Hi Readers, beginning this month, older adults will receive their NEW Medicare cards. The purpose of replacing the old ones is simple: The new ones do not have the social security number. The National Council on Aging [NCOA] recently sent this information to me and I hope you find it useful. I have also included some resources from Medicare.gov including the mailing schedule for the new cards. AgeDoc
New Medicare Cards: 5 Things You Need to Know Before They Arrive
by: The My Medicare Matters Team at NCOA
Beginning April 2018, the Centers for Medicare and Medicaid Services will be sending new Medicare cards to beneficiaries. The new cards are being sent to decrease Medicare beneficiaries’ vulnerability to identity theft by removing the Social Security-based number from their Medicare identification cards and replacing it with a new unique Medicare Number.
Your new card will no longer include your Social Security number. It will include your name, new Medicare number, and the dates your Medicare Part A and Part B coverage started.
Start using your new Medicare card once you receive it. Destroy the old one immediately, since it contains your Social Security number. If you happen to lose or misplace your card you can get a replacement, but you can also can access your new Medicare number on a Medicare Summary Notice or through Medicare.
Medicare will never call you uninvited and ask you to give us personal or private information to get your new Medicare Number and card. Scam artists may try to get personal information (like your current Medicare Number) by contacting you about your new card. If someone asks you for your information, for money, or threatens to cancel your health benefits if you don’t share your personal information, hang up and call 1-800-MEDICARE (1-800-633-4227).
American Society on Aging [ASA] Board Chair Bob Blancato, Chair-Elect Karyne Jones, and CEO Bob Stein today condemned remarks offered by Interior Secretary Ryan Zinke during testimony to the Senate Energy and National Resources Committee on Tuesday.
As reported in The Hill, Zinke said “When you give discounted or free passes to elderly, fourth graders, veterans, disabled, and you do it by the carload, there's not a whole lot of people who actually pay at our front door. So, we're looking at ways to make sure we have more revenue in the front door of our parks themselves.”
ASA leaders responded by saying “On behalf of the older and disabled Americans and veterans in our membership we take offense at the comments of the Interior Secretary about all of these groups not continuing to enjoy free access to national parks. It is especially disingenuous coming from a Cabinet Secretary who according to published reports spent almost $140,000 in taxpayer funds to fix doors leading into his office. This proposal to impose these new fees should be shown the door.”
ASA will continue to support policies that provide preferential access to public resources for older Americans, youth, the disabled and the veteran community.
According to Marci Phillips, Director of Public Policy and Advocacy at the National Council on Aging [NCOA], several programs impacting seniors have been included in the FY19 budget. As she stated on the NCOA website, these are proposed changes that will wrap up on March 23. I suggest following this issue on the NCOA link below and make your voices heard:
Ms. Phillips also included another article about the Bipartisan Budget Act of 2018, passed on February 9. While there are some positive changes for older adults, there are also cuts to some important programs, as shown below:
"Those… who allege that old age is devoid of useful activity… are like those who would say that the pilot does nothing in the sailing of his ship, because, while others are climbing the masts, or running about the gangways, or working at the pumps, he sits quietly in the stern and simply holds the tiller. He may not be doing what younger members of the crew are doing, but what he does is better and much more important. It is not by muscle, speed, or physical dexterity that great things are achieved, but by reflection, force of character, and judgment; in these qualities old age is usually not … poorer, but is even richer."
From "Cicero, On Old Age."
Cicero's De Senectute (on Old Age), translated with introduction and notes by Andrew P. Peabody (Leopold Classic Library, 2015).
Although scientists are working to find the cause of Alzheimer’s Disease and eventually a cure and/or preventive strategy, there is little focus on taking proactive measures to protect our brains. At the Alzheimer’s Association International Conference in August, Dr. Lon Schneider, professor at the Keck School of Medicine at USC, urged a proactive approach, as one-third of dementias can be prevented through lifestyle changes. Here are some of the recommendations:
1. Take care of your health. The brain is connected to the rest of the body! Maintain a healthy weight, get diagnostics on time, adhere to eating nutritious food by making every calorie count, maintain oral health, take medicines as prescribed, and get lots of sleep.
