Study: Cognitive Training Shows Staying Power

   (NIH) - 1/16/2014 - Training to improve cognitive abilities in older people lasted to some degree 10 years after the training program was completed, according to results of a randomized clinical trial supported by the National Institutes of Health.
   The findings showed training gains for aspects of cognition involved in the ability to think and learn, but researchers said memory training did not have an effect after 10 years.
   The report, from the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) study, appears in the January 2014 issue of the Journal of the American Geriatrics Society. The project was funded by the National Institute on Aging (NIA) and the National Institute of Nursing Research (NINR), components of the NIH.
   “Previous data from this clinical trial demonstrated that the effects of the training lasted for five years,” said NIA Director Richard J. Hodes, M.D. “Now, these longer term results indicate that particular types of cognitive training can provide a lasting benefit a decade later. They suggest that we should continue to pursue cognitive training as an intervention that might help maintain the mental abilities of older people so that they may remain independent and in the community.”
   “ACTIVE is an important example of intervention research aimed at enabling older people to maintain their cognitive abilities as they age,” NINR Director Patricia Grady said. “The average age of the individuals who have been followed over the last 10 years is now 82. Given our nation’s aging population, this type of research is an increasingly high priority.”
   The original 2,832 volunteers for the ACTIVE study were divided into three training groups — memory, reasoning and speed-of-processing — and a control group. The training groups participated in 10 60- to 70-minute sessions over five to six weeks, with some randomly selected for later booster sessions. The study measured effects for each specific cognitive ability trained immediately following the sessions and at one, two, three, five and 10 years after the training.
   The investigators were also interested in whether the training had an effect on the participants’ abilities to undertake some everyday and complex tasks of daily living. They assessed these using standardized measures of time and efficiency in performing daily activities, as well as asking the participants to report on their ability to carry out everyday tasks ranging from preparing meals, housework, finances, health care, using the telephone, shopping, travel and needing assistance in dressing, personal hygiene and bathing.
   At the end of the trial, all groups showed declines from their baseline tests in memory, reasoning and speed of processing. However, the participants who had training in reasoning and speed of processing experienced less decline than those in the memory and control groups. Results of the cognitive tests after 10 years show that 73.6 percent of reasoning-trained participants were still performing reasoning tasks above their pre-trial baseline level compared to 61.7 percent of control participants, who received no training and were only benefiting from practice on the test. This same pattern was seen in speed training: 70.7 percent of speed-trained participants were performing at or above their baseline level compared to 48.8 percent of controls. There was no difference in memory performance between the memory group and the control group after 10 years.
   Participants in all training groups said they had less difficulty performing the everyday tasks compared with those in the control group. However, standard tests of function conducted by the researchers showed no difference in functional abilities among the groups.
   “The speed-of-processing results are very encouraging,” said Jonathan W. King, Ph.D., program director for cognitive aging in the Division of Behavioral and Social Research at NIA and co-author. “The self-reported improvements in daily function are interesting, but we do not yet know whether they would truly allow older people to live independently longer; if they did, even a small effect would be important, not only for the older adults, but also for family members and others providing care.”
   The ACTIVE study followed healthy, community-dwelling older adults from six cities — Baltimore; Birmingham, Ala.; Boston; Detroit; State College, Pa.; and Indianapolis. The participants averaged 74 years of age at the beginning of the study and 14 years of education, 76 percent were female, 74 percent were white and 26 percent were African-American. The 10-year follow-up was conducted with 44 percent of the original sample between April 1998 and October 2010.
   The ACTIVE study was conducted by the following investigators:

• George W. Rebok, Ph.D., Johns Hopkins University, Baltimore
• Karlene Ball, Ph.D., University of Alabama at Birmingham
• Michael Marsiske, Ph.D., University of Florida, Gainesville
• John N. Morris, Ph.D., and Richard N. Jones, Sc.D., Hebrew Senior Life, Boston
• Sharon L. Tennstedt, Ph.D., New England Research Institutes, Watertown, Mass.
• Frederick W. Unverzagt, Ph.D., Indiana University School of Medicine, Indianapolis
• Sherry L. Willis, Ph.D., University of Washington, Seattle

   The National Institute of Nursing Research (NINR) supports basic and clinical research that develops the knowledge to build the scientific foundation for clinical practice, prevent disease and disability, manage and eliminate symptoms caused by illness, and enhance end-of-life and palliative care. See: http://www.ninr.nih.gov. For more information on research, aging, and health, go to http://www.nia.nih.gov.

