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Wednesday, May 25, 2022

Genetics Affect Drug Reactions in Older Adults



Increasingly, patients with Alzheimer’s, cancer, depression, chronic pain and cardiovascular disease are getting genetic testing to personalize and optimize their quality of care.  


Pharmacogenetics, also known as pharmacogenomics, is the study of how genes affect an individual’s response to drugs. Genetic testing searches for changes or variations in genes that may signal which medication might be the most effective or have fewer side effects for a particular patient.

Genomic Testing

For example, scientists have been working to understand why antidepressants help some people but don’t work for others. Humans use cytochrome P450 enzymes to process medications. These enzymes vary in different people due to inherited (genetic) traits, causing medications to affect each person differently. Your doctor can use a cytochrome P450 (CYP450) test to investigate how your body metabolizes a certain drug. The test can provide information about how you may process different medications.

Poor metabolizers have less active or inactive alleles, which are gene variations caused by chromosomal mutations. This places them at a higher risk of overdosing or experiencing an increase in toxicity with some drugs. On the other hand, ultra-rapid metabolizers can experience a lack of drug efficacy because medicine leaves their body too quickly, before they can work as intended. However, prodrugs such as clopidogrel and codeine can induce the opposite reaction after metabolization.

CYP450 2D6 Testing Available

It is possible to get a genotyping test via the internet. PUSH Health uses a licensed medical provider and Quest Diagnostics labs to collect information and samples. Results are delivered electronically in about four business days for a total of $154.51, which is typically paid privately. (Check first to see if your health insurance provider will cover the cost of any needed testing. Some do.)

The PUSH Health website states that the test checks for proteins that may play a role in “hormone, cholesterol and vitamin D metabolism,” and that the test can also “help with managing dosing for medications treating mood disorders.”

Genotyping tests like CYP450 are used in other areas of medicine too. A CYP2D6 test is valuable in determining which cancer drug, such as tamoxifen for breast cancer, is likely to be most effective for treatment. The CYP2C9 test can help doctors pinpoint the right dose of the common blood thinner warfarin to avert dangerous side effects. 

Drugs Often Ineffective, Dangerous

While 4 billion prescriptions are written every year in the US, only about half demonstrate the expected therapeutic efficacy. Adverse drug reactions (ADRs) are the fourth leading cause of death and cost an estimated $136 billion annually. According to research, genetic factors can impact up to 95% of a person’s drug response and are estimated to be a factor in up to 20% of total reported ADRs.

Furthermore, the COVID-19 pandemic forced growth in the field of personalized care and boosted demand for pharmacogenomics, as drugs were used before FDA approval, for compassionate use, or in clinical trials. In recent years, regulatory agencies worldwide, including the FDA, have approved the aggregation and dissemination of pharmacogenomic (PGx) information on hundreds of drug labels.

Use Still Infrequent

However, doctors are not always on board. In 2012, over 10,000 US physicians conducted a nationwide survey by US physicians revealing that although 97.6% of respondents agreed that genetic variations may influence drug response, only 10.3% felt adequately informed regarding pharmacogenomic testing. Additionally, only 12.9% of the doctors had ordered such a test in the last six months, while 26.4% anticipated doing so in the next six months. Only 29% of all respondents had received any education in the field. Those who had were more likely to incorporate testing in their practice. 

A 2019 study did not find much progress. Researchers noted that 

“in the last years, health authorities such as Health Canada and the FDA have set PGx biomarker information on labels of over 100 and 200 drugs, respectively. Despite these recommendations, the use of PGx testing in routine clinical care remains infrequent. Reasons that explain the slow uptake of PGx in clinics include unfamiliarity of health care providers with PGx, cost associated with testing, time constraints, absence of clear clinical guidelines, lack of easily accessible tests, and several ethical considerations."

Technological Advances Enable Genotyping

It is only recently that the field of pharmacogenetics was made possible by advances in genetic research and data gathering. Electronic medical records (EMRs) have provided a massive influx of statistical data that has barely begun to be mined, covering symptoms, diagnostics, biomarkers, therapy, and adverse effects. . In the future, artificial intelligence will enhance discovery and impact everything from medical devices to lifestyle management solutions. 

