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Posted 04/06/2017



Conference on Aging at Lynchburg College









Hope you can join us at the TUESDAY, June 6, 2017 Conference on Aging at Lynchburg College. We have many exciting programs and exhibitors, including the National Council of Certified Dementia Practitioner’s Alzheimer’s Disease and Dementia Care Seminar on June 7th for anyone interested in becoming a Certified Dementia Practitioner.  See attached brochure for more information.


You can register on-line at:


Please note that we have a new campus venue for the event and space is limited so register early. This year we will be in the recently renovated Drysdale Student Center.


A limited number of event scholarships are available and will be distributed on a first-come, first served basis. For more information, call us.

If you would like a copy of the brochure mailed to you, please email your name and mailing address. If you have any questions, please call us at 434-544-8456 or email us at

Have a wonderful day! We look forward to seeing you on June 7th.


Denise Scruggs





Posted 06/17/2016

Final Rule: Medicaid and CHIP Programs; Medicaid Managed Care, CHIP Delivered in Managed Care, and Revisions related to Third Party Liability


View in browser | Distributed by Center for Medicaid and CHIP Services (CMCS)

Today the Center for Medicare & Medicaid Services (CMS) put on display at the Federal Register the Medicaid and CHIP Managed Care Final Rule, which aligns key rules with those of other health insurance coverage programs, modernizes how states purchase managed care for beneficiaries, and strengthens the consumer experience and key consumer protections. This final rule is the first major update to Medicaid and CHIP managed care regulations in more than a decade. 


The final rule is available at


For more information on Managed Care, visit








Posted 12/16/2015



Holiday Gift Ideas for People with Alzheimer's
and their Caregivers

According to the 2013 Alzheimer’s Disease Facts and Figures, one out of nine people age 65 and older have Alzheimer’s and nearly one out of every three over age 85 has it.  There are currently more than 5 million people in the United States living with Alzheimer’s and almost 10 million caring for someone with the disease.  Therefore chances are pretty high that this holiday season, you’ll be buying a present for parents, grandparents, relatives or friends who have been touched by the disease.  

Holiday Gifts for Caregivers

Nearly one in four caregivers of people with Alzheimer’s disease and other dementias provide 40 hours a week or more of care.  Seventy-one percent sustain this commitment for more than a year, and 32 percent do so for five years or more.  One of the best gifts you can give someone caring for Alzheimer’s is something that relieves the stress or provides a bit of respite for the caregiver.

The Gift of time:  Cost-effective and truly meaningful gifts are self-made coupons for cleaning the house, preparing a meal, moving lawn/shoveling driveway, respite times that allow the caregiver time off to focus on what he/she needs.

Gift Certificates: Give gift certificates for restaurants and laundry/dry cleaning services, especially those that deliver; lawn care services; computer/technology support; maid services; personal pampering services such as messages, facials, manicures/pedicures.

Books: In addition to fictional and non-fictional books that a caregiver might enjoy, there are a number of books created to assist caregivers such as “The 36-Hour Day: A Family Guide to Caring for Persons with Alzheimer Disease, Related Dementing illnesses, and Memory Loss in Later Life,” by N.L.Mace and P.V. Rabins; “A Dignified Life: The Best Friends Approach to Alzheimer’s Care: A Guide for Family Caregivers,” by V. Bell and D. Troxel; and “Alzheimer’s: A Caregiver’s Guide and Sourcebook,” by H. Gruetzner.

Digital Video Recorder (DVR)/DVDs/CDs:  Purchase DVR/TiVo and years worth of services that will enable a caregiver to record favorite shows he/she may not be able watch,  purchase his/her favorite movies or music CDs for the caregiver to enjoy on their down time.

Holiday Gifts for People Living with Alzheimer's

Early Stage:  Approximately 2.5 million people currently living with Alzheimer’s are in the Early Stage of the disease, a period when they can live active, healthy lives, but may begin to notice subtle changes.  Here are some gift ideas for people living in the early stages of the disease.

Items to help remember things such as magnetic reminder refrigerator pads, Post-It notes, baskets or trays that can be labeled within cabinets or drawers, a small pocket-sized diary or notebook, erasable white boards for key rooms in the house, a memorable calendar featuring family photos – write special family occasions such as birthdays and anniversaries.

Items that may help with daily activities such as a memory phone that can store up to eight pictures with the names and contact information of family and friends, automatic medication dispenser that can help the person living with Alzheimer’s remember to take his/her medicine, nightlights that come on automatically when it gets dark, and clock with the date and time in large type.

Entertainment:  Plan an outing to a movie, play or concert, sporting event, museum or possibly an organized holiday shopping outing with friends and family, favorite musical CDs or CD with compilation of favorite tunes, VHS/DVD collection of favorite movies.  Also activities such as scrapbooking or other craft projects that are social in nature.

You might want to think twice before buying some gifts: Giving electronics may seem like a good idea to make life easier for someone with Alzheimer’s or dementia, but that isn’t always the case.  If you decide to give someone with the disease a new piece of electronic equipment, remember to review the operating instructions with them slowly and more than once.  Make a copy of the instructions for the person with the disease and  for yourself, so you can talk them through the process on the phone if you need to.

Moderate/Late Stage:  People in the later stages of Alzheimer’s generally need assistance with day-to-day activities as their memory problems continue to worsen.  Here are some gift ideas for people living in the later stages of the disease.

Items that provide sensory stimulation:  In the later stages of the disease sensory stimulation may bring back pleasant memories, so gift ideas include scented lotions, a fluffy bathrobe in his/her favorite color, a soft blanket or afghan to keep the person warm.

Clothes: Comfortable, easy to remove, easily washable clothes such as sweat suits, knits, large banded socks, shoes with Velcro ties, wrinkle free nightgowns, nightshirts and robes.

Music: Research shows that music has a positive impact on individuals with Alzheimer’s, bringing them back to good times, increasing stimulation and providing an opportunity to interact with family members.  So buy favorite CDs or burn a CD full of musical favorites.