Report Details Health, Status of Older Americans

   (NIH) - 8/19-2012 - Today's older Americans enjoy longer lives and better physical function than did previous generations, although, for some, an increased burden in housing costs and rising obesity may compromise these gains, according to a comprehensive federal look at aging. The report, Older Americans 2012: Key Indicators of Well-Being, tracks trends at regular intervals to see how older people are faring as the U.S. population grows older.
   In 2010, 40 million people age 65 and over accounted for 13 percent of the total population in the United States. In 2030, the number and proportion of older Americans is expected to grow significantly — to 72 million, representing nearly 20 percent of the population said the report, by the Federal Interagency Forum on Aging-Related Statistics.
   Older Americans 2012, the sixth report prepared by the Forum since 2000, provides an updated and accessible compendium of indicators, drawn from official statistics about the well-being of Americans primarily age 65 and older. The 176-page report provides a broad description of areas of well-being that are improving for older Americans and those that are not. Thirty-seven key indicators are categorized into five broad areas — population, economics, health status, health risks and behaviors, and health care. This year's report also includes a special feature on the end of life.
   Highlights of Older Americans 2012 include:
   Increased labor force participation by older women — Participation of older women in the labor force has increased significantly over the past 40 years. In 1963, 29 percent of women aged 62-64 worked outside the home; in 2011, that had increased to 45 percent. In 1963, 17 percent of women aged 65-69 were in the labor force; in 2011, that had increased to 27 percent. For women 70 and older, 6 percent worked in 1963, increasing to 8 percent in 2011. Some older Americans work out of economic necessity. Others may be attracted by the social contact, intellectual challenges or sense of value that work often provides.
   Declines in poverty, increases in income since 1974 — Older Americans are in better economic shape now than they were in 1974. Between 1974 and 2010, the proportion of older people with income below the poverty thresholds (less than $10,458 in 2010 for a person 65 and older) fell from 15 percent to 9 percent. The percentage with low income (between $10,458 and $20,916 in 2010 for people 65 and older) dropped from 35 percent to 26 percent. There were also notable gains in income over the period, as the proportion of people 65 and older with high income ($41,832 and above in 2010) rose from 18 percent to 31 percent.
   Increased housing problems — The most significant issue by far is housing cost burden, which has been steadily increasing over time. In 1985, about 30 percent of households with householders or spouses age 65 and over spent more than 30 percent of their income on housing and utilities. By 2009, the proportion of older people with high housing cost burden reached 40 percent. For some multigenerational households, crowded housing is also fairly prevalent.
   Rising rates of obesity — Obesity, a major cause of preventable disease and premature death, is increasing among older people. In 2009-2010, 38 percent of people age 65 and over were obese, compared with 22 percent in 1988-1994. In 2009-2010, 44 percent of people age 65-74 were obese, as were 29 percent of those age 75 and older.
   More use of hospice — The percentage of older people who received hospice care in the last 30 days of life increased from 19 percent in 1999 to 43 percent in 2009. The percentage of older Americans who died in hospitals dropped from 49 percent in 1999 to 32 percent in 2009. The percentage who died at home increased from 15 percent in 1999 to 24 percent in 2009. In 2009, there were notable differences in the use of hospice services at the end of life among people of different race and ethnicity groups.
   Older Americans 2012: Key Indicators of Well-Being is available online at http://www.agingstats.gov.