The role of PGx in therapy optimization is continuously evolving. Currently, some applications have proven very effective. One such application is dosing for the anticoagulant warfarin, in which 60% of individual variability in dosing can be explained by the analysis of three enzymes, combined with an individual’s age and weight.

In fact, a 2016 review of 80 studies found that 55% of those studies showed that PGx testing was cost-effective, 16% demonstrated that PGx was cost-saving, and 13% showed it was cost-dominant, defined as being both cost-saving and clinically beneficial. 

One challenge that remains is implementing PGx testing on a broader level so that patients could present the information to healthcare professionals as a matter of course. The goal would be to prescribe the right drug for the right patient more often. Additionally, it would generate an enormous sum of data to improve research outcomes and speed quality and cost-effectiveness. 

The quickest route to improved PGx testing is, in appropriate circumstances, for patients to request it, healthcare professionals to use it, and healthcare facilities to incorporate its use in care.





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Tuesday, May 24, 2022

Asset Location: Which Assets Should Seniors Hold in What Accounts?



Want to pay less in taxes next year? Follow our advice on asset location, both before and in retirement, to avoid giving more money than necessary to Uncle Sam.  


"You can't control market returns, and you can't control tax law, but you can control how you use accounts that offer tax advantages — and good decisions about their use can add significantly to your bottom line," says Matthew Kenigsberg, Vice President of Investment and Tax Solutions at Fidelity Investments. 

Your biggest expense in retirement may not be home maintenance, travel, or even health care. Taxes may be your largest bill, according to government non-profit FINRA, which oversees US broker-dealers. https://www.finra.org/investors/learn-to-invest/types-investments/retirement/managing-retirement-income/taxation-retirement-income Part of savvy financial planning is to minimize taxes by allocating different types of investment assets to different accounts.

Two Kinds of Investment Taxes

You may already be aware that there are two main types of taxes on investments: 

Ordinary tax is what you pay every year based on your income, and it can vary from year to year. You pay ordinary tax on interest and dividend income. Ordinary tax can vary from zero to 37%. (Check your rate here).

Who Benefits Most From Asset Location Strategies?

Four criteria determine how much you can benefit from asset location adjustments. Even if only one applies to you, it’s worth checking into. The more criteria that apply to you, the greater the potential benefit. 
  1. Your ordinary income tax rate is currently high.
  2. You think you’ll pay a lower marginal tax rate in the future.
  3. You have a lot of tax-inefficient investments in taxable accounts.
  4. You are investing for a long time horizon.
Capital gains tax works a little differently. When you sell an asset, such as a stock, the difference between the price you bought it for (the basis) and the price you sell it for is the capital gain (or loss). Currently, capital gains tax can be as low as nothing up to a high of 20% for assets that you have owned for at least a year and a day (known as long-term capital gains). The percentage you pay depends on your income. Assets that you have owned for a year or less before selling are taxed at your ordinary rate. 

Three Types of Investment Accounts 

Most investments fall into one of three main types of accounts:
  1. Taxable accounts include basics like your checking and savings accounts and money in a traditional brokerage account (not connected to a retirement account of any kind). You are taxed at your ordinary rate on dividends and interest, or at the capital gains rate for investments, such as stocks, that increase in value. 
  2. Tax-deferred accounts include retirement accounts such as traditional 401(k)s, 403(b)s, IRAs, and annuities. You don’t pay any taxes on these accounts, often for decades, until you withdraw from them, at which time the money you pull out is taxed as ordinary income. These accounts are subject to required minimum distributions determined by a government formula that start when the holder reaches age 72.
  3. Tax-exempt accounts like Roth IRAs, Roth 403(b)s and Roth 401(k)s hold assets, often for decades, that will not be taxed at all upon withdrawal, nor will it increase in value. Interest and dividends will not be taxed. Additionally, a Roth is not subject to required minimum distributions. You may be wondering why you shouldn’t just switch all your money to a tax-exempt account. Apart from having to pay ordinary tax on money you invest in a Roth, there are income and contribution limits. Health savings accounts (HSA)s are fully tax exempt in that you don’t pay tax on the contribution, and you don’t pay tax on qualified withdrawals. An HSA is only available if you have a high-deductible health plan.