2. Sitting. I covered this topic here in the AgeDoc blog in March of 2015. Studies show that too much sitting is actually dangerous. Not only does it compress vital organs, but it impairs circulation. What is “too much?” Sitting for 8-12 hours is harmful, and the recommended maximum amount daily is about 4-5 hours. Avoid a sedentary lifestyle, exercise regularly, and take frequent walking or standing breaks.
3. Avoid Social Isolation. Recent studies found that social isolation is as damaging to health as smoking 15 cigarettes per day! Social isolation increases inflammation and brain imaging showed that loneliness “causes a reaction in the same area of the brain as physical pain” (IlluminAge, 2017, p. 2).
4. Sleep. Older adults need about 7-9 hours of sleep. During sleep, the brain logs memories and experiences from the previous day and the brain is cleaned of toxins. Sleep deprivation may be a fall hazard and can lead to accidents. For more information on the importance of sleep, see these articles here in the blog: Sleeping Position and Brain Waste Removal, 10/18/13; Sleep and Obesity Prevention, 8/19/13; Older Adults and Sleep Deprivation, 1/2/16.
5. Air pollution. According to the American Heart Association, people living in geographical regions with poor air quality score lower on thinking and memory assessments. In areas with high pollution, avoid exposure on days when the levels are high. Even if you reside in an area without any pollution, take precautions when in heavy traffic to avoid exhaust from cars by using the “recirculate” function. As I reported here in the blog on 11/5/2010, Environmental Threats to Health Aging, Mexico City is one of the most polluted cities in the world. There, autopsies of children showed plaques and tangles in their brains. I have since learned that in Mexico City, plaques and tangles have been identified in the brains of dogs, adolescents, and young adults as well. While this does not prove cause/effect, it suggests a link to pollution and brain health.
The five listed in this posting were acquired from the September-October 2017 Aging in Stride, a publication from IlluminAge Corporation. For the entire list of the twelve enemies of brain health, please access this informative article:
Frauds that made the Senate aging committee's 2017 rankings include:
• Sweepstakes scams, run by perpetrators who contact victims by phone, tell them they have won a financial prize, and then require advance payment of a fee to collect the purported winnings.
• Robocalls, using advanced electronic technology that enable would-be scammers to maximize the number of potential victims reached.
• Computer scams a fraud in which callers impersonate representatives of well-known technology companies and convince victims to allow remote access to their home computers to check for problems. The scammers then charge fees to remove purported electronic viruses.
• Elder financial abuse, in some cases involving relatives or friends who gain access to victims' identification data, bank accounts or other records.
• Grandparent scams, a con game in which fraudsters phone with phony claims that a grandchild is in trouble and needs help paying a hospital bill, returning home from overseas or gaining release from jail.
FBI, Scams and Safety
In fact, seniors lose billions of dollars a year to home repair scams, investment scams, IRS scams and various other cons targeting older people. The FBI’s Common Fraud Schemes webpage provides tips on how you can protect yourself and your family from fraud. Senior citizens especially should be aware of fraud schemes for the following reasons:
· Senior citizens are most likely to have a “nest egg,” to own their home, and/or to have excellent credit—all of which make them attractive to con artists. People who grew up in the 1930s, 1940s and 1950s were generally raised to be polite and trusting. Con artists exploit these traits, knowing that it's hard or impossible for these individuals to say “no” or just hang up the telephone.
· Older Americans are less likely to report a fraud because they do not know whom to report it to, are too ashamed at having been scammed, or don’t know they have been scammed. Senior victims may not report crimes, for example, because they are concerned that relatives may think the victims no longer have the mental capacity to take care of their financial affairs.
· When an older victim does report the crime, they often make poor witnesses. Con artists know the effects of age on memory, and they are counting on older victims not being able to supply enough detailed information to investigators. Also, the victims’ realization that they have been swindled may take weeks—or more likely, months—after contact with the fraudster. This extended time frame makes it even harder to remember details from the events.