Framed Photographs/Photo Collage: Copy photos of family members and friends at photo centers, insert the names of the people in the photo and put in frames or in a photo album created specifically for that person.

Safe Return: Enroll the person in the later stages of Alzheimer’s in the Alzheimer’s Association’s Safe Return, a nationwide identification program that provides assistance when a person with Alzheimer’s or a related dementia wanders and becomes lost locally or far from home.







Posted 05/12/2015 

The use of canes and other mobility devices is on the rise among older adults


About one-quarter of adults aged 65 years and older used mobility devices--such as canes, walkers, and wheelchairs--in 2011, and about a third of these reported using multiple devices. The use of such devices was not linked with an increased risk of falling, but people who used canes were more likely to report limiting their activities because they worried about falling.

The findings indicate that the percentage of older adults using mobility devices has increased in recent years, and the use of multiple devices is common.

"Staying active is a key component to staying healthy and maintaining mobility and function. It's important for people to use the device that best matches their needs in order to stay as mobile as possible, but safely," said Dr. Nancy Gell, lead author of the Journal of the American Geriatrics Society study.


Posted 12/20/2014 

Why Eldercare Will Need More Gen Xers, Millennials--& Money

Why Eldercare Will Need More Gen Xers, Millennials--& Money

Story tools

From the outside, Kathryn Robison, 29, looks like any other graduate student on campus at Youngstown State University in Ohio. But as she's finishing her master’s degree in American Studies, she’s also juggling another big responsibility: Caring for her grandmother.

She recently took a year-and-a-half break from school to serve as her grandmother’s primary caregiver in Raleigh, N.C., and now serves as a backup caregiver, since her mom took over the reins full time.

Robison originally volunteered for the role after a discussion with her mom.

‘Someone Has to Be With MeMa’

“My mom was saying, ‘I don’t know what we’re going to do. Someone has to be with MeMa, someone has to live with her.’”

I said, “Do you want me to do it? I don’t have a family. I’m not dating anyone.” The planned six months turned into a year and a half, and for part of the time, Robison commuted to her classes in Ohio by plane every week. “Paying for the plane tickets was less than the cost of having someone care for her,” she says.

While she was glad to be able to take on the role, it did strain her financially. Being a full-time caregiver meant passing up the opportunity to take on other paid jobs. The family paid Robison about $1,000 a month out of her grandmother’s fixed income, and the job was 24-hours a day, seven days a week.

“Caregiving is incredibly stressful, especially for someone with mental deficiencies like dementia,” Robison says. She notes that other than dementia and balance issues, her grandmother is healthy, and at age 74, could live a while longer.

Because of shifting demographics in the country, Robison’s story will become an increasingly familiar one.

Over the next 30 years, the number of people age 65 or older will double and by 2040 will reach 81.2 million, according to Census Bureau data analyzed by Steven Wallace associate director of the UCLA Center for Health Policy Research.

He points out that by 2030, baby boomers will hit age 85, and will likely need increasing amounts of care.

With more aging family members in need of caregiving services, more Gen Xers and Millennials will be providing it, in tandem with paid caregivers and government programs.

Shrinking Numbr of Caregivers

“Caregiving is generally viewed as a private issue and traditionally for women,” said Lynn Friss Feinberg, senior strategic policy advisor for the AARP Public Policy Institute, at the annual Gerontological Society of America (GSA) conference in Washington, D.C., in November.

Currently, Feinberg says, most long-term care is provided by family and friends, who juggle their jobs and family responsibilities.

The current ratio of family caregivers per every “vulnerable person” is 7 to 1. But soon, because of the aging population, it will be 3 to 1, she says. That will put even more pressure on family caregivers and make it harder for them to continue managing all their other responsibilities.

Kenneth Matos, senior director of research at the Families and Work Institute, notes that 1 in every 4 households in the country is performing some degree of eldercare, and that ratio is growing. Unlike childcare, he says, adult caregiving tends to be less predictable, and as a result, can be harder to manage with other responsibilities like work.

“With eldercare, you don’t know when [the older adult] might get better and can’t predict their capacity. With childcare, they get sick and then get better in a few days,” Matos said at the GSA conference. Childcare is also generally a happier task and more joyful than caring for someone in decline.

According to research by the Families and Work Institute, 29 percent of employed caregivers say they need “help balancing their work and family responsibilities,” he said. And 70 percent of caregivers say they arrive late, leave early, take time off or adapt in other ways to make it possible to both work and be a caregiver. Matos notes that being a caregiver encompasses a range of duties, from maintaining medical records to being a patient advocate.

“Caregivers are stressed out because they’re unprepared, and the primary responsibility falls on them,” said Meredith Ponder, federal policy and advocacy manager of the Washington-based organization National Association of Nutrition and Aging Services Programs, at the GSA conference. Given longer life spans today, she adds, “Adults may spend more years caring for their parents than their children.”

Planning for the Future

Robison says her experience caring for her grandmother has made her think about the importance of taking out long-term health care insurance for herself one day, as well as saving for retirement.

“What we think we need is usually nowhere near the amount we need. ... If my grandmother didn’t have a family, where would she be? Who would advocate for her?”

Robison adds that the situation continues to strain her family members, who want to make sure their MeMa is living as well as possible. “None of us are trained caregivers. We’re just doing the best we can.”







Posted 12/01/2014 

Moderate coffee consumption may lower the risk of Alzheimer's disease by up to 20 percent

Drinking 3-5 cups of coffee per day may help to protect against Alzheimer's Disease, according to research highlighted in an Alzheimer Europe session report published by the Institute for Scientific Information on Coffee (ISIC), a not-for-profit organization devoted to the study and disclosure of science related to coffee and health.

