Are Seniors Prone to COVID -19, because of Weakened Immune Systems?

Are Seniors Prone to COVID -19? According to the CDC, eight out of every 10 COVID-19 deaths in the U.S. have been in adults age 65 and older. This age group also accounts for nearly 70% of all coronavirus hospitalizations nationwide.

That’s because the prevalence of underlying health conditions, like diabetes and heart disease, as we grow older plays a critical role. However, the experts at the Oklahoma Medical Research Foundation contend that there’s another answer for part of the blame: our immune system, the biological network whose job is to protect us against foreign invaders like viruses. That’s from The Oklahoman’s recent article entitled, “Weakened immune system leaves elderly prone to the virus.”

“The general line of thinking is that immunity falters with normal aging, just like our muscle mass and cognitive function,” said Dr. Hal Scofield, a physician-scientist at Oklahoma Medical Research Foundation. “You don’t see pro athletes playing after age 50. We have a shelf life physically, and that goes for immunity, too.”

That decreasing immunity means that the elderly are more prone to serious complications not only from COVID-19 but also from seasonal illnesses, such as the flu.

T cells and B cells, special types of white blood cells involved in the immune response, offer clues to why immunity declines with age, according to OMRF immunologist Susan Kovats, Ph.D. “We don’t know all the specifics behind the decline in immune function with aging, but we do know that both T cell and B cell function deteriorates with age,” she said.

T cells are created by a small organ in your chest called the thymus, “which slowly shrinks over time and is essentially gone in your adult years,” said Kovats.

Meanwhile, the ability of B cells to produce highly specific antibodies that inactivate viruses also drops as we get older. B cell numbers decline to a greater extent in elderly men, Kovats said. This may explain why they are more apt to die from severe COVID-19 disease. These age-related declines explain why, for example, a virus like shingles is more likely to appear from a weakened immune system later in life.

“If you’ve had chickenpox, the shingles virus stays in your body forever,” said Dr. Scofield, who also serves as associate chief of staff for research at the Oklahoma City VA. “When you’re young, your immune system keeps the virus in check. As you age, your body begins to lose its defenses and that increases your likelihood of getting shingles.”

The weakened immunity that is seen in the elderly has also made the annual flu shot less effective for that age group. The CDC reports that just 25% of people age 50 and older were protected during the 2018-19 flu season.

“The immune responses to vaccines are not as good overall in the elderly, and this is a legitimate concern as COVID-19 vaccines are hurried to the finish line,” said Kovats. “A lot of work is being done to try to understand why the immune response weakens, and significant effort has gone into changing how vaccines are made for this age group, in order to solicit better immune responses.”

Because seniors are prone to Covid, researchers at Oklahoma Medical Research Foundation and across the U.S. are investigating the mysteries of aging, as well as the immune system, to better protect a population that now has over 50 million Americans over the age of 65.

“COVID-19 is unlike anything the body has ever seen before, and older people do not respond well to pathogens or viruses they’ve never been exposed to,” Scofield said. “This is going to be a challenge, but the more we learn about how the immune system works, the better we’ll be at protecting our seniors in future outbreaks.”

Reference: The Oklahoman (June 2, 2020) “Weakened immune system leaves elderly prone to the virus”

 

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How Do I Care for a Dementia Patient in the Pandemic ?

Dementia Patient in the Pandemic – Roughly 60% of dementia caregivers receive assistance from relatives, friends or service providers. However, actions like New York PAUSE and county shelter-in-place orders have kept those caregivers from visiting. Without relief, caregivers find themselves on duty around the clock with no one else to help.

NNY360’s recent article entitled “Dementia caregiving and COVID-19: Make a meaningful connection through activities” acknowledges that caregiving is a full-time job without the pandemic. Now, caregiving for a Dementia Patient in the Pandemic crisis has shown how caregiving is really a cooperative activity, with spouses, siblings, nieces, nephews, friends, children and grandchildren each taking a role.