What Accounts to Use for Different Assets

Because different assets are taxed differently, they should not be tossed willy-nilly into any old account. Here is a list of asset types and what they entail:

Taxable accounts are great for stocks and stock funds that you buy and hold. You will get taxed on the dividends every year, but capital gains won’t be due until you sell them. Stock index funds and index ETFs are also good choices since they trade infrequently. Municipal bonds, also known as “munis,” are perfect for taxable accounts since they generate tax-free income.

Tax-deferred accounts (such as traditional IRAs and 401(k)s) are ideal for bonds and taxable bond funds, which otherwise generate interest that gets taxed annually as ordinary income. Make sure you put any inflation-adjusted bond funds, also known as TIPS, here. The value of these funds goes up with inflation, which the IRS will treat as interest income if they are not sheltered. Another use of tax-deferred accounts is for actively traded stocks. Gains from these are treated as ordinary income and taxed annually unless they are sheltered.

Tax-exempt accounts should hold assets that are taxed at the highest rate, which is often your ordinary income tax rate. Assets that are good for your tax-deferred accounts will also be great here with the added benefit that you can withdraw from them without paying a dime of tax. Actively traded/managed stock mutual funds are widely held and can generate significant capital gains. Keep them here for tax-free growth. Note that some HSAs can be invested in stocks; if your HSA doesn’t offer this option, you may want to look for one that does. 

What about cryptocurrency? The government began taxing it for the 2021 tax year, so the decision to invest is an important consideration. If you just buy crypto (including Bitcoin and Ethereum, for example) with dollars and hold it, it’s not taxed. But when you use it to buy something or trade it, watch out. 

“Whenever you sell the investment, or exchange the investment for another investment, that is when a taxable transaction happens,” according to Daniel Johnson, founder of RE|Focus Financial Planning in Asheville, North Carolina. “You’ve got to be careful if you’re doing a lot of trading. If you’re going in and out of different types of cryptocurrency, every single time you place that trade, it is a taxable event.”

Asset location is an important part of tax-reduction strategy before and during retirement. Comb through your existing accounts to see if there are any allocations that should be switched over, and make sure to follow the guide when you make changes in the future. Knowing how to utilize the tax advantages you have at your disposal can help ensure your money lasts longer than you do.




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Thursday, May 19, 2022

The “Affinity Communities” Trend is Set to Explode for Over-60s



Tapping into a common human desire to form friendships with people having similar interests, outlooks, or backgrounds, affinity senior communities attract like-minded older adults from across the country.  


It is not just golf courses that unite older adults within a housing community these days. The trend is taking off for dog lovers, LGBTQ people, travel buffs, and many more subsets. Some have been in operation for decades, but many are new to the concept and expanding the definition of what an “affinity community” can be. 

Many existing communities exemplify the trend, although they may not feature a formalized care component. Older Asian Americans can take advantage of the assisted living community at Aegis Gardens in Fremont, CA. Retired musicians, actors, writers, and artists (or those who wish they had been) can find an apartment at the Burbank Senior Arts Colony in Los Angeles. Summertown, TN offers cabins for nature enthusiasts at Rocinante. Retired letter carriers even have their own gathering place at Nalcrest in Central Florida. 

Finding Your Own Niche Community


You may be wondering how to go about finding your own affinity community. One way is to simply do an online search. There is a senior living provider that has trademarked “Affinity,” so be sure to double-check search results. 

Another avenue is the Private Communities Registry (PCR) website. You can input a state or country and filter amenities to find results. Looking for a community with a dog park in Georgia? Housing with fishing in Montana? PCR can match you up. Be aware that these are master-planned communities and may include all ages or lack assisted living facilities, etc. Still, this is a great place to start looking for an inclusive new home.


University Communities

Intellectual stimulation and cultural opportunities are available at university-based retirement communities (UBRCs). These are located on or near college campuses, allowing residents to audit courses or participate in research. There are more than 50, and can be found at universities like Penn State, Dartmouth, Stanford, Cornell, and Notre Dame. Most also offer skilled nursing care.

One UBRC is Kendal at Ithaca, near Ithaca College and Cornell University in upstate New York. Residents interact with college students on a variety of projects. When the three dining areas needed a redesign, students executing the project built full-size models and made videos so residents could provide input. Kendal at Ithaca is also a study center for aging and memory. 

"Cornell has realized that we're a living laboratory for studies in aging, so our residents get interviewed, and we're constantly fielding proposals from graduate students for research projects," says Betsy Schermerhorn, Director of Marketing and Admissions for Kendal at Ithaca.