The number of people in Europe aged over 65 is predicted to rise from 15.4% of the population to 22.4% by 20251 and, with an aging population, neurodegenerative diseases such as Alzheimer's Disease are of increasing concern. Alzheimer's Disease affects one person in twenty over the age of 65, amounting to 26 million people world-wide

Recent scientific evidence has consistently linked regular, moderate coffee consumption with a possible reduced risk of developing Alzheimer's Disease. An overview of this research and key findings were presented during a satellite symposium at the 2014 Alzheimer Europe Annual Congress.

The session report from this symposium highlights the role nutrition can play in preserving cognitive function, especially during the preclinical phase of Alzheimer's, before symptoms of dementia occur. The report notes that a Mediterranean diet, consisting of fish, fresh fruit and vegetables, olive oil and red wine, has been associated with a reduced risk for development of Alzheimer's Disease. Research suggests that compounds called polyphenols are responsible for this protective effect, these compounds are also found in high quantities in coffee.

Epidemiological studies have found that regular, life-long moderate coffee consumption is associated with a reduced risk of developing Alzheimer's Disease with the body of evidence suggesting that coffee drinkers can reduce their risk of developing the disease by up to 20%. A recent paper, suggested that moderate coffee consumption was associated with a lower risk of developing dementia over a four year follow-up period, however the effect diminished over longer follow up period.

Finally, the report explores the compounds within coffee, which may be responsible for this protective effect, identifying caffeine and polyphenols as key candidates. Caffeine helps prevent the formation of amyloid plaques and neurofibrillary tangles in the brain - two hallmarks of Alzheimer's Disease. In addition to this, both caffeine and polyphenols reduce inflammation and decrease the deterioration of brain cells - especially in the hippocampus and cortex, areas of the brain involved in memory.

Dr. Arfram Ikram, an assistant professor in neuroepidemiology at Erasmus Medical Centre Rotterdam, presented his findings at the symposium. He commented: "The majority of human epidemiological studies suggest that regular coffee consumption over a lifetime is associated with a reduced risk of developing Alzheimer's Disease, with an optimum protective effect occurring with three to five cups of coffee per day."

Dr. Iva Holmerova, vice chairperson of Alzheimer Europe, commented: "The findings presented in this report are very encouraging and help to develop our understanding of the role nutrition can play in protecting against Alzheimer's Disease. Coffee is a very popular beverage enjoyed by millions of people around the world and I'm pleased to know that moderate, lifelong consumption can have a beneficial effect on the development of Alzheimer's Disease."

The session report details the key scientific research presented by Dr. Neville Vassallo, Dr. Arfan Ikram and Dr. Astrid Nehlig during a session entitled: Nutrition and Cognitive Function, which took place on the 23rd October in Glasgow, UK.


For more information on coffee and neurodegenerative diseases, please visit


Posted 11/09/2014 

Why Hire a Geriatric Care Manager?

During one especially dicey period with my mother, then in an assisted living facility, my brother and I hired a geriatric care manager, first for a consultation and then for additional help at an hourly rate. It felt like such an extravagance, given that we weren’t rolling in money, but the care manager helped solve a series of complex problems that I doubt I’d have solved by myself, mostly involving brokering a compromise with the facility, whose management wouldn’t let me hire a private aide for my mom but could not provide what she needed.

Relations had soured to the point that all I could do was scream at them, which was making a bad situation worse, so having an advocate was a blessing. Also, the care manager, who visited regularly with my mother, often was privy to concerns she was keeping from me, and she was always there for me by telephone, which was a lifesaver.

Many of you have asked questions about geriatric care management and how it is performed. I posed some of them to Patricia Mulvey, a care manager who has worked in hospitals, nursing homes, home-care agencies, hospice and bereavement programs, and as an independent contractor. Currently she is the director of the private geriatric care management service at the Jewish Home Lifecare System, which runs several long-term care facilities in New York City and its suburbs. With some modest editing, here are her thoughts.

Would you explain what geriatric care managers do, how they are trained and certified, how much they cost, and how consumers can make wise decisions if they decide to hire one?

A professional geriatric care manager has been educated in various fields of human services — social work, psychology, nursing, gerontology — and trained to assess, plan, coordinate, monitor and provide services for the elderly and their families. Advocacy for older adults is a primary function of the care manager. We belong to the National Association of Professional Geriatric Care Managers and are certified by one of the three certification organizations for care management — the National Association of Social Workers, the National Academy of Certified Care Managers, or the Commission for Case Managers.

Our rates vary by region and firm. Some firms charge an initial assessment fee; others bill by the hour only. In New York, an initial assessment is in the range of $250 to $750 for a one-and-a-half-hour assessment visit. Hourly charges run from $150 to $200. Some firms also require a retainer to cover the last month’s bill.

To be a savvy consumer, check the credentials of the care manager you are considering hiring to be sure they are a member of the National Association of Professional Geriatric Care Managers, as well as a member in good standing of their basic professional organization — say, the National Association of Social Workers. They also should be certified by one of the certification boards. You should check references and interview candidates.

An important part of working with the client and their families is chemistry. Be sure you get along with and like the individual you are considering hiring. They should be available 24 hours a day, seven days a week, and you should have access to their cell phone number or answering service. You should also be aware of other members of their team — nurses they may work with or their support staff — in case you have a question and can’t wait for the care manager to return your call.

What circumstances are most suitable and valuable for using a geriatric care manager? To put it another way, if you were in a caregiving situation and had limited means, when would this extra expense be money well spent?

An example is when things are going well — the elder is managing on his or her own, with little help and oversight, but the family is noticing slight changes, or the physician has indicated a change in status or diagnosis. This would be the time where it would be very beneficial for the family to know what resources are available to them, how much they would cost, how to access these resources and what options are available. Some of the key points to cover would be these.