Even though people are confined to their homes, it is critical not to get caught in a rut of watching television for hours on end or taking extended naps.

Keeping the mind active is important because anxiety, depression and feelings of isolation are common for those living with dementia and their caregivers. Social distancing increases that confinement and can exacerbate those conditions.

The Alzheimer’s Association suggests planning simple activities and establishing a daily routine, as those activities provide purpose and meaning, while providing a means to strengthen the bond between the person living with the disease and the caregiver.

These activities don’t have to be fancy. It can be a simple game of cards or a jigsaw puzzle, or something routine like setting the table or folding clothes. The important thing for caregivers to remember is to be patient and provide guidance. It’s a chance to do something together and take your mind off of what’s happening in the world.

The most important part of any activity is the sense of accomplishment. The person completing the task should feel that they were helpful. Contributing to the household can give them a sense of a job well done. Here are a few ideas:

  • Listen to your favorite music, because it has calming qualities and just having it on in the background can improve their mood.
  • Reminiscing activities can incorporate many things around the home. For example, page through an old photo album or watch home movies. If you haven’t started a family history, use the time to record stories and memories on your mobile device.
  • Make your favorite recipes. This is a great way to get someone with memory loss involved in the process. Use a recipe like making bread or cookies where you can roll up your sleeves, wash your hands and get to work kneading the dough.
  • Do tabletop activities like puzzles, LEGOS, or folding laundry.
  • Do crafts like coloring, painting, knitting, making jewelry, or nature printing with leaves or flowers from your home.

Reference: NNY360 (May 3, 2020) “Dementia caregiving and COVID-19: Make a meaningful connection through activities”

 

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Elder Abuse Continues as a Billion-dollar Problem

Aging baby boomers are a giant target for elder abuse scammers. A report issued last year from a federal agency, the Consumer Financial Protection Bureau highlighted the growth in banks and brokerage firms that reported suspicious activity in elderly clients’ accounts. The monthly filing of suspicious activity reports tied to elder financial exploitation increased four times from 2013 through 2017, according to a recent article from the Rome-News Tribune titled “Financial abuse steals billions from seniors each year.”

When the victim knew the other person, a family member or an acquaintance, the average loss was around $50,000. When the victim did not have a personal relationship with their scammer, the average loss was around $17,000.

What can you do to protect yourself, now and in the future, from becoming a victim of elder abuse ? There are many ways to build a defense that will make it less likely that you or a loved one will become a victim of these scams.

First, don’t put off taking steps to protect yourself, while you are relatively young. Putting safeguards into place now can make you less vulnerable in the future. If you are diagnosed with Alzheimer’s or another form of dementia five or ten years from now, it may be too late.

Create a durable power of attorney as part of your estate plan. This is a trusted person you name as your legal representative or agent, who can manage your financial affairs if need be. While it is true that family members are often the ones who commit financial elder abuse, you’ll need to put your trust in someone. Usually this is an adult child or a relative. Make sure that the POA suits your needs and is properly notarized and witnessed. Don’t count on standard templates covering your unique needs.

Consider the guaranteed income approach to retirement planning. Figuring out how to generate a steady stream of income as you face the cognitive declines that occur in later years might be a challenge. Planning for this in advance will be better.

Social Security is one of the most valuable sources of guaranteed income. If you will receive a pension, try not to do a lump sum payout with the intent to invest the money on your own. That lump sum makes you a rich target for scammers.

Consider rolling over 401(k) accounts into Roth accounts, or simply into one account. If you have one or more workplace retirement plans, consolidating them will make it easier for you or your representative to manage investments and required minimum distributions.

Make sure that you have an estate plan in place, or that your estate plan is current. Over time, families grow and change, financial situations change and the intentions you had ten, twenty or even thirty years ago, may not be the same as they are today. An experienced estate planning attorney can ensure that your wishes today are followed, through the use of a will, trust and other estate planning strategies.