· Senior citizens are more interested in and susceptible to products promising increased cognitive function, virility, physical conditioning, anti-cancer properties, and so on. In a country where new cures and vaccinations for old diseases have given every American hope for a long and fruitful life, it is not so unbelievable that the con artists’ products can do what they claim.
NCOA [National Council on Aging]
Financial scams targeting seniors have become so prevalent that they are now considered “the crime of the 21st century.” Why? Because seniors are thought to have a significant amount of money sitting in their accounts.
Financial scams also often go unreported or can be difficult to prosecute, so they are considered a “low-risk” crime. However, they are devastating to many older adults and can leave them in a very vulnerable position with little time to recoup their losses.
It is not just wealthy seniors who are targeted. Low-income older adults are also at risk of financial abuse. Moreover, it is not always strangers who perpetrate these crimes. Over 90% of all reported elder abuse is committed by an older person’s family members, most often their adult children, followed by grandchildren, nieces and nephews, and others.
1. Medicare/Health insurance scams
Every U.S. citizen or permanent resident over age 65 qualifies for Medicare, so there is rarely any need for a scam artist to research what private health insurance company older people have to scam them out of some money.
In these types of scams, perpetrators may pose as a Medicare representative to get older people to give them their personal information, or they will provide bogus services for older adults at makeshift mobile clinics, then use the personal information they provide to bill Medicare and pocket the money.
2. Counterfeit prescription drugs
Most commonly, counterfeit drug scams operate on the Internet, where seniors increasingly go to find better prices on specialized medications. This scam is growing in popularity—since 2000, the FDA has investigated an average of 20 such cases per year, up from five a year in the 1990s. The danger is that besides paying money for something that will not help a person’s medical condition, victims may purchase unsafe substances that can inflict even more harm. This scam can be as hard on the body as it is on the wallet.
3. Funeral and Cemetery scams
The FBI warns about two types of funeral and cemetery fraud perpetrated on seniors.
In one approach, scammers read obituaries and call or attend the funeral service of a complete stranger to take advantage of the grieving widow or widower. Claiming the deceased had an outstanding debt with them, scammers will try to extort money from relatives to settle the fake debts.
Another tactic of disreputable funeral homes is to capitalize on family members’ unfamiliarity with the considerable cost of funeral services to add unnecessary charges to the bill. In one common scam of this type, funeral directors will insist that a casket, usually one of the most expensive parts of funeral services, is necessary even when performing a direct cremation, which can be accomplished with a cardboard casket rather than an expensive display or burial casket.
In early 2017, NCOA warned of three new scams that were prevalent:
Mass mailing fraud: The U.S. Department of Justice has seen a spike in mass mailing fraud targeted at the senior citizens. This scam involves personalized, sometimes “registered” letters in your mailbox that appears to indicate you have won a sizable prize and just need to pay a small processing fee for it to be sent to you.
Older Americans have lost millions of dollars in this scam, and unfortunately, responding to such a letter targets the person for future fraudulent mailings.
Two types of IRS scams have been making the rounds in the past year:
• Fake notices that claim you owe money as a result of the Affordable Care Act (“Obamacare”). These are especially tricky, says the Federal Trade Commission, because their design mimics the real IRS notices.
• Automated calls from the IRS claiming that you owe back taxes, and requesting you pay via gift card. Sometimes these fake IRS calls are not automated, but rather a live person calling from a Washington, DC area code (202) using high-pressure scare tactics to get your money (for example, saying the police are coming to arrest you for not paying your taxes). There are several red flags and tips to know whether you are dealing with the real IRS vs. a scammer:
o The IRS never initiates contact with you via phone call, email, or through social media.
o The IRS cannot threaten to have you arrested or deported for not paying.
o You will never be asked to pay using a gift card, pre-paid debit card, or wire transfer; the IRS also never takes credit/debit card information over the phone.
o If you owe the IRS back taxes, you will always have the opportunity to question or appeal the amount.
o Dubbed by the Treasury Inspector General for Tax Administration as the most pervasive impersonation fraud in IRS history, the swindle involves suspected scammers based in the U.S. and India who telephone Americans and threaten arrests unless purported tax debts are not paid immediately. At least 1.97 million people have been targeted, with as many as 200 victimized per week during the scam's peak last year, according to the inspector general.