  • What is day care? What types of rehab might be available? What does “short-term rehab” mean?
  • What is “respite” and where might it be available? Who pays for it?
  • Information about home care services. What kind of care and how much care can be provided at home?
  • Who pays for what services? This is key because a common misconception is that Medicare pays for long-term care.
  • What is the difference between Medicare and Medicaid?
  • What does insurance, either medical or long-term care, actually pay for?
  • What happens at the end of a hospitalization when discharge is imminent? Time is of the essence, because it is often Medicare or the insurance company’s determination as to how quickly things related to discharge must happen.
  • Is the health care proxy in place, appropriately witnessed and current? Is there a power of attorney? Does your state recognize other documents, such as a living will?
  • Has the conversation about the wishes stated in the health care proxy been discussed with the individual who has been nominated proxy? Does the physician have a copy of the document?
  • With a long-term care insurance policy, what is required for the policy to begin coverage?
  • What resources are available to pay for services? How much can the family afford? And who is going to pay for what?

A relationship with a professional geriatric care manager can allow the children of the elderly person to be children, while someone else manages the situation. When a son or daughter is providing the hands-on care to the parent, the quality time they have to be there emotionally for their parent is limited…. The care manager can handle the difficult interpersonal issues, address the immediate problem, remain connected once the crisis passes and get back involved as the situation requires it.

I’d imagine that long-distance caregiving and trying to keep someone in their own home with reliable help would be the two hardest things to navigate without professional assistance. Can you tell us some of the special challenges of having an elderly parent in Florida, or Chicago, or any place where you can’t go scope out the situation regularly and thus need eyes and ears on the ground?

As for home care, I know from friends how arduous it is to manage a staff of people working in a parent’s home. They quit. Or you have to fire them. They compete with one another for who’s top dog. The client, who is so dependent, becomes almost an emotional hostage, needing the aide so badly they may be afraid to complain or offend. How does a care manager guide families through this?

It is imperative to have eyes and ears available locally. This is not a process that can be managed long-distance, even as in-touch as we are with cell phones, text messaging and video conferences. We always work with another care manager in the other location to have an independent individual assess the facility and situation. I’ve frequently moved parents from the tri-state area to California, Florida or Arizona to be closer to their children, and moved the parents to the New York area from those very same states. Moving is one of the most stressful life events we can experience, and this applies at any age. The client needs as much support as possible, someone to help them pack, stop the newspaper, disconnect the cable, and much more.

Anyone with help in the home most definitely would benefit from help coordinating the aides and other staff going in and out of the home. Adding home care to the services delivered to an elder can be very traumatic — it’s saying that “you can’t take care of yourself anymore.” How would you feel if someone you didn’t know turned up one day and moved into your spare room, cooked meals in your kitchen, sat with you when you were watching TV or reading? It’s a huge transition for people to incorporate help into the home.

A care manager can closely monitor the situation, soothe over the hurt feelings and address the anger that comes from losing our independence. And yes, you are right, the elder may become an emotional hostage, afraid to say something for fear of retribution or recrimination. It’s best to let a professional address issues the elder is concerned with.


In an upcoming post, Ms. Mulvey will answer questions about how caregivers ought to look after themselves and why they often don’t, the differences between caregiving for a parent suffering from Alzheimer’s disease versus physical frailty, and how a lifetime of family baggage can cause strains between siblings and between adult children and parents during this role-reversing experience.






 Posted 10/31/2014




Posted 10/27/2014 



Activities For All Seasons


A change in seasons is an excellent time to be creative about your exercise routine and try something new. There are many ways to be active throughout the year.



 When your grandchildren visit, head outside to build a snowman together.Cold outdoor temperatures  are an excellent time to take dance lessons or join a mall-walking group.


 As the temperatures  start to get warm, get your garden ready for spring and summer. The lifting and bending you do when gardening are great for strength and flexibility. A bike ride is a great way to enjoy the warmer temperatures.


 Swim laps or take a water aerobics class. These are both refreshing once the weather gets steamy. Walking in the mall is a cool way to beat the heat.


 Fall leaves provide great opportunities for physical activity.You can take long walks to see the beautiful fall colors. Once the leaves have fallen, raking is good exercise. As the weather begins to cool, join an indoor sports league, such as basketball, handball, or bowling.






Posted 11/22/2013


Go4Life Tip Sheets


Staying Motivated to Stay Active
Be Physically Active without Spending a Dime
Have Fun! Be Active with Your Dog!

These are just a few of the tip sheets you can read on the Go4Life website. Go4Life tip sheets provide a wealth of information to help you add exercise and physical activity to your daily routine and have fun at the same time. And you can share these useful tips with others by simply printing copies for your family and friends.

Looking for our Spanish Tip Sheets? Visit our dedicated Spanish Tip Sheet page to download or print information in Spanish.

¿En busca de nuestra hojas informativas en español? Visite nuestra página específica para hojas informativas en español para descargar o imprimir esta información.

Organize by Topic | Organize by Title

Health Benefits







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Work Out at Work(238.38 KB)






Posted 07/22/2013


Lethal Placebo

Lethal Placebo





Everyone seems to love a riveting conspiracy theory- except, of course, the victims of it. We enjoy the gathering momentum of our collective outrage, and casting our passionate aspersions at some malefactor in the military industrial complex. In my world, that malefactor is often Big Pharma. Everyone loves to hate the harms that drugs do and the profits they generate along the way. Denigrating Big Pharma is a cultural pastime, and rollicking good fun.

And in the larger context of health care, it even makes sense. The prime directive of medicine, after all, is primum non nocere. Medicine becomes a legitimate target for scorn when it is a purveyor of net harm.

But what truly matters here is not the means, but the ends- the harm itself. What matters is life lost from years, and in the more extreme cases, years lost from life. And I have just such a tale to tell, but the means are peculiar. It’s not the drug that’s killing people- it’s the placebo.

My Yale colleague, Dr. Phil Sarrel, has devoted his career in large measure to a detailed knowledge of the overall health effects, and in particular the vascular effects, of ovarian hormones. Ovarian hormones- estrogen and its metabolites, and progesterone - profoundly influence a woman’s health from menarche to menopause, and then influence a woman’s health some more by disappearing.