Resource: Rome News-Tribune (April 27, 2020) “Financial abuse steals billions from seniors each year.”

 

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The Symptoms of Early-Onset Alzheimer’s Disease

Considerable’s article entitled “7 surprising early signs of Alzheimer’s” provides us with some signs of early-onset Alzheimer’s disease.

Theft or other law-breaking. Any behavioral change as people age is of concern, but this can be a sign of Frontotemporal Dementia (FTD), another progressively damaging, age-related brain disorder. FTD usually hits adults aged 45-65. People’s executive function—their ability to make decisions—can be impacted by FTD, which may explain why they become unable to discern right from wrong.

Frequent falls. A study of 125 older adults asked them to record how frequently in an eight-month period that they fell or tripped. Researchers examined the brain scans of those who fell most frequently and saw a correlation between falls and the early onset Alzheimer’s Disease.

Forgetting an object’s function. We all forget where we put the keys. However, if you can’t remember what a key is for, or where dirty dishes are supposed to go, then it may be the first signs of Early-Onset Alzheimer’s Disease or dementia.

Inappropriate diet. Prior to the onset of Alzheimer’s, patients typically to eat more (roughly 500 calories more a day) than their aging counterparts but they still tend to lose weight. Doctors think this is a metabolic change. Some elderly actually eat inanimate objects prior to their diagnosis, but researchers don’t know the reason. Because Alzheimer’s and dementia affect the brain’s memory, it may be because their brain receives hunger signals but is unable to discern how to react to them. Some patients eat paper or other inedible objects.

Inability to recognize sarcasm. If you fail to recognize sarcasm or take it very literally and seriously, it may be a sign of atrophy in your brain. A study at the University of California – San Francisco found that Alzheimer’s patients and those with Frontotemporal Disease were among those who couldn’t recognize sarcasm in face-to-face encounters. The brain’s posterior hippocampus is impacted, which is where short-term memory is stored and where a person sorts out such things, like sarcasm.

Depression. If someone has never suffered from clinical depression but develops it after age 50, it could be an early sign of Early-Onset Alzheimer’s. It doesn’t mean if you’re diagnosed with depression in older age that you will develop Alzheimer’s or other cognitive decline. However, you might, so get treatment sooner because some researchers believe that hormones released in the depressed brain may damage certain areas of it, leading to the development of Alzheimer’s or other dementia.

Unfocused Staring. Alzheimer’s Disease is a change in cognitive and executive functioning in the brain. This means that your ability to recall facts, memories and information is compromised, as well as the ability to make decisions. The brain becomes unfocused and staring in a detached way may be an early sign of so-called “tangles” in your brain.

These symptoms may be signs of Early-Onset Alzheimer’s Disease, or they may be the signs of other underlying issues. See your doctor if you have any of these signs. This may be a sign of something else but talk to your doctor to be safe.

Reference: Considerable (December 8, 2020) “7 surprising early signs of Alzheimer’s”

 

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What are the Big Dental Care Issues for Seniors?

People with dental anxiety typically are not too eager to visit the dentist. However, ignoring your oral health puts you at risk for dental problems in the future, says Considerable’s March 2020 article entitled “7 top dental problems for people over 50.” Let’s look at these common dental care issues for seniors:

  1. Tooth decay. The protective, outer layer of tooth enamel wears down from years of chewing, eating acidic foods and drinking carbonated beverages. We’re more likely to have cavities as we age, and cracks expose the tissue to inflammation and irritation, letting bacteria in and causing decay near the root of the tooth.
  2. Tooth sensitivity. As we age, surfaces of our teeth may become sensitive to hot and cold temperatures, especially when decay has already set in, or if the roots of the teeth are exposed.
  3. Shifting teeth. Teeth shift as we get older, which causes overcrowding, making it more difficult to floss and causing food traps to form. These can become areas for tooth decay to spread.
  4. Dry mouth. The calcium and phosphate in saliva help protect our teeth from decay, but many seniors take prescriptions that may decrease saliva production. Side effects can include dry mouth, bad breath and a metallic taste. Cavities can form as fast as three months after symptoms of dry mouth start.
  5. Gingivitis. If your gums are red, puffy and bleed when you brush or floss, you may have gingivitis. If left unchecked, it can turn into something far worse. Research shows a connection between gum inflammation and other health conditions like respiratory issues, diabetes, stroke and heart disease.
  6. Periodontitis. This is a gum disease that causes infections in the gum, jawbone and the ligaments that support the teeth. When the gum pulls away from the tooth, deep pockets are created which create an open spot for bacteria-laden plaque to collect. If not addressed, there’s a higher risk for receding gums, wobbly teeth, deterioration of the jawbone and tooth loss.
  7. Oral cancer. There is a higher risk of oral cancer in those who are heavy drinkers or smokers. A regular dental examination should include the dentist’s examination of the soft tissue in the mouth, as well as the throat and jaw to detect any signs of oral cancer.

Early detection is the best defense against dental problems, so visit your dentist at least twice a year for regular cleanings and exams (and possibly more frequently as you age). Keep up with preventative measures at home, like regular brushing, flossing and using fluoride, as needed. This will help you keep your beautiful smile for a long time.

Reference: Considerable (March 12, 2020) “7 top dental problems for people over 50”

 

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Advance Designation of Representative Payee for Social Security

Advance Designation of Representative Payee for Social Security – For many years, people have had the right to designate an agent to handle a number of different legal, business and medical matters. That includes finances, medical decisions, wills and even funerals. What Americans have not been able to do until now, says the article “Social Security and you: New Advance Designation for Representative Payee” from The Dallas Morning News, is designate an agent to handle Social Security benefits.

As of April 6, 2020, the Social Security Administration announced that there is a new option that lets a recipient make an Advance Designation that names a person to serve as your “ representative payee .” This is a really big deal, but it hasn’t received too many headlines.

Maybe that’s because under this law, anyone could apply to be a representative payee, receiving someone else’s Social Security payment and using it to pay the recipient’s living expenses. There’s a lot of room for abuse.

The best way forward? Make a decision and name a person while you have capacity. The Advance Designation option is only available to “capable” adults and emancipated minors who are applying for or receiving Social Security benefits, Supplemental Security Income (SSI) or Special Veterans Benefits.

A Social Security recipient can name as many as three people, who could serve as a representative payee if the need arises. There’s a lot of flexibility: you can withdraw your choices, change the order of the three people and name new people at any time. Just in case anyone forgets who they named, Social Security is going to send a notice each year, listing advance designees for review.

How will it work? When the SSA believes a person needs help managing benefits, they will contact the advance designees. The SSA reserves the right to discard your choices and make its own appointment.

How do you make the designation? Go online to the SSA website, especially now when phone, in-person and in writing are all either backlogged or not possible to do right now. After you’ve created and successfully logged into the mysocialsecurity website, you’ll see a box titled “Advance Designation of Representative Payee.” It will be towards the bottom of the page. You’ll need the name, phone number and a description of the relationship you have with the person.

Who should you name? The SSA prefers family members, friends or qualified organizations. Your choices should be made carefully. The people you name need to be trustworthy, good with finances, organized and have no prior felonies. They will need to be able to maintain good records and receipts and be available and responsive, if the SSA requests an audit or an in-person visit.

When should you do this? How about now? Like having a will and an estate plan, this is not something that you should put off. And as you are likely at home, there’s no reason not to!

Reference: The Dallas Morning News (April 19, 2020) “Social Security and you: New Advance Designation for Representative Payee”

 

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What Should I Ask, If My Mom Is in a Quarantined Nursing Home

Federal guidance for a quarantined nursing home  state that members of the public and non-essential health care personnel and staff shouldn’t be permitted to visit (with a few exceptions, such as an end-of-life situation — as long as the visitor isn’t showing signs of a respiratory illness), according to guidelines from the Centers for Medicare & Medicaid Services.