Back or Knee Brace Post Card:
You receive a colorful postcard stating that the sender has been trying to contact you about ordering a Medicare-covered back or knee brace. All they need is for you to send your Medicare information. What’s to lose? This scam is particularly insidious, because you may actually receive something in the mail, usually a Velcro-style band for your back or knee. The scammer then bills Medicare for a device worth hundreds or thousands of dollars more than the one you received. Moreover, armed with your Medicare information, they can continue to bill Medicare for services not rendered. Medicare has strict coverage rules for its services and supplies, and it pays to keep these tips in mind:
• Never respond to open solicitations for Medicare-covered supplies/services.
• Only provide your Medicare number to health care providers or facilities at the time you are actively seeking service.
• Carefully monitor your Medicare statements for any claims for services or supplies billed to you which you did not receive. You can set up an account at MyMedicare.gov and access your claim information online anytime.
Malnutrition among older adults is increasing worldwide and is a major public health issue. Researchers estimate that about one-third of older adults are malnourished, and one-half are at risk for nutrition, leading to serious health declines, diminished quality of life, and mortality. Consequences of malnutrition include cognitive decline, sarcopenia [muscle wasting], anemia, poor wound healing, impaired immunity, and decreased bone mass (Amarya et al., 2015). Annually, malnutrition among older adults costs $51. Billion to treat diseases related to it (Aging Today, 2017). Malnutrition is prevalent among overweight, obese, thin, and healthy looking older adults, and from all socioeconomic groups. The purpose of this posting is to provide awareness of the importance of nutritional screening and to eat a balanced diet to avoid malnutrition.
Malnutrition is defined as an imbalance of nutrients as the result of ingesting foods low in nutrients or not eating a balanced diet to maintain optimum health. Some signs of malnutrition among older adults are muscle weakness, fatigue, increased illness, infection, confusion, and feeling irritable.
Causes of malnutrition include limited income, trouble swallowing and chewing, poor dental health, poor appetite, taste disturbances, living alone, bereavement, lack of mobility, pricey medications, living in a food desert [more than 7 miles from a grocery store], and inability to prepare food. Older adults who live too far from grocery stores may resort to shopping for groceries in mini-marts and gas stations, resulting in a diet lacking in fresh fruits and vegetables. Older adults have diminished tongue sensors, and therefore do not realize that food is salty. Diminished taste receptors result in “normal” foods that taste bland. Hot dogs and canned soup are the two foods most eaten by older adults. Why? Hot dogs are cheap and easy to cook in the microwave. Canned soup is also cheap, and most have pop lids and can be heated in the microwave. Unfortunately, hot dogs and canned soup are loaded with sodium, and a steady diet of soup and hot dogs may lead to malnutrition and excessive sodium intake.
Community advocacy using a multidisciplinary approach has shown to increase awareness and create solutions and promote policy change (Aging Today, 2017). One solution to address food insufficiency caused by poverty is the SNAP Program, which is an acronym for Supplemental Nutrition Assistance Program, formerly known as “food stamps.” For older adults who meet the threshold, a credit card is provided to help pay for food. Gone is the “shame” factor, as paying for groceries with a credit card is commonplace. In Alabama, a one-person household qualifies with an annual income of $15, and for a two-person household, $20k qualifies. More information about this program is available on the AL.gov website. Another strategy for combating malnutrition is funded by the Older American’s Act of 1965. Hot noon meals are served five days per week at senior and community centers throughout the United States. In Limestone County, there are five nutrition centers, and in Madison County, there are six centers. There, seniors gather to share a nutritious and healthy noon meal. An added benefit is social interaction, which may alleviate social isolation so common among older adults.
Screening for nutritional status is another way to reduce malnutrition. For professionals, the Mini Nutritional Assessment [MNA] or the short form [MNA-SF] from the Nestle Nutrition Institute are two accepted screening for determining malnutrition among older adults. In the community, I use the Nestle MNA or the MNA-SF for assessing nutritional status.