Dr. Sarrel was in the vanguard of those who saw serious problems with the large, randomized clinical trials, published just at the turn of the millennium, that refuted our prior faith in the disease-preventing potential of hormone replacement therapy. The HERS trial, and the massive and massively influential Women’s Health Initiative (WHI), purportedly showed that we had been wrong about the advantages of hormone replacement, and that the practice resulted in net harm.

Even I was among those who noticed right away that the net harm was very, very slight- and grossly exaggerated in media headlines. But Dr. Sarrel was among those with the expertise to induce bigger worries.

Both trials had used the exact same form of hormone replacement, so-called “Prempro,” a combination of Premarin and medroxy-progesterone acetate. Premarin is estrogen derived from the urine of pregnant horses, and thus not native to humans. Medroxy-progesterone acetate is a synthetic progesterone, not native to any species, and many times more potent than human progesterone. Most experts, including my colleague, had long preferred other forms of hormone replacement, considering Prem/Pro a dubious choice.

But when HERS and the WHI tarred the practice of hormone replacement, it was with a broad brush. The news was not that Prem/Pro, one questionable approach to hormone replacement, resulted in benefits for some women and harms for others, with a very slight net harm at the population level. The news was: hormone replacement therapy harms women!

We already had potentially serious problems at this point, but the plot thickens considerably. Dr. Sarrel was also among those to note that these clinical trials administered Prem/Pro to women a decade after menopause. They did this to be sure the women were not just merely, but most sincerely post-menopausal. But we had cause to suspect then, and abundant reason to know now, that the benefits of ovarian hormone replacement accrue right at the time of menopause, and in the decade that follows. Timing is often crucial in medicine, as in life. Administer, for instance, a potent diuretic while a patient is fluid overloaded, and it can be lifesaving. Give just the same drug after they have already eliminated that excess fluid, and the result is apt to be hypotension and even death. Timing matters- and the hormone replacement trials got it seriously wrong.

All of this suggests that many women who might have benefited from good hormone replacement administered with good timing have missed out on those benefits because of the headlines engendered by HERS and the WHI. But the story does not end here, either. It ends, as noted, with a lethal placebo.

Quite a few months ago, Dr. Sarrel and I had the first of our recent intense flurry of meetings at my lab. He had brought me a paper published in JAMA in 2011, reporting on one particular subgroup included in the WHI: women who had undergone hysterectomy. The only reason to include progesterone in hormone replacement is to protect the uterine lining from overgrowth, so women who have had a hysterectomy are prescribed (or were, back in the days when hormone replacement was not the bogeyman) estrogen only.

Dr. Sarrel’s read of this paper was that the younger women- those age 50 to 59 and therefore just on the far side of menopause- had a considerably higher mortality rate when given placebo, rather than when given estrogen. I am formally trained in biostatistics and epidemiology, so my colleague asked me to verify this impression, which I did. Our project, and the resulting publication of our paper yesterday in the American Journal of Public Health, grew from there.

Working with a team from my lab, we devised a very simple formula to translate the excess death rate seen in the placebo group of the estrogen-only arm (i.e., just estrogen versus placebo) of the WHI to the entire population of such women in the United States: women in their 50’s, who had undergone hysterectomy. Hysterectomy is very common, arguably too common, so this population numbers in the many millions. We then needed to add into the formula the most reliable estimates we could find for the precipitous drop in estrogen prescriptions following the publication of the original WHI results back in 2002.

We, of course, had to run the details of our analysis through the gauntlet of peer review. And our paper now stands, in a highly esteemed journal, on full display before a jury of peers. So I can spare you the details of our methods, and focus on the punch line.

We estimated that over the past decade, due to a wholesale abandonment of all forms of hormone replacement for all categories of women by both the women themselves and their doctors, minimally 20,000, and quite possibly more than 90,000 women have died prematurely. We were very careful to incorporate only reliably conservative figures into our formula, so the numbers might actually be higher still. Being extremely cautious, we report that over 40,000 women have died over the past ten years for failure to take estrogen.

This death toll of estrogen avoidance, or better still, estrogen ‘aversion,’ represented some 4,000 women every year. Whatever the emotional impact of that figure, it should be greater- because any one of those women could be your spouse, or mother, or sister, or daughter, or friend. And the impact should be greater because the massively over-simplified, over-generalized, distorted “hormone replacement is bad” message continues to reverberate, and rates of all kinds of hormone replacement use continue to decline.

Stated bluntly, we think the mortality toll of estrogen avoidance is not merely a clear, present, and on-going danger, it is a worsening one. More women are dying from this omission every year. And the next one in that calamitous line could be a woman you love; it could be you.

I write this column, as my colleagues and I wrote our paper: with a sense of urgency, and even desperation. My career is entirely devoted to the prevention of avoidable harms, and the protection of years of life, and life in years. This is as clear-cut a case of preventable harms, and as readily fixable, as we are ever likely to see.

Here, then, are the take-away messages:

1) All forms of hormone replacement for all women at menopause was never right, but nor is NO forms of hormone replacement for NO women at menopause. There was always baby and bathwater here, and we have egregiously failed to distinguish between the two.

2) The millions of women who have undergone hysterectomy are candidates for estrogen-only hormone replacement at menopause, and when that treatment is provided at the time of menopause and for the years that immediately follow, it can both alleviate symptoms AND save lives. It could save the lives of thousands of women every year in the U.S., and no doubt many thousands more around the world where the tendency toward hormone replacement aversion also prevails.

Every woman who has had a hysterectomy should be open to the option of estrogen therapy at menopause, and should discuss it with her doctor. Every health care professional needs to know that some forms of hormone replacement for some women at menopause remain potentially life saving, and needs to address the topic accordingly.

3) Medical news is often translated into provocative headlines that abandon the nuances of the actual findings for the sake of maximal impact. This certainly happened when we learned that one form of hormone replacement resulted in a very slight excess of total net harm for one particular group of women, but is a far more systemic problem; it happens all the time. All of us plying our wares where medicine and the media come together need a bracing reality check: there are lives at stake! When headlines distort the actual state of medical knowledge and take on a life of their own, they can affect patient behavior and clinical practice-and the result can be the very harm medicine is pledged to avoid. I call upon my colleagues involved in the reporting of medical news to embrace the great responsibility that comes with the great power of the press, and to deliver their headlines accordingly. How many avoidable deaths is a maximally titillating, but misleading, headline really worth?