"It's good for us because it helps residents keep up-to-date with the university," says resident and former Cornell administrator and professor Cindy Noble, "and it's good for Cornell because it keeps them in contact with former faculty and alums, many of whom are loyal donors.”
You don’t have to be affiliated with Ithaca or Cornell (or any college or university) to join Kendal at Ithaca, however. Many are attracted by the winding trails, creative arts studio, library, and dog play area. The winemaking group sets up tastings in Kendal’s wine cellar, and there’s a local theater.

Endless Options

About 200 to 300 residents are needed for a thriving retirement community. That’s a fairly low bar for entry, especially since these communities generally allow anyone access. That makes for more diverse options. Yes, there really is a community specifically for Jimmy Buffett enthusiasts at the Latitude Margaritaville in Hilton Head, FL. Go to Rainbow’s End in Livingston, TX to gather with other RV owners and find assisted living options as well as respite care. 

People born in another country may find comfort in one of the many communities geared toward specific ethnicities. Native American, Hispanic, and Greek American senior communities are some of the most popular around Chicago, while some in California cater to Japanese Americans and Chinese Americans. Residents can speak their native language, celebrate native holidays as well as those of their adopted country, and eat familiar foods together.

Affinity communities may be particularly attractive for groups that may otherwise feel marginalized. After moving to the LGBTQ community Rainbow Vision in Santa Fe, NM, resident Patrick Russell, a retired university administrator, finally felt understood and at home. 

"I'd never been at a place where I was in the majority," says Russell of Rainbow Vision. "It's become so matter-of-fact here that I forget that being a gay person is the least bit unusual.” There is a cabaret and lounge on the property that is open to the public, offering entertainment to go with the award-winning restaurant and fitness center. 

Various affinity community residents report that these communities seem to function well because friendships are more easily formed among people who share a mindset, vision, or even a hobby. As more and more baby boomers retire, this living trend will doubtless expand.





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Monday, May 16, 2022

A Tech Concierge May Increase Your Business Catering to Over-60s



If you haven’t created a tech concierge position to help clients set up and maintain software and hardware, you may be missing out on creating brand loyalty and increased ROI.  


Seniors are increasingly reliant on technology to stay in touch with family and friends, keep up with finances, monitor their health, and access a host of everyday activities. A recent AARP survey found that most older adults have a more positive feeling about using technology compared to how they felt before the pandemic. However, it is still easy to get hung up when trying to video chat or install a new skill on Alexa, for example. 

The role of tech concierge has come to the forefront for senior living facilities in particular, although it could apply to many businesses serving older adults. Often, these are people who know the organization’s platforms and the devices it uses, and they are trained to help residents and staff utilize the technology.

Outsourcing a Tech Concierge


It is not always easy to fill positions in today’s hiring climate. You may choose to outsource a tech concierge. Sentrics can provide phone support or in-house services. Their phone line is available 24/7, and you will never get a recording or be rerouted. Another such service is Tech Concierge. Both of these companies will help your company’s staff, clients, or both.

“I would encourage everyone to jump in so that you can begin experimenting with this role and seeing how to position it for the future,” says Tammy Farris, Director of Strategic Innovation at Watermark senior living in Tucson. “Because I think it is going to change from what we even know of it today.”

Technology Use Is Growing Among Seniors

Around three years ago, Watermark began offering classes at its senior living facilities to teach residents how to use email, share photos, make video calls, and perform other tasks. This was helpful, but many residents needed more assistance with the tools or wanted to learn how to do other things. In a single community, staff was spending about 60 hours per week helping with tech questions. 

“We were surprised at the volume of requests, and so that’s when we started to talk about this concept of having a tech concierge,” says Farris. United Methodist Communities was on a similar path. They had a technician who traveled between their four retirement communities, beginning about four years ago. Although many of their clients were tech-averse, technology was playing an increasingly important role in their daily lives and providing a higher quality experience. 

“So we knew we had to meet that need, because it was certainly under met,” says Travis Gleinig, Director of IT at United Methodist Communities.

What a Tech Concierge Does

This may be a dedicated position, or it could fall to another staff member as part of their duties. Whichever the case, this person should be trained in how to work with older adults and have expansive knowledge of technology installation and use. On one day, they may be asked to install a voice assistant and set up capabilities, and on another, find and install a magnifier app on a smartphone.