There are several screening tools including the Nutritional Risk Index (NRI), Geriatric Nutritional Risk Index (GNRI), Subjective Global Assessment (SGA), Mini Nutritional Assessment Screening Form (MNA-SF), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002). While the MUST screening has been shown to have the highest reliability, it is most often administered upon hospital admission (Poulia et al., 2012).
Aging Today (2017), American Society on Aging, 25(5), p. 1, 14. San Francisco, CA.
Poulia, K., Yannakoulia, M., Karageorgou, D., Gamalestou, M., Panagiotakos, D.B., Sipsas, N.V., & Zampelas, A. (2012). Evaluation of the efficacy of six nutritional screening tools to predict malnutrition in the elderly. Journal of Clinical Nutrition, 31(3), 378-385.
Hi Readers, as I shared in my previous blog posting, 90% of older adults DO NOT have Alzheimer’s Disease [AD], yet AD gets enormous media attention and older adults are overly concerned about it, sometimes ignoring other more pressing health matters. The CDC (2016) has identified the leading causes of death in older adults in this order, indicating that heart disease and cancer are by far more prevalent than AD:
“Heart disease 507,138k
Malignant neoplasms [Cancer] 419.389k
Chronic lower respiratory diseases 131,804k
Cerebrovascular diseases 120,156k
Alzheimer’s disease 109,495k” (CDC, 2016, p. 133)
Hidden within these statistics is the issue of overweight and obesity among older adults. Among adults, BMI of 18.5-24.9 is normal, 25-29.9 is overweight, and 30+ is obese (CDC, 2016). Obesity is defined as, “an unhealthy excess of body fat, which increases the risk of medical illness and premature mortality” (Amarya, Singh, & Sabharwal, 2014, p. 63). According to the CDC (2016), there are three subcategories of obesity, as shown below:
· “Class 1: BMI of 30 to 34.9
· Class 2: BMI of 35 to 39.9
· Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity” (para. 4).
While there have been some recent studies linking overweight and longer life among older adults, those findings are disputed. What we DO know and agree on is that OBESITY among older adults may lead to declining health status, increased health care spending, chronic morbidities [hypertension and stroke, Type 2 diabetes, metabolic syndrome, arthritis, urinary incontinence, and cancer], leading to loss of mobility, dependence, institutionalization, and early death (Amarya et al., p. 63). About 35% of older adults are obese, making this a major health crisis far more prevalent than Alzheimer’s Disease. Sadly, many of my clients who have sought advice on preventing and delaying Alzheimer’s Disease have been obese. In counseling older clients, practitioners must sometimes tell them what they do not want to hear, that obesity is the problem and not Alzheimer’s Disease.
A former client, age 75, laughed at me when at the end of our talk about retaining independence and healthy aging, I spoke to her about obesity, as “Helen” was at least 100 pounds overweight [Class 3 Obesity BMI] and sedentary. “I am the healthiest fat person you have ever known” was her response, and then she told me about participating in water aerobics three times per week. I reminded Helen that she had recurring congestive heart failure, hypertension, and arthritis, and that she was at risk of having a major health event and loss of independence if she did not take steps to lose weight and make some lifestyle changes. Because Helen was trying to decide on moving to assisted living or remain at home, I recommended finding a suitable assisted living soon and prepare her house for sale as proactive strategies. Helen disagreed with my assessments and huffed out of the office.
Sadly, Helen’s son phoned me about six months later and told me that his mother had a massive stroke and could not speak, suffered short-term memory loss, and she was moved to an assisted living facility with 24/7 supervision on the West Coast near her children. He and his four siblings were disposing of her home and personal belongings, as the prognosis was bleak. A year later, “Roger” phoned to tell me that Helen’s health status had declined and she died in a nursing home.
Although I could not convince Helen to change her habits toward a healthier lifestyle, and she got angry with me, I did everything I could as a gerontologist to give her professional and honest advice toward maintaining her independence and optimum aging. This is an example of always telling clients the truth, although it may not be accepted.
Amarya, S., Singh, K., & Sabharwal, M. (2014). Health consequences of obesity in the elderly. Journal of Clinical Gerontology and Geriatrics, 5(3), 63-67. doi:10.1016/j.jcgg.2014.01.004