Estate Planning CEO, Employee Face Charges

Indictment Alleges Defrauding of Terminally-ill and Elderly
   PROVIDENCE, R.I. - 11/26/2011 - A Rhode Island attorney and an employee of his Cranston, R.I., estate planning company were charged in a 66-count federal grand jury indictment returned November 17 alleging that they conspired to steal and to use the identities of terminally-ill patients and elderly individuals to obtain more than $25 million in illicit profits from insurance companies and bond issuers.
   Attorney Joseph A. Caramadre, 49, president, CEO and majority owner of Estate Planning Resources, and Raymour Radhakrishnan, 27, an employee of Estate Planning Resources, are charged with conspiracy and multiple counts of mail fraud; wire fraud; identity theft; aggravated identity theft; and money laundering. Caramadre is also charged with one count of witness tampering.
   The two-year investigation and indictment were announced by Peter F. Neronha, U.S. Attorney for the District of Rhode Island; Richard DesLauriers, Special Agent in Charge of the FBI’s Boston Field Office; Robert Bethel, Inspector in Charge of the Postal Inspection Service (USPIS), Boston Division; and William P. Offord, Special Agent in Charge of the Boston Office of the Internal Revenue Service – Criminal Investigation (IRS-CI).
   The indictment alleges that Caramadre and Radhakrishnan made misrepresentations to terminally-ill and elderly patients and their family members in order to obtain their personal identity information. It is alleged they used the information, including names; dates of birth; and social security numbers, to obtain more than 200 variable annuities and to open more than 75 brokerage accounts in order to purchase “death-put” bonds in the victims’ names without their knowledge and consent. It is alleged that the defendants either forged the signatures of terminally-ill people on account documents or obtained the signatures by means of misrepresentations. When the terminally- ill person died, it is alleged that Caramadre and others reaped substantial profits by exercising death benefits associated with the investments. The scheme allegedly generated more than $25 million in illicit profits.
   It is alleged that Caramadre launched the scheme in 1995. Radhakrishnan is alleged to have begun participating in the scheme when he was hired by Caramadre in 2007.
   According to the indictment, one means by which the defendants undertook their alleged scheme was to regularly place advertisements in the Rhode Island Catholic newspaper, offering a $2,000 charitable gift to people suffering from a terminal illness. It is alleged that Radhakrishnan met with individuals and their family members who responded to the advertisement and gave them money on Caramadre’s behalf, while, at the same time, making an assessment as to the life expectancy of the person. It is alleged that if Radhakrishnan believed the person was likely to die in the near future, he would tell them Caramadre had more money available for them. Radhakrishnan and Caramadre then allegedly either forged the terminally-ill person’s signatures or obtained their signatures on account opening documents by making misrepresentations and omissions about the nature of the documents.
   The indictment alleges that some terminally-ill people were misled when they were told their signatures were needed for receipts documenting Caramadre’s charitable gift.
   Others were allegedly misled when they were told that an account would be opened to benefit the terminally-ill person’s surviving family members, or that an account would be opened to benefit other families suffering from terminal illness. The indictment alleges that Caramadre and Radhakrishnan concealed from the terminally-ill people, their families and care givers that Caramadre and his investors stood to make a substantial profit from their deaths.
   In addition, the indictment alleges that Caramadre and Radhakrishnan made numerous misrepresentations to insurance companies, brokerage houses and other corporate entities. It is alleged that they falsely claimed that the terminally-ill people were clients of Caramadre’s law practice and that the terminally-ill people were not paid or given money to become annuitants. It is also alleged that the defendants misrepresented the financial assets and investment experience of the terminally-ill people; misrepresented the relationship between the terminally-ill people and Caramadre or his clients; that the proceeds of the accounts would go to the terminally-ill; falsely claimed that Caramadre paid for the terminally-ill people’s burial expenses at the request of the Catholic Church; and concealed Caramadre’s ownership interest in many of the investments.
   According to the indictment, Caramadre attracted capital from wealthy and prominent individuals and corporations as investors by telling them that he discovered a “loophole” which permitted the use of terminally-ill persons on variable annuities and as co-owners on joint brokerage accounts to be used to purchase death-put bonds. Caramadre allegedly entered into profit-sharing agreements with some of these outside investors, through which Caramadre allegedly received a significant percentage of all profits earned.
The indictment seeks the forfeiture by Caramadre of property derived from the scheme.
An indictment is merely an allegation and is not evidence of guilt. A defendant is entitled to a fair trial in which it will be the government’s burden to prove guilt beyond a reasonable doubt.
   The case is being prosecuted by Assistant U.S. Attorneys Lee H. Vilker and John P. McAdams of the District of Rhode Island.
   Source: Financial Fraud Enforcement Task Force

Compound Improves Lifespan of Obese Mice

   (NIH) - 8/20/2011 - Researchers have reported that obese male mice treated with a synthetic compound called SRT1720 were healthier and lived longer compared to non-treated obese mice. The experimental compound was found to improve the function of the liver, pancreas and heart in mice.
   The National Institute on Aging (NIA) supported the study, in collaboration with Sirtris, a GlaxoSmithKline company. The study was primarily conducted by the NIA, part of the National Institutes of Health, and is published online in the Thursday, August 18, 2011, issue of Scientific Reports.
   "This study has interesting implications for research on the biology of aging. It demonstrates that years of healthy life can be extended in an animal model of diet-induced obesity by a synthetic compound that modulates a gene pathway associated with aging," said NIA Director Richard J. Hodes, M.D. More research is needed to assess the relevance of these findings in people, Hodes and the researchers noted.
  SRT1720, a patented molecule, has been shown to activate the SIRT1enzyme, part of a class of enzymes called sirtuins. Sirtuins have been previously implicated in aging processes and are thought to contribute to the positive effects of dietary restriction (also known as calorie restriction) in higher organisms, including nonhuman primates.
   In this study, scientists compared the health of 1-year-old, or middle-aged, male mice fed a high-fat diet with a high dose of SRT1720, a low dose of SRT1720 or no SRT1720. Additionally, these mice were compared to a control group of 1-year-old male mice fed a standard diet.
   "As we hypothesized, SRT1720 mimics dietary restriction, moderating many of the harmful effects of the high-fat diet and obesity. Furthermore, we found that the higher dose of the compound had a stronger effect and there were no signs of toxicity from SRT1720 even after 80 weeks of treatment," said study leader and senior author Rafael de Cabo, Ph.D., of the Laboratory of Experimental Gerontology at the NIA.
   Scientists reported changes caused by SRT1720 in the following areas:

•    Lifespan. While all mice on the high-fat diet gained weight, mice treated with SRT1720 had an increased average and maximum lifespan compared to mice on the high-fat diet without SRT1720. From birth, the mice on the higher dose lived an average of 18 percent longer, and the mice on the lower dose lived an average of 4 percent longer than the mice on the high-fat diet without SRT1720. From 56 weeks of age, mean lifespan in low-dose mice increased by 11 percent and in high-dose mice by 44 percent.

•    Liver. Mice treated with SRT1720 had less fat accumulation on their livers compared to non-treated, high-fat-diet mice. Scientists also tested liver function using two measurements. In both tests, mice treated with SRT1720 demonstrated better liver function than non-treated mice on a high-fat diet, but only one test showed the liver of treated mice to have equal function as mice on standard diet. Livers of treated mice were smaller than those from untreated mice on a high-fat diet, although they were still larger than livers of mice on a standard diet. In addition, SRT1720 suppressed liver inflammation and protected mice against cell death in the liver.

•    Pancreas. SRT1720 protected high-fat-diet mice from resistance to insulin, which is often associated with obesity and can precede diabetes. Glucose (blood sugar) measurements were approximately equal for all groups of mice, including mice on a standard diet. Insulin levels were approximately double in mice on the high-fat diet without SRT1720 compared to mice on the standard diet and on a high-fat diet with SRT1720.

•    Heart. High-density lipoprotein (HDL), associated with good cardiovascular health, was highest in mice on a high-fat diet with a high dose of SRT1720, even compared to mice on a standard diet. SRT1720 protected mice against cell death in the heart and suppressed inflammation. All groups of mice on a high-fat diet experienced the same increase in cholesterol, compared to mice on a standard diet.

•    Exercise and oxygen metabolism. Mice on a high-fat diet had higher levels of oxygen consumption during periods typically characterized by less activity. SRT1720 reversed this trend; treated mice had lower resting levels of oxygen. High-fat-diet mice with no or a low dose of SRT1720 were less active than mice on a high dose of SRT1720 or on a standard diet.

•    Genes. SRT1720 suppresses genes typically expressed in mice on a high-fat diet. For example, SRT1720 suppressed genes that are associated with aging in the liver and previously identified as associated with aging in the kidney and brain.

   To verify that the positive health effects caused by SRT1720 were, at least in part, dependent on the Sirt1 pathway, scientists conducted a series of experiments using cell cultures. The researchers also assessed changes to mitochondrial respiration in adult Sirt1-specific knockout mice. The tests showed that SRT1720 did not have an effect in mice or cultures lacking the Sirt1 gene although it did have an effect in mice and cultures with Sirt1.
   While the findings are promising, scientists emphasize the limitations of their research.
   "In mice, SRT1720 reversed many of the health problems associated with a high-fat diet and did not have toxic side effects, but it is too early to know whether these findings could be replicated in other animal models, much less humans," said de Cabo. "The bottom line is that we need much more research before considering     
   SRT1720 or related compounds as a possible treatment for diseases of aging."
   The study was a collaborative effort between the laboratories of de Cabo; James L. Ellis of Sirtris, and David A. Sinclair, Ph.D., co-director of the Glenn Laboratories for Molecular Biology of Aging at Harvard Medical School, Boston and consultant to Sirtris. Researchers from the following institutions also collaborated in the study: University of Pennsylvania School of Medicine, Philadelphia; University of Oklahoma Health Sciences Center, Oklahoma City; Ècole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland; University of Michigan, Ann Arbor; and University of Kentucky, Lexington.
   This research was performed under a Cooperative Research and Development Agreement between the NIA and Sirtris, a GSK company.
   Source: National Institutes of Health