We’ve all seen the commercials on television; drug companies are required to report the various potential harms of their products, as they should be. But no one is required to report the potential harms of placebo. For the past decade, millions of women who might have enjoyed more life in years, and tens of thousands who might have enjoyed more years of life by taking estrogen, were, in essence, taking a “placebo” instead. And in this case, it was the placebo causing the harm. In this case, the placebo was- and all too often remains- lethal.


Dr. David L. Katz;




Posted 05/08/2013

American Diabetess Association

Dear Healthcare Provider,
If you diagnose patients with type 2 diabetes, you’ll want to learn more about the American Diabetes Association’s free program for the newly diagnosed: Living With Type 2 Diabetes.

Get Started

Order free copies of the booklet, Where Do I Begin? to give to your patients at diagnosis. This booklet, available in English and Bilingual Spanish, provides a basic introduction to type 2 diabetes for the patient.

One provider using the booklet states, “Where Do I Begin? offers complex information in a format that is easy to comprehend, so my teaching can be reinforced by a take-home piece. Thank you.” Another commented,”[This] booklet is one of the best things the ADA has done.”

Order Where Do I Begin?

Keep Going

For more information, tools and resources, help your patients enroll in the year-long Living With Type 2 Diabetes program. The program is free and gives patients the information and support they need to learn to live with this disease. As one enrollee states, “[This is an] excellent source of information and motivation. Very uplifting. Gave me a sense of ‘I can do this, I can beat this, I can still have a happy healthy life. The choice is mine.’”

The program is available in English or Spanish, and enrollees may choose to receive information online or through the mail.

Help your patients get started by enrolling in one of three ways:

  • Online at

  • By calling 1-800-DIABETES (1-800-342-2383)

  • Returning a completed Business Reply Card from the Where Do I Begin? booklet

Please contact with any questions.

With warm regards,

Jane Chiang, MD
Senior Vice President, Medical Affairs and Community Information
American Diabetes Association


Posted 03/01/2013


Good News – A New Solution to Pay For Long Term Care: Conversion of Life Insurance into a Long Term Care Benefit Plan

The National problem is that we are all living longer, and it’s costing a lot of money for the Consumer to pay, for the Insurance Company to pay, or for Medicaid to pay.

Legislators have long been aware of this fact.

To deal with this Age Wave, new Legislation was passed that now allows a Senior, over 65, to Convert the proceeds of their Life Insurance Policy into a Long Term Care Benefit Plan. A portion of the future value Death Benefit is exchanged for a present value Long Term Care Benefit, and is used to pay for LTC Care at Home, or in any LTC Facility in the US.

The proceeds of the Life Insurance Conversion are deposited into a Irrevocable Guaranteed Bank Trust Account, Administered and protected by a Third Party Fiduciary, and are paid Monthly, directly to the Home Care Providers, or to the Facility Care Providers, to cover the cost. The proceeds can only be used for LTC Care.

If the insured should pass away before the LTC Benefit Plan Amount is exhausted, the remaining balance is paid to the Estate.

In 2010, NCOIL, The National Council of Insurance Legislators, passed the Life Insurance Disclosure Model Act. It says that before lapsing a Life Insurance Policy, the Insurance Company must notify the Policyholder that they have a legal right to convert the proceeds to a LTC Benefit Plan, if they have the need, and so choose. Prior to this, a great majority of all Life Insurance policies for those over 65, with LTC needs, lapsed and the Policyholder got nothing.

Most over 65, have still not purchased LTC Insurance when they should have, or could not medically qualify to get coverage. They now have to pay for Long Term Care out of their life savings. Far too many seniors let their very valuable $100,000 to $500,000 Life Insurance Policies lapse, because the premiums are too expensive to pay, while at the same time having to paying very expensive LTC costs out of pocket.

They stop paying the Premiums on the Life Insurance, and drop the Policy, and get nothing.

Contributing to this huge national problem is that, unfortunately, the Consumer also very often abandons their very valuable Life Insurance Policy, in order to qualify for Medicaid. Life Insurance is a “non countable asset” towards Medicaid spend down, and the Death Benefit is consider an asset for Medicaid purposes.

Now, that money that would be otherwise lost , can pay for Care for an additional number of years, and hopefully prevent the senior from ever going to Medicaid at all, or at least, pay for a number of years of Care.

Trillions of dollars locked into Life Insurance Policies can now be Converted to a Long Term Care Benefit Plan.

This is a real new solution to the problem. We are trying to get the word out to the LTC Home Care Community that is impacted greatly by this positive new legislation.

I recently had a call from a 82-year-old man from Napa, California who wanted to buy a Long Term Care Insurance Policy for himself. He explained that he was now in a wheel chair, and was being cared for at home by his two adult children. They both worked full time, with children.

It was becoming more and more difficult for them to continue their role: working, taking care of the kids, and taking care of Dad. I explained that it was too late. We could not get a Long Term Care Policy for him.

I asked if he had a Life Insurance Policy. He said yes, but “that won’t help, it only pays when I die.”

He said that he had a $200,000 Life Insurance Policy, but because the premiums were now so high, about $8000 per year, he had not paid his premium in a while, and that it had probably lapsed. He explained that paying the annual $8000 Life Insurance Premium, and now having to pay out of pocket for Home Care, was just too much. One had to go, and it was the Life Insurance.

He would forfeit all the premiums he had paid for 40 years, and forfeit the $200,000 Death Benefit, and get nothing. We were able to save the Life Insurance from lapsing, by about one week. We converted The Death Benefit, to a Long Term Care Benefit Plan Account. Instructions are to send a Monthly check to the Home Care Providers.