“We’re definitely pulling out job descriptions and postings for multiple positions and emphasizing the ability to embrace technology,” says Farris. “You have to have patience…compassion, and you have to be a good teacher.”

Billing For a Tech Concierge

Many communities are beginning to consider rolling the cost of the position into their monthly charges. After all, it can be a selling point to let families know that a tech concierge is included in the fee.

“If you include from the get-go that technology interaction — ‘You have this, and here’s how you use it, and I’ll come by your apartment when you move in and I’ll get you onboarded’ — that’s a totally different experience,” says Gleinig. “And that’s way more valuable than the community down the road that says, ‘Here, we have XYZ, and good luck.’”

Others are choosing to bill for the time separately, usually in 15 or 30-minute increments. For example, Watermark charges $15 for 15 minutes. “I think it’s definitely going to end up in the direction where a community has a tech concierge as part of the cost of living here,” says Gleinig.

No matter how the position is implemented, it can only help residents and their families feel more confident and cared for. Even as new residents become more tech-savvy over the coming years, technology itself will become increasingly complicated. Having a tech concierge may be the difference between choosing one residence over another.




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Tuesday, May 10, 2022

Seniors Who Became Successful



Plenty of older adults have achieved acclaim after 60. It’s never too late to pursue a passion or try something new.  


It’s easy to occasionally feel like you’re just too old to (fill in the blank). Maybe it involves learning a new skill or doing something that you haven’t done for decades. We can psyche ourselves out as we grow older and fail to even try. Don’t let that happen to you.

There are plenty of stories of people who achieved beyond anyone’s expectations when they were past their 60th birthday. Reading about their success can encourage each of us to expand who we are and what we do, no matter our age. We can still fulfill some of those childhood goals or get inspired to try our hand at something we have never previously considered. Let the following stories inspire you!

  • Harry Bernstein was enduring profound loneliness after the death of his wife of 67 years when he began writing his first book. Drawn from his childhood experiences growing up with an alcoholic father and mother who struggled to feed their six offspring, the book also covers the love story of his Jewish sister and her Christian boyfriend. The Invisible Wall: A Love Story That Broke Barriers was published when Bernstein turned 96. He went on to write three more books, all centering on his life. 
  • George W. Bush, former U.S. president, was 64 when he picked up a paintbrush and embarked on a totally new hobby in 2013. He’s now regarded as an accomplished oil painter and has toured with his portraits of American servicemen and women, as well as paintings of American immigrants. Painting offered the former president a new challenge completely different from the high stakes political decisions he made as head of a world power. Twenty-four of his portraits of world leaders hang in his presidential library located in Dallas.
  • Kenichi Horie was the first person ever to sail solo and non-stop across the Pacific. He completed the voyage from Osaka, Japan to San Francisco in 1962 at the age of 23. Now, he’s 83 and attempting to reverse that voyage, sailing solo from San Francisco back to his native country. At five feet tall, Horie says that he never needs to get in shape for an adventure. “I’m always fine, always in shape … No overeating, no over-drinking.” 
  • Laura Ingalls Wilder was in her 60s when she began writing the story of growing up while America was still being settled by pioneers. It was a gritty memoir of near starvation and hardship laced with the love of her family, but publishers initially rejected it. Some told her it would be a great children’s series if she could tone down the more adult themes. Ingalls Wilder took that advice and expanded her book into one of the most beloved series of all time. More than 60 million volumes of Little House on the Prairie have sold since the author’s daughter, Rose Wilder Lane, encouraged her mother to jot down her memories. That first book that Ingalls Wilder wrote was later published with the title Prairie Girl, in case you’d like to read the version written for adults. 
  • Anna Maria Robertson “Grandma” Moses had wanted to be an artist since she was a little girl, but a hectic life keeping a house of 10 children and maintaining a farm left her no time to pursue her passion. Finally, at age 78, she began painting in earnest and became one of the most preeminent folk artists of all time. Grandma Moses won a slew of awards, had her photo on the cover of magazines, and became a celebrity. In 2006, 45 years after her death at age 101, one of her pieces sold at auction for more than a million dollars. 
  • Mariko Yugeta of Japan is a modern-day example of someone holding onto a dream. A runner in her 20s, she put the sport on hold to raise her four children. It wasn’t until she was in her 50s that she could get more serious about her sport. In 2019, she became the first woman in the world to run a marathon in less than three hours. No one else has since been able to join her in that heady accomplishment. In fact, that record beat Yugeta’s own time of 3:09.21 when she ran her first marathon at age 24. “I’ll keep running for as long as I can,” she says. “There are official records for the over-70 age group, and I’d love to have a go at breaking those.”



