The US doesn't have enough Geratricians. Currently, there about 7,000 Geriatricians practicing in the US. And the shortage is getting worse, because our medical schools and teaching hospitals are training one or two geriatricians for every nine specialists in higher paying specialties like cardiology or orthopedic surgery,

Geriatricians make less money because their patients are on Medicare and their services are reimbursed a lower rate than private insurance patients. Additionally, the treatment of the elderly is less attractive to young doctors selecting a specialty.

Public relations programs to convince the public of the value of Geriatricians has not had much of an impact on the shortage. So medical schools are adding more courses on the treatment of the elderly for all doctors and some foundations are providing grants to fund those courses. Because there are too few Geriatricians, primary care doctors also need to receive extra training in the treatment of elderly patients and perhaps even be required to be certified in elderly treatment.

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Memory screenings are cheap and effective Physicians need to use them more. It is estimated, that physicians miss at least half of the cases of mild and moderate dementia, only recognizing it when the brain disorder is at least moderately advanced. Early diagnosis benefits, include treatments and lifestyle choices, such as proper nutrition and mental stimulation

According to a survey of participants in the AFA 2006 National Memory Screening Day, 73% had memory concerns, but fewer than 10% had discussed those conserns with their physician. Clearly, Americans need to consider their brain health as they age.

Over 2,000 sites in 46 states offer confidential memory screenings, including all of Kmart's 1,100 pharmacies nationwide. The face-to-face screening consists of a series of questions and tasks that take about 5 minutes to administer. If you score low or are concerned, you are encouraged to pursue follow-up evaluations. Last year, about 10% of those screened were referred to a health care professional for further evaluation.

Dementia can be predicted with 87% accuracy by a relatively simple test developed by researchers at the San Francisco VA Medical Center. The test is a combination of medical history, a physical exam, and cognitive testing. No special equipment is required and it can be given in a doctor's office or at the patient's home. The test measures the salient risk factors for dementia, including age 70 or more, low cognitive scores, poor dexterity or slow walking, a history of coronary artery bypass surgery, and a BMI of 18 or less.

Unexpected medical problems cause 1 in 4 American workers to retire early. They had lower-than-expected income due to health problems. In retirement planning, it is not just about money. You have to take health into account as well. Poor health can certainly significantly impact your finances.

See full story at Boston Globe Online, Moving into retirement.

People who are 65 years of age or older and who have a higher than average caffeine intake are indicated to be a lower risk of coronary vascular disease and also heart mortality than those of the same age with a lower recorded intake. The reason is most likely to be due to the beneficial effect of caffeine on blood pressure. It was also found that the higher their intake, the more beneficial the results except for those who were overly hypertensive.

The same was not found to be true in people below age 65.

Elderly nursing home residents (average 89 years old) taking part in a study were given 800 IUs of vitamin D daily for five months. They were found to take less falls than those who were given lower doses, no vitamin D or a sugar pill placebo. Most participants in the study were white women who had experienced a fall within the previous year.

For the duration of the five-month study, 61 participants, or 59%, suffered falls. The group taking the daily doses of vitamin D daily was the only group to exhibit a reduced fall risk. They were found to be 72% less likely to fall than those taking the placebo. Researchers took other factors in to account including BMI (body mass index and age.

It is recognized that there are many reasons why people fall. Although vitamin D is known to strengthen bones it is not proven to strengthen muscle. The researchers therefore concluded that it's not certain if vitamin D was the only reason for the decrease in falls for residents taking a specific dose of 800 IU of vitamin D on a daily basis.

SOURCES: "Dietary Supplement Fact Sheet: Vitamin D." News release, Blackwell Publishing; Broe, K. Journal of the American Geriatrics Society, February 2007; Office of Dietary Supplements, National Institutes of Health.

My golf buddy recently got shingles. I didn't know what it was. It turns out, most people don't know about shingles unless they know someone who has had shingles, or they develop it themselves. Shingles, a disease caused by the same virus as chickenpox, affects roughly one million Americans each year.

Shingles is nasty and very painful.The first signs of shingles may not be visually noticeable. People often experience tingling, burning, itching or pain. During the first few days of symptoms, fluid-filled blisters will break out in a rash, usually on one side of the body or face. Patients are usually given analgesics along with antiviral medications for treatment. If possible, treatment should begin within 72 hours of the onset of symptoms. The rash is often painful and will heal in two to four weeks, in most people.

After a person gets the chickenpox, most often during childhood, the inactivated virus can live on in certain nerve cells in the body. In healthy people, the body's immune system usually keeps the virus at bay. As people age or their immune system becomes compromised, the virus can reactivate and result in shingles. Thus the risk of shingles increases with age. One out of two people who live to the age of 85 will have had shingles.

Diminshing cognitive functions such as deterioration in memory, reduced ability to process information quickly, and reduced verbal fluency have been linked to risk of dementia in old age. Taking supplements of folic acid may significantly improve cognitive function in older men and women.

