My mother is 89 years old and suffers from advanced dementia so I'm perhaps more interested than most of you in new information about the aging brain. Having said that, I find fascinating the results of a recently published study published in the August 27, 2008, online issue of Neurology® - the medical journal of the American Academy of Neurology.

The study documents 30 years of testing of people's mental skills from age 70 to death. The study involved 288 people with no dementia who were followed from age 70 to death, with an average age at death of 84. The participants' mental skills were measured up to 12 times over a period of 30 years, and they were evaluated to make sure they had not developed dementia.

"These changes are different and separate from the changes in thinking skills that occur as people get older," said study author Valgeir Thorvaldsson, MSc, of Goteberg University in Sweden. "We found accelerated changes in people's mental skills that indicated a terminal decline phase years before death."

For instance, perceptual speed - measured by how quickly one can compare figures - begins declining 15 years before death. Spatial ability - everyday tasks such as finding one's way in the environment and learning the layout of a new environment - starts declining eight years before death. And verbal ability starts declining about six-and-a-half years before death.

Thorvaldsson noted that verbal abilities declined sharply in the terminal phase and did not decline significantly due to age only. "This indicates that people remain stable in their verbal abilities unless they are experiencing disease processes that also increase their mortality risk," he said. "A change in verbal ability might therefore be considered a critical marker for degeneration in health in older people."

How much longer will I live? While not frequently verbalized, this question is in all of our minds and one would assume that it's much more prevalent in those of advanced age. As I see it, this study's uniqueness lies in identifying specific declines in mental skills as markers of life expectancy.

Americans without health insurance for any part of 2008 will spend $30 billion of their own money for medical care. Many cannot pay their own expenses and they rack up another $56 billion in medical expenses. Most of that amount - $43 billion - is paid by various state and federal government programs: $18 billion by Medicare and Medicaid, $15 billion by state and local government indigent programs, and $10 billion by the Veterans Administration.

The uninsured that pay out of their pocket for medical care pay more overall and get a lot less care for their money. Someone who is uninsured all year pays 35 percent ($583) out of pocket toward their average annual medical costs of $1,686 per person. In contrast, annual medical costs of the privately insured average $3,915, with $681, or 17 percent, paid out of pocket.

For years, the medical community has assumed that the early detection of prostate cancer by PSA testing improved health outcomes of all men tested. Now, the U.S. Preventive Services Task Force (USPSTF) recommends against routine cancer screening for men over 75. PSA tests do dectect the disease, but more harm than good can be done with treatment, starting with prostate biopsy and perhaps surgery and or radiation and chemotherapy.

The recommendation is based on the fact that the average 75 year old American male will live less than 10 additional years and probably die of causes other than prostate cancer, So why risk the emotional and physical trauma of current treatment methods. Of course the decision to test or not is an individual one. For example, a 75 year old male in excellent health should live considerably longer than the average and will probably want to continue with PSA testing.

Databases with the prescription drug histories of 200 million Americans are now being used by many health insurance companies to evaluate applications for individual health insurance. The data work like a credit report for health. The data originate with pharmacy benefit managers and contain details like the prescribing doctor, dates, drugs, dosages, etc.. The benefit companies then give their client insurance companies access for a fee. Insurance companies can better evaluate the expected risk for a particular applicant so this is a great value for them. It works a lot faster that their alternative which is to request medical records from the applicant's physicians.

Privacy and consumer advocates complain that there are more and more companies holding vast amounts of patients' health information, mostly unknown to the average consumer. The database companies say they provide information to insurers only after having been released by consumers.