AARP’s recent article entitled “6 Questions to Ask if Your Loved One Is in a Quarantined Facility” explains that assisted living communities are a different situation, because they’re governed by the states. As a result, there have been no broad rules covering their management during the outbreak. However, the American Health Care Association/National Center for Assisted Living, an industry trade group, is advocating that its facilities to follow the federal government’s guidance for quarantined nursing homes.

To ease the anxiety, many of these quarantined nursing homes are making great efforts to communicate with family members, such as emails, phone calls and websites, outlining their policies and instructions for connecting with residents and posting photos of residents’ daily activities.

However, many family members are still worried about how their loved ones are doing, when they can’t confirm their well-being first-hand person. Therefore, if you have questions about their care, you need to be assertive. Be firm, polite and persistent. Here are some questions that you might ask, if your loved one is in a quarantined nursing home :

  1. Has anyone at the facility tested positive for COVID-19? Quarantined Nursing homes and long-term care facilities have been hard hit by COVID-19, so ask about testing of all staff members, residents and any vendors who service the facility.
  2. How are you keeping the facility clean and keeping the risk of infection low for residents? Ask about the protocols put into place to protect the patients. This should include screening staff who are caring for your parents, and what are they doing to keep the place sanitized.
  3. Is the facility maintaining regular healthy-living programs? The patients need to have services, like physical therapy and occupational therapy programs designed to keep your loved one from deconditioning.
  4. How are the residents being engaged? Are there activities, like games, presentations and music to keep the residents engaged?
  5. How do I communicate with my parent? Some facilities have set up visits via Skype, WhatsApp and FaceTime between families and their loved ones.
  6. How is the facility working with drop-off deliveries? You may want to deliver something like flowers or baked goods for dad at the care facility, so find out the procedure.

Reference: AARP (April 15, 2020) “6 Questions to Ask if Your Loved One Is in a Quarantined Facility”

 

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Caring for Alzheimer’s and Dementia Patients during Stay-At-Home Orders

The Havre Daily News’ recent article entitled  “Alzheimer’s Association offers tips for keeping people with dementia engaged during stay-at-home orders” reported that, to help caregivers engage their family members suffering from Alzheimer’s and other dementia, the Alzheimer’s Association has provided some ideas to assist.

Alzheimer’s disease is a progressive disorder that causes brain cells to degenerate and die. This disease is the most common cause of dementia, which is defined as a continuous decline in thinking, as well as behavioral and social skills that disrupts a person’s ability to function independently.

When considering how to help a person with dementia stay engaged during the pandemic, the release from the Alzheimer’s Association said, you can start by asking yourself these questions:

  • What do they like to do?
  • What are they able to do?
  • What are they in the mood for today?

The Alzheimer’s Association says that spending time with a family member or loved one with Alzheimer’s and other dementia can still be a meaningful and fun experience, especially if you take your cue from them. Let’s look at some ideas:

Encourage involvement in daily life activities. These types of basic activities can help the person feel like a valued part of the household. This can be things like setting the table and folding laundry. The tasks can give a dementia patient a sense of success and accomplishment.

Be ready to adjust and modify activities. Some activities that the person enjoys may need to be changed or modified, because of the stay-at-home orders in effect in most states. A few ideas are low-impact at-home workout videos; playing games like checkers, cards, or board games; or looking at photo albums.

Concentrate on individual enjoyment. Someone who’s worked in an office might enjoy activities that involve organizing, such as collating papers, putting coins in a holder, or creating a to-do list. A former farmer or gardener may like being in the fresh air and working in the yard.

Don’t be afraid to request help. Ask family members and friends for help with some non-contact chores. This might include help putting the trash out, collecting the mail, or tending to the yard. You should also look into meal and grocery delivery services.