Report: Caregiving Costs Weigh on Americans

  WESTPORT, Conn.- (BUSINESS WIRE) - 6/14/2011 - Americans who provide care for their aging parents lose an estimated three trillion dollars in wages, pension and Social Security benefits when they take time off to do so, according to “The MetLife Study of Caregiving Costs to Working Caregivers: Double Jeopardy for Baby Boomers Caring for Their Parents.”
   Produced by the MetLife Mature Market Institute in conjunction with the National Alliance for Caregiving and the Center for Long Term Care Research and Policy at New York Medical College, the study reports that individually, average losses equal $324,044 for women and $283,716 for men. The percentage of adults providing care to a parent has tripled since 1994.
    The researchers analyzed data from the National Health and Retirement Study (HRS) to determine the extent to which older adult children provide care to their parents. They also studied gender roles, the impact of caregiving on careers and the potential cost to the caregiver in lost wages and future retirement income.
    “Nearly 10 million adult children over the age of 50 care for their aging parents,” said Sandra Timmermann, Ed.D., director of the MetLife Mature Market Institute. “Assessing the long-term financial impact of caregiving for aging parents on caregivers themselves, especially those who must curtail their working careers to do so, is especially important, since it can jeopardize their future financial security.”
    In addition, the study found that:
    Adult children age 50+ who work and provide care to a parent are more likely than those who do not provide care, to report that their health is fair or poor.
    The percentage of adult children providing personal care and/or financial assistance to a parent has more than tripled over the past 15 years and currently represents a quarter of adult children, mainly Baby Boomers.
   Working and non-working adult children are almost equally likely to provide care to parents in need.
   Overall, caregiving sons and daughters provide comparable care in many respects, but daughters are more likely to provide basic care (i.e., help with dressing, feeding and bathing) and sons are more likely to provide financial assistance defined as providing $500 or more within the past two years. Twenty-eight percent of women provide basic care, compared with 17 percent of men.
    For women, the total individual amount of lost wages due to leaving the labor force early because of caregiving responsibilities equals $142,693. The estimated impact of caregiving on lost Social Security benefits is $131,351. A very conservative estimated impact on pensions is approximately $50,000. Thus, in total, the cost impact of caregiving on the individual female caregiver in terms of lost wages and Social Security benefits equals $324,044.
    For men, the total individual amount of lost wages due to leaving the labor force early because of caregiving responsibilities equals $89,107. The estimated impact of caregiving on lost Social Security benefits is $144,609. Adding in a conservative estimate of the impact on pensions at $50,000, the total impact equals $283,716 for men, or an average of $303,880 for male or female caregivers age 50+ who care for a parent.
    “These family caregivers, the celebrated members of the sandwich generation, are juggling their responsibilities to their own families and to their parents,” said Gail Hunt, president and CEO of the National Alliance for Caregiving. “There is also evidence that caregivers experience considerable health issues as a result of their focus on caring for others. The need for flexibility in the workplace and in policies that would benefit working caregivers is likely to increase in importance as more working caregivers approach their own retirement, while still caring for their loved ones.”
    “As the percentage of employees who are caregivers continues to grow, there will be greater demand on employers for help and support. There are many workplace resources and programs that can be made available that benefit all stakeholders since financial stress can negatively impact physical health and workplace productivity,” Timmermann said.
   The study contains implications for individuals, employers and policymakers. It points out that employers can provide retirement planning and stress management information and can assist employees with accommodations like flex-time and family leave. Individuals, it says, should consider their own health when caregiving and should prepare financially for their own retirement. Policymakers are made aware of the fact that more states are considering paid family leave, especially as it is accrued through workers’ compensation funds. On the federal level, a voluntary long-term care insurance program is part of the Affordable Care Act and will likely increase public awareness of the issue.
    The MetLife Study of Caregiving Costs to Working Caregivers provides updated information first reported in two MetLife studies: Sons at Work: Balancing Employment and Eldercare (2003) and The MetLife Juggling Act Study: Balancing Caregiving with Work and the Costs Involved (1999).

Methodology

    The study uses data from the Health and Retirement Study (HRS) conducted biannually by the University of Michigan with funding from the National Institute on Aging. First fielded in 1992, the HRS, a nationally representative sample, surveys adults over the age of 50 and provides extensive information on this population, including data on income, work and health status, and whether respondents provide basic, personal care and/or financial assistance to their parents. After cases with missing data were eliminated from the 2008 panel, the sample was restricted to 1,112 men and women who had a parent living.