cover for their New Times album.

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


Blog posting provided by Society of Certified Senior Advisors