The Alzheimer’s Association now has free expanded educational programs via telephone and online. These programs provide crucial information about Alzheimer’s and related dementias, effective communication techniques, understanding and responding to dementia-related behaviors and more.

There are also additional resources for caregivers on the association’s website at https://www.alz.org.

Reference: Havre Daily News (April 14, 2020) “Alzheimer’s Association offers tips for keeping people with dementia engaged during stay-at-home orders”

 

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Rules for the HIPAA Waiver Relaxed?

The United States Department of Health and Human Services has announced that it won’t enforce penalties for HIPAA Waiver violations of certain provisions of the HIPAA privacy rule against healthcare providers or their business associates for good-faith disclosures of protected health information (PHI) for public health purposes during the COVID-19 emergency.

The HHS Office for Civil Rights said that it was exercising its “enforcement discrimination” in announcing its change in policy during the coronavirus pandemic, a declared emergency period, reports Modern Healthcare in its article “HHS eases HIPAA enforcement on data releases during COVID-19.”

A HIPAA waiver of authorization is a legal document that permits an individual’s protected health information (PHI) to be used or disclosed to a third party. This waiver is part of a series of patient-privacy measures set forth in the Health Insurance Portability and Accountability Act (HIPAA) of 1996.

PHI covered under HIPAA is information that can be connected to a specific individual and is held by a covered entity, like a healthcare provider. HIPAA has set out 18 specific identifiers that create PHI, when linked to health information.

The notification was issued to support federal and state agencies, including the CMS and the Centers for Disease Control and Prevention, that require access to COVID-19 related data, including protected health information.

“The CDC, CMS, and state and local health departments need quick access to COVID-19 related health data to fight this pandemic,” OCR director Roger Severino said in a statement. “Granting HIPAA business associates greater freedom to cooperate and exchange information with public health and oversight agencies, can help flatten the curve and potentially save lives.”

HIPAA’s privacy rule only permits business associates of HIPAA-covered entities to disclose protected health information for certain purposes, under explicit terms of a written agreement.

The moratorium enforcement doesn’t extend to other requirements or prohibitions under the privacy rule, nor to any obligations under the HIPAA security and breach notification rules, OCR said.

Reference: Modern Healthcare (April 2, 2020) “HHS eases HIPAA enforcement on data releases during COVID-19”

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COVID19 in Nursing Homes: Should You Bring Mom Home?

If you have a loved one currently living in a nursing home, you’re probably worried about COVID19 in nursing homes right now. You may not be able to visit them or check in on their care. You may be afraid that the next COVID19 outbreak will strike their facility.

And … you may be struggling with the decision about whether it’s best for them to stay in the facility, or if you should bring them home.

These are all reasonable concerns. There have been more than 5,670 coronavirus deaths in long-term care facilities nationwide, according to state health data reported by NBC News on April 15.

But would Mom or Dad fare better, even with all due social distancing, in the family home?

Some issues to carefully consider if you are struggling with this question now:

  • Are you prepared to shoulder the entire burden of care for your loved one now? If not, are there other family or community resources that could help – and can you access them in the current situation?
  • What does your loved one want? Do the benefits of moving them out outweigh the stress of disruption and displacement?
  • Can you really keep your elderly loved one safer at home … especially if they have chronic conditions such as heart, lung, or kidney disease?
  • How long will you be able to keep up with your loved one’s care at home … and
  • Will your loved one be able to return to the facility if you cannot keep up … or after the danger has passed?
  • Will your loved one lose their Medicare or Medicaid benefits if they leave the nursing home?

These questions, and more, should be addressed before making the decision to remove your loved one from a nursing facility. Check with an elder law attorney who is familiar with your situation, state and federal laws, and nursing home policies who can explain your options and guide you to an informed decision.

Resources: NBC News, Coronavirus deaths in U.S. nursing homes soar to more than 5,500, April 15, 2020; March 18, 2020;

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