A group of 818 men and women over-50s were followed for three years. Some were given 800 micrograms of a synthetic form of folic acid per day, the rest took a placebo. The scientists found that the group who took the folic acid improved on all aspects of cognitive functioning compared to the group that took the placebo.

Some research studies have linked folic acid supplement taking with reductions in various age-related impairments such as hearing loss and Alzheimer's. Others are not so clear, but there seems to be consensus that it helps improve cognitive function in elderly people with high concentrations of the amino acid homocysteine in their blood, which could indicate increased riks of stroke, heart disease and Alzheimer's.

The study was led by Jane Durga from the Wageningen University in The Netherlands and is to be published in the Lancet.

A new study published in the Annals of Internal Medicine has indicated that not only does growth hormone (GH) not help you live longer, but it comes with a substantial potential for adverse side effects, such as diabetes, carpel tunnel syndrome and swollen joints. Growth hormones have been promoted for years as wonder products that can prevent, even reverse, the aging process.

Researchers from the University of Stanford looked at 31 studies. The study looked at a total of 220 participants - average age was 69 - who received growth hormone. The researchers found that growth hormones did bring about a slight reduction in body weight and a slight increase in muscle. They did not detect, however, any change in the patients' cholesterol levels, aerobic capacity or bone density.

The researchers did find that there was an increase in developing soft tissue edema (swelling), arthralgias, carpal tunnel syndrome and gynecomastia. They were also more likely to experience the onset of diabetes mellitus and impaired fasting glucose.

Dr Hau Liu, team leader, said "There is certainly no data out there to suggest that giving growth hormone to an otherwise healthy person will make him or her live longer. We did find, however, that there was substantial potential for adverse side effects. In short, the studies provided no real evidence that the therapy resulted in increased fitness."

Annals of Internal Medicine
16 January 2007, "Systematic Review: The Safety and Efficacy of Growth Hormone in the Healthy Elderly"

Two Medicare recipients taking the same drugs but living in different states could face costs that differe by thousands of dollars - even if each had chosen the lowest-cost plan available to them. And within a state, the difference in a person's costs for the same drugs could top $10,000 a year or more, depending on which plan he or she chose. Such wide variation in prices demonstrates that Medicare prescription drug plans are substantially more affordable in some states than in others. The difference in plan costs appears to have little to do with the cost of living in different states. In fact, some of the states with the lowest cost-of-living-adjusted average incomes had some of the highest drug plan costs.

For example, the 78-year-old woman might pay $4,113 out of her own pocket each year for her four medicines if she chose the lowest-cost plan available in Michigan, while the same drugs would cost her $16,856 if she lived just over the border in Ohio and had chosen the lowest-cost plan there. On average across the United States, her plan costs would be $8,146.

This shows just how high the stakes can be when a senior is deciding which plan to choose, or deciding whether or not to switch plans. It is extremely important that Medicare beneficiaries use the online cost calculator or get other assistance as they choose their plans because choosing a plan based on a familiar name may not lead to the lowest costs for a person's medicines.

The results, published in the January Journal of General Internal Medicine, online at http://www.springerlink.com/content/7177637783wu21wj/

A gene variation that helps people live into their 90s and beyond also protects their memories and ability to think and learn new information, according to a study published in the December 26, 2006, issue of Neurology, the scientific journal of the American Academy of Neurology.

The study examined 158 people, who were 95 years old or older. Those who had the gene variant were twice as likely to have good brain function compared to those who did not have the gene variant. The researchers also validated these findings in a group of 124 who were between age 75 and 85 and found similar results.

“It’s possible that this gene variant also protects against the development of Alzheimer’s disease,” said study author Nir Barzilai, MD, the director of the Institute for Aging Research at Albert Einstein College of Medicine in Bronx, NY. Work is being done to develop drugs that can mimic the effect of this gene variation, Barzilai said.

My mother, who is 87, suffers from dementia. In addition to memory loss, her IQ is fraction of what it used to be. Having seen the results of dementia, I'm afraid it will strike me as well. My work keeps me mentally active. In addition I do crossword puzzles because I've heard that, "If you use it you won't loose it".

However. there is no empirical proof that brain teasers, crossword puzzles, or any of the other mental exercises out there will slow mental decline, or thwart Alzheimer's disease. Last spring, University of Virginia neuroscientist Timothy A. Salthouse analyzed a large number of studies meant to show that mental challenges arrest brain decline. He found none that proved its thesis. So far, he concluded, "the mental-exercise hypothesis is more of an optimistic hope than an empirical reality."

Salthouse discovered that most brain-training studies suffer from a "chicken or the egg" problem. It could be that people who performed well in studies involving mental exercises were more mentally agile to begin with. It is true that practice makes perfect, says Matthew L. Shapiro, a neuroscientist at Mount Sinai School of Medicine in New York. "The more you try to remember, the better your skill at remembering." Still, he says there is little evidence that those improvements will lead to overall mental improvement, and a brain disease "will ultimately overwhelm any efforts to better your skills."

What do you think?