The man no longer has to pay the $8000 annual Life Insurance Premium, his Home Care Agency gets a regular Monthly check, his adult children are relieved of Care responsibilities, and they don’t have to sell the house to pay for care. If he should die before all the money is used, what is left from the Conversion goes back to his estate. 

Posted 01/10/2013

Dementia Drugs May Be Riskier For Men


Elderly people with dementia should be prescribed antipsychotics carefully, say Ontario doctors who found men are at higher risk of hospitalization and death than women when the treatment begins.

Little is known about potential differences for risk of serious events between men and women over the age of 85.

Doctors should continue to be vigilant about prescribing drugs to manage dementia in both older men and women, researchers say.(Enrique Castro-Mendivil/Reuters)

Researchers focused on new prescriptions of a class of drugs called atypical antipsychotics that are used to manage behavior problems associated with dementia.

"It tells us a little bit more about drug therapy and perhaps what might be affecting women and men differently," said Dr. Paula Rochon, a senior scientist at Toronto's Women College Hospital.

In Wednesday's issue of the Journal of the American Geriatric Society, Rochon and her co-authors said of 21,526 older adults with dementia in Ontario who started taking the medications, about seven per cent of the women and nearly 11 per cent of the men died or were hospitalized during the 30 days after the treatment started.

Little is known about how drugs may affect men and women differently after the age of 85, says Dr. Paula Rochon.(Courtesy Women's College Hospital)

"While younger women may be more likely than younger men to experience an adverse drug event, our results suggest that the incidence of serious events in the elderly is reversed and that older men are more likely than older women to experience a serious event related to atypical antipsychotic initiation," the study's authors concluded.

While the risk of developing a serious event after starting treatment was higher in men than women, Rochon said they're in no way saying doctors should only focus on men. Rather, she said doctors should continue to be vigilant about resorting to prescribing drugs to manage dementia in both men and women.

Since older women outnumber older men in the population, while the rate of the serious events like such as death was higher among men, almost 200 more women than men experienced those, the researchers said.

The results couldn't be explained by traditional risk factors such as age, if the patient was in a long-term care facility compared with at home, other illnesses or dose.

Posted 10/29/2012

Medicine Safety: A Toolkit for Families



When taken correctly, medicines can go a long way to help relieve symptoms (for example, pain relief or upset stomach), fight certain infections and even improve the functioning and quality of life of those with common chronic illnesses such as arthritis, cancer, hypertension, heart disease, diabetes or depression.


If your family is like most, your medicine cabinet is probably full of medicines, from over-the-counter pain relievers to prescription drugs, multi-vitamins and herbal remedies. There are probably bottles of medicines that you don’t even remember picking up at the pharmacy.


It can be hard to get a handle on all of the medicines your family members take, but it’s important to be in the know to protect their health and safety. Did you know most Americans fail to ask questions about their medicines, and half don’t use their medicines as prescribed?


It’s true. And while medicines have lots of benefits—not the least of which is helping to make you and your loved ones feel better—they can also be harmful if not used properly.


This toolkit will help you protect yourself and your loved ones. It provides practical information about:
Avoiding medication misuse
Getting the facts about your family’s medicines
Keeping a family medical record
Tips for safe medicine use in children and older adults and during pregnancy
Questions to ask your health team


Bottom line: You are your family’s best advocate. By learning about the benefits and risks of medicines, you can help everyone get the most from their medicines, avoid problems and stay safe.

When in doubt, always ask your family doctor, other prescriber, nurse or pharmacist.

Protect Your Family: Get the Most from Your Medicines

Talk to your doctor, pharmacist or other healthcare professionals to understand why a certain medicine is recommended, what side effects to watch for and any possible interactions with what you are currently using.
Know what you and your family members are taking - know the ingredients; when, how and how long to use medicines; as well as what they are supposed to do and when to expect results, and when to contact your doctor or pharmacist if you experience a problem.
Read and re-read the label, follow the instructions and always double check you have the right medicine for the right person.
Avoid interactions by knowing which other medicines, dietary supplements, foods and/or beverages might cause problems if used with your prescription medicine.
Pay attention to the medicine’s effects. Ask your children or partner how certain medicines are making them feel.

Remember the 3 R’s for Safe Medication Use

1. All medicines, prescription and nonprescription, have RISKS as well as benefits. You need to weigh these risks and benefits carefully for every medicine you take.
2. Respect the power of your medicine and the value of medicines properly used.
3. Take Responsibility for learning about how to take your medication safely.



Posted 09/07/2012

Fall Facts:

How Often Falls Occur


  •   About one third of the elder population over the age of 65 falls each year, and the risk of falls increases proportionately with age. At 80 years, over half of seniors fall annually.
  •   As alarming as they are, these documented statistics fall short of the actual number since
    many incidents are unreported by seniors and unrecognized by family members or caregivers.
  •   Frequent falling. Those who fall are two to three times more likely to fall again.
  •   About half (53%) of the older adults who are discharged for fall-related hip fractures will experience another fall with in six months.

    Fear of Falling


  •   20% to 30% of seniors fear falling.
  •   90% percent of falls that do not result in injury can still have a detrimental impact on health and well-being.
  •   30-50% of elders report that fear of another fall results in loss of confidence and self-imposed restriction of activities, thereby increasing the risk of falls.

    Why Seniors Fall


      A summary of 12 studies cites the following most common reasons for falls. The effect of drugs on the elderly, and the difficulties surrounding medication compliance, are also believed to be the root cause for many of falls incidents.


    Common Reasons for Falls



    Where Seniors Fall


      55% of all falls take place inside the home.


      More than three-quarters take place either inside or in close proximity to the home, where a medical alert system can be of immediate assistance.


      More fall injuries are caused by falls on the same level (vs. stairs) and from a standing highlight, i.e. tripping while walking.

    Where Seniors Fall


    Falls As A National Health Priority


      30 billion is spent annually on healthcare related to falls. Medicare costs alone for hip fractures as a result of falls is projected to be 240 billion dollars by 2040.