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Friday, May 6, 2022

Famous & 65

Look who's turning 65 this month

Find out which celebrities are turning 65 this month!


Image Source: Wikipedia

May 8 - Bill Cowher, linebacker, football coach, sports analyst

Bill Cowher was a team captain, linebacker, and MVP in his senior year playing football for NC State University. However, he had an unremarkable career in the NFL, a circumstance he attributes to helping him become an extraordinary coach. He primarily played special teams during his time on the field and worked hard for his spot on the roster. Cowher thinks such players make better coaches than the guys who headlined and had a lot of success. 

Talk about success…Cowher joined the Pittsburgh Steelers as head coach in 1992 and retired at the end of the 2006 season. In that time, the team won eight division championships, two AFC Championship Games, and a Super Bowl. This amazing record earned Cowher a spot in the Pro Football Hall of Fame in 2020.

Cowher has seen his share of tragedy; his first wife, Kaye, died from skin cancer in 2010. The couple’s three daughters went on to attend college, and two married pro athletes. In 2014, Cowher married Veronica Stigeler. Four years later, the couple moved to New York. 

Cowher has said that life is not about what you accomplish, but rather the lives you touch along the way. He can be proud that nine of his assistant coaches went on to become head coaches in either the NFL or NCAA, and one of his players, Mike Vrabel, is now the head coach of the Tennessee Titans.

Cowher continues to work as a sports analyst on The NFL Today.

 




Image Source: Wikipedia

May 16 - Joan Benoit Samuelson, long-distance runner

One of America’s greatest distance runners, Joan Benoit Samuelson has had a long career defined by records, any one of which serve to preserve her place in history. She was the first Olympic Games women’s marathon champion, triumphing at the 1984 Los Angeles Summer Olympics. She has put down times that have stayed at the top of the record books for decades, winning the Chicago Marathon women’s division in 1985 with a time that held the record for 32 years. Her run in the 1979 Boston Marathon was the fastest time achieved by an American woman for the following 28 years. 

Oh, and about those Olympic trials for the 1984 Games? Samuelson hurt her knee quite severely, and it looked like she was out. She had to undergo arthroscopic surgery just 17 days before the trials were scheduled. It would be impossible to recover from that and run well for two and a half hours, wouldn’t anyone assume? But Samuelson managed to beat her closest rival by 30 seconds to secure her place at the Games, where a gold medal was soon hanging from her neck.

Perhaps what earns Samuelson a mention in a blog dedicated to seniors is her remarkable performance in the 2019 Boston Marathon. Forty years after her first victory there, with her son and daughter running with her, she achieved her goal of running a time within 40 minutes of her winning time in 1989. In fact, she came within 30 minutes of her record time! 

Samuelson currently lives in her home state of Maine, where she coaches women’s cross country and long-distance runners. The high school athletic field is named the Joan Benoit Samuelson Track and Field. She also gives motivational speeches and is a sports commentator. 






Image Source: Wikipedia

May 22 - Lisa Murkowski, US Senator from Alaska

Lisa Murkowski has held a senate seat for her home state of Alaska since 2002, making her the senior senator. A Republican, she is considered a moderate and voted with Democrats to convict the former president of incitement of insurrection in his second impeachment trial. The Alaska Republican Party censured her for her vote.

Murkowski’s father, Frank, is a former US Senator and governor of Alaska. He appointed Lisa to the Senate in 2002 when he resigned his seat to become governor of the state. While the move raised many eyebrows, his daughter ran for and won a complete term in 2004, proving she was capable on her own merits. And in 2010, Murkowski became only the second US senator to win by write-in, defeating both the Democrat and a Tea Party candidate.

She has become consequential on the political scene, serving as chair of the Senate Energy and Natural Resources Committee for six years and as vice-chair of the Senate Indian Affairs Committee since 2021. She worked as an attorney before starting her career in government.





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