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Now is the time to contact your U.S. Senators and Congressional representative to urge them to do all in their considerable power to sustain a HUD budget that will acknowledge the presence of low-income disabled senior citizens in your community. Do not refer to “affordable housing”. Specify “low income” Section 8 subsidized projects for disabled seniors.  

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Hearing loss is one of the most common health conditions in older adults and one of the most widely undertreated. Getting sound to the brain is the “first and most important step” in preventing sensory deprivation that can contribute to cognitive dysfunction. Judith Graham’s January 23, 2013 New York Times article, “Study links cognitive deficits, hearing loss,” is a must-read.  

A Johns Hopkins Medicine researchers’ study suggests that elderly people with compromised hearing are at risk of developing cognitive deficits — problems with memory and thinking — sooner than those whose hearing is intact. Even seniors who hear sounds relatively well often report that words sound garbled or mumbled, indicating deterioration in hearing mechanisms that process complex speech. 

The extent of hearing problems in older people and their association with the onset of dementia and with falling has been documented. In his latest investigations, “Hearing Loss and Cognitive Decline in Older Adults” [JAMA Intern Med. 2013,] Dr. Frank Lin looked at almost two thousand older adults who participated over many years in a long-term study. Participants’ mean age was 77; none had evidence of cognitive impairment when the research period began. In 2001 and 2002, they received hearing tests and cognitive tests; cognitive tests alone were repeated three, five and six years later. Annual rates of cognitive decline were found to be 41% greater in older adults with hearing problems than in those without. Elderly people with hearing problems experienced a five-point decline on the exam in 7.7 years, compared with 10.9 years for those with normal hearing. Given that nearly two-thirds of adults age 70+ have hearing problems, these are important findings.  

One consequence that explains these findings is social isolation. When people have a hard time distinguishing what someone is saying to them, as is common in older age, they often stop accepting invitations, attending concerts or classes, or going to family events. Over time, this social withdrawal can become a self-fulfilling prophecy, leading to the loss of meaningful relationships and activities that keep older people feeling engaged with others. Bottom line for older adults themselves, caregivers, and geriatricians is Pay attention to hearing loss!! A substantial body of research by cognitive scientists has established that seniors’ cognitive health depends on exercising both body and brain and remaining socially engaged. This study should be a wake-up call to clinicians that auditory tests need to be among the tests they employ to look at an older person’s health. 

Another potential explanation for these new finding lies in a concept known as “cognitive load,” which assumes that we have only a certain amount of cognitive resources, and if we expend a lot of them processing sensory input coming in — in this case, sound — it is going to be processed more slowly and understood and remembered less well. In other words, when your brain has to work hard to hear and identify meaningful speech from a jumble of sounds, you’ll have less mental energy for higher cognitive processing.  

JAMA, the Journal of the American Medical Association, is available in the central Berkeley Public Library (third floor) and online.  

NEWS  

About 8,600 elderly Singaporeans suffered from hearing impairment and sought treatment in 2012. About 1,500 needed a hearing aid and went through a hearing aid evaluation test. About 800 of these seniors began using hearing aids, which cost about $1,000 to $1,500. But Medisave does not cover this because it is primarily meant to support large hospitalization bills. To help low-income elderly, the Centre for Enabled Living (CEL) has a Special Assistance Fund that provides a hearing aids subsidy.  

The incidence of chronic constipation increases with age, but its causes remain unknown and recommendations for treatment vary widely. A review of 16 randomized controlled trials (average age of the people in the trials was 65) has separated those treatments backed by scientific evidence from those that are not. Writing online in The Canadian Medical Association Journal, researchers reviewed studies of dietary fibers, laxatives, enemas and suppositories, stimulants and stool softeners, drinking water, and exercise. They found (1) that lactulose and polyethylene glycol (laxatives sold under various brand names) had statistically significant effects in several trials; (2) evidence for dietary fiber was lacking or inconsistent; (3) little or no evidence that enemas, suppositories, physical activity or increased fluid intake had any beneficial effect on chronic constipation. The best clinical trial evidence is for lactulose and for polyethylene glycol, according to lead author, Dr. Dov Gandell, a geriatrician at the University of Toronto, but other remedies may work and “It depends on the patient.” 

Bloomberg News reports that the elderly and disabled enrolled in Medicare will pay less for drugs next year, and insurers offering plans with extra benefits will see taxpayer subsidies reduced because of record low spending growth. Part D, the standard deductible for Medicare’s drug program, will be $310 in 2014, about 4.6% less than this year, and co-payments also will be reduced. 

Read about the several possible reasons and the one main reason why doctors don’t speak out in cases of faulty products and actions, discussed in Feb. 17, 2013’s New York Times.  

The National Institute of Senior Centers (NISC) Programs of Excellence Awards are designed to honor and promote outstanding efforts made by senior centers throughout the nation to offer innovative, creative, and replicable programs for older adults. 2012’s award-winners have been selected from 62 nominations. Twelve award winners and honorable mentions were chosen. Each program is proof of the important work happening at many senior centers. There was one award-winner in California: Rancho and Lakeview Senior Centers, in Irvine. 

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