  •   The average cost of a fall injury was $19,440 (including hospital, nursing home, emergency room and home healthcare, but not physician services).
  •   The Elder Fall Prevention Act has been passed by Congress for the development of effective public education, expansion of services and research on best practices.



    Posted 09/07/2012



    Helping the person with Alzheimer's communicate


    People with Alzheimer's and other dementias have more difficulty expressing thoughts and emotions; they also have more trouble understanding others. Here are some ways to help the person with Alzheimer's communicate:

    • Be patient and supportive.
      Let the person know you're listening and trying to understand. Show the person that you care about what he or she is saying and be careful not to interrupt.
    • Offer comfort and reassurance.
      If he or she is having trouble communicating, let the person know that it's okay. Encourage the person to continue to explain his or her thoughts.
    • Avoid criticizing or correcting.
      Don't tell the person what he or she is saying is incorrect. Instead, listen and try to find the meaning in what is being said. Repeat what was said if it helps to clarify the thought.
    • Avoid arguing.
      If the person says something you don't agree with, let it be. Arguing usually only makes things worse — often heightening the level of agitation for the person with dementia.
    • Offer a guess.
      If the person uses the wrong word or cannot find a word, try guessing the right one. If you understand what the person means, you may not need to give the correct word. Be careful not to cause unnecessary frustration.
    • Encourage unspoken communication.
      If you don't understand what is being said, ask the person to point or gesture.
    • Limit distractions.
      Find a place that's quiet.The surroundings should support the person's ability to focus on his or her thoughts.
    • Focus on feelings, not facts.
      Sometimes the emotions being expressed are more important than what is being said. Look for the feelings behind the words. At times, tone of voice and other actions may provide clues.

    Read more:


    Posted 08/28/12 




    Great turnout for the fair, we were able to meet lots of great people!  Thanks for coming to meet us!!!

    Posted 06/25/2012.

    Come by and see us at the Senior Fair on Friday 06/22/12!!


    Sign up for our gift card giveaway!!


    We will be giving away FREE senior recipe's with

    nutrition guides too!


    ***** From 10:00AM to 2:00PM ****


    Oakwood Country Club

    3409 Rivermont Avenue
    Lynchburg, VA  24503


    Click on the map below for driving directions.


    Click the map to open an interactive map in a new window.


    Posted June 10, 2012.




    Graceful Aging: Elderly Parent Support

     by Linda Recinos, RN, BSN, GCM


    Is Your Parent Getting the Right

    Medicine at the Right Time?

    Posted March 11, 2011 by Linda Recinos, RN, BSN, GCM


    35% of senior hospitalizations are related to medication mismanagement, according to Home Healthcare Nurse magazine. This means your parent is at risk for a potential hospital admission if you don’t get his or her medication schedule under control.  The following situation is becoming increasingly more common:

    While visiting your father at his home one day, you notice that his legs andankles are swelled up with fluid and leaving finger imprints where you touch them. His congestive heart failure symptoms are flaring up and you ask him if he has taken his medications. With a confused look, he tells you he doesn’t remember and you notice that his medication bottle is nearly full. You are the key to helping him restore his compliance.

    This can be a scary scenario for any adult child of elderly parents but, with a little help, patients can be assisted to gain great control of their medication routine. Some things that can be done are:

    • Make sure his prescription labels are in large print
    • Attach color coded stickers on the medicine bottle caps
    • of when to take each medication
    • Add a check off box to the medication chart for each day
    • Set an alarm for different medication times
    • Make a reminder phone call every day

    If the above activities don’t seem to be working with your parent, then it may be time to switch to an electronic medication delivery device called a Medication Carousel.

    The Medication Carousel is a disk-shaped device that has a tray of 28 medication slots that rotates one compartment at a time. It can be programed for each slot to rotate to the open window in the lid at a particular desired time. A preselected alarm noise and a flashing red light alert your parent that it is time to take their medications.  It does everything except swallow the pills for them. Ask one of our nursing healthcare professionals how you can purchase or rent a medication carousel.



    Graceful Aging: Elderly Parent Support

     by Linda Recinos, RN, BSN, GCM

    Does Your Mom’s Weight Loss Weigh Heavy on Your Mind?

    Posted February 13, 2011 by Linda Recinos, RN, BSN, GCM


    During an afternoon phone conversation with your mother, she reveals that she hasn’t  had a bite to eat yet, because she woke up at 10 am that day! You probe and find out that she has been eating one or two food items a day and that’s all. When you come over and get her on the scale, you find out she is eight pounds lighter than she was three months ago. Grocery shopping for her is just the beginning of how you can turn the situation around and provide her with quality nourishment.


    It is very important that seniors follow the MyPyramid for Older Adults and eat three well balanced meals daily in order to get their proper amounts of protein, carbohydrates, vitamins, and minerals as well as keep their immune system up.(the updated MyPlate has not yet come up with a senior adult version so this pyramid is still recommended for seniors)

    Food Pyramid


    Protein is one of the most important food components and it typically seems to be a low priority with senior meals. They should be eating various sources of protein each day to promote tissue repair, and provide cell regeneration, energy, and mental alertness.  Here are some excellent examples of good protein choices:

    • Broiled or grilled chicken breast, turkey breast, and fish
    • Hard boiled, scrambled, or poached eggs
    • Low-fat cottage cheese
    • Low-fat yogurt
    • High-protein Boost or Ensure supplement drinks

    If your mother still seems to be challenged with eating proper meals, then she could benefit from  the nutrition management services of a registered nurse. A geriatric care management nurse could meet one on one with you and your mother to provide nutritional counseling, guidance and ongoing monitoring, assessment, and interventions for your mother. The nurse can work in collaboration with your mother’s primary doctor and provide that home component feedback to him for his interventions as well. With proper adherence to a solid nutritional plan, her appropriate weight can be reestablished and maintained.




    Proud Member of:

    Sigma Theta Tau    Beard Center on Aging    ALCA   NGNA