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NEWS RELEASE 1-OCT-2020Social isolation increases anxiety and asymmetry in brain atrophy in Alzheimer's disease
UNIVERSITAT AUTONOMA DE BARCELONA
PRINT E-MAILA study in mice conducted by the UAB shows that social isolation worsens the effects of Alzheimer's disease, with hyperactivity levels reaching up to twice as much as in the pathology itself
- The research also confirms an increase in the asymmetric atrophy of the hippocampus, a brain area central to memory
- The study was published in a special edition of Frontiers in Psychiatry entitled Death and Mourning Processes in the Times of the Coronavirus Pandemic (COVID-19), dedicated to assessing the effects of this pandemic
Researchers at the Department of Psychiatry and Legal Medicine and at the Institut de Neurociències (INc) of the Universitat Autònoma de Barcelona (UAB) have conducted a study which allows estimating, from the viewpoint of translational neuroscience, the effects of isolation in the current pandemic scenarios in elderly patients with dementia. The findings also may serve as a guide to the rethinking of vital conditions after the Covid-19 crisis. The study was published in Frontiers in Psychiatry, in a special edition of Frontiers in Psychiatry entitled Death and Mourning Processes in the Times of the Coronavirus Pandemic (COVID-19), dedicated to assessing the effects of this pandemic.
The researchers analysed the effects of isolation in male mice models suffering from advanced stages of Alzheimer's disease through a series of behavioural tests, which could be compared to several areas found in elderly residence homes. They compared these results with mice models of Alzheimer's that were not isolated, and with other healthy animal models undergoing a normal ageing process. The study was conducted with male mice because these are more affected by Covid-19 and are also the ones to show more deterioration of the neuro-immuno-endocrine system and worse survival conditions when suffering dementia.
The main findings demonstrate that isolation exacerbates hyperactivity up to twice as normal in mice with Alzheimer's disease, and also causes the appearance of strange behaviours. This increase was demonstrated consistently in the gross motor skills, related to the movement of arms, legs, feet or the entire body. However, it also affected fine motor skills, small movements made by hands, wrists, fingers, toes, lips and tongue. The isolated animals showed emotional patterns comparable to anxiety and changes in their stress management strategies.
"The results are concerning, given that anxiety is one of the main neuropsychiatric symptoms associated with dementia, which produces a large burden on the caregiver and, in some cases, makes clinical management a challenge", points out Aida Muntsant, first autor of the research, which is included as part of her PhD thesis.
Effects of isolation on memory
Researchers also analysed the effects of isolation on other neuropathological variables, and obtained different results. "Although the characteristic variables of the disorder, like taupathy, were not modified, some others such as asymmetric hippocampal atrophy increased with isolation. This dysfunction was recently described in human patients with dementia and modelled here for the first time with animal models of Alzheimer's disease. The finding is important, given that asymmetry has been linked to greater vulnerability to stress factors", states Lydia Giménez-Llort, Professor in Psychiatry and researcher at the INc directing the study.
The study also confirmed that the mice suffering from Alzheimer's disease lost body and renal mass, effects which also have been observed in Covid-19 patients, although the loss was greater with those in isolation. The loss in spleen mass, an important organ of the peripheral immune system, was only observed in isolated animals.
Rethinking isolation among the elderly
"Thinking of what the post-Covid-19 era will be like for the elderly implies a great deal of effort in redesigning all conditions of life, interventions in care and rehabilitation, and the management of forced solitude as part of new physical distancing measures. Therefore, it is necessary and urgent to estimate the impact these measures will have on the more vulnerable elderly population, such as those suffering from dementia", the researchers point out.
The study also highlights the need for personalised interventions adapted to the heterogeneous and complex clinical profile of people with dementia, and to consider how all of this affects the obligations of caregivers, whether they be professionals or members of the patient's family.
The results of the study form part of Aida Muntsant's PhD thesis and are a product of the research led by Lydia Giménez-Llort, under the framework of the project ArrestAD H2020 Fet-OPEN-1-2016-2017-737390, led by Dulce Papy of the Paris-Est Créteil University, UPEC.
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María Jesús Delgado
More on this News ReleaseSocial isolation increases anxiety and asymmetry in brain atrophy in Alzheimer's diseaseUNIVERSITAT AUTONOMA DE BARCELONA
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Pandemic Erects Barriers for Prized Bloc of Voters in Nursing Homes, Senior FacilitiesBy Rachel BluthOCTOBER 9, 2020
Voting booths in a polling place set up in a retirement home in Carmichael, California on Nov. 4, 2014. (Mardis Coers/Contributor via Getty Images)
This story also ran on Los Angeles Times. This story can be republished for free (details).The convergence of the coronavirus pandemic and election season has complicated this year’s voting for residents of nursing homes, assisted living facilities and other long-term care centers.
Many seniors who need help to get or fill out their ballots may be stymied by shifting rules about family visits. Voting procedures — whether in person or by mail — are under increased scrutiny, adding to the confusion. Facilities that used to host voting precincts likely won’t do so this year because of concerns about the spread of COVID-19.
“We’re basically not allowed to go out into the public right now, we’re more vulnerable, and our immune systems are compromised anyway,” said Janice Phillips, a 14-year resident of Village Square Healthcare Center, a skilled nursing facility in San Marcos, California. “We’re basically locked in.”
Phillips, 75, who has rheumatoid arthritis, has voted by absentee ballot for years without problems. This year she is encouraging her fellow residents to vote by mail as well. She works with the facility’s activities staff, going resident by resident, to make sure folks are registered. As president of the resident council, Phillips has also raised the issue at community meetings.
Older Americans are a consistent voting bloc courted by both parties.
According to AARP, 71% of Americans 65 and older voted in the 2016 presidential election, compared with 46% of people 18-29. “For many older adults, it’s a point of pride for them that they’ve voted in every election since they were 18,” said Leza Coleman, the executive director of California’s Long-Term Care Ombudsman Association.
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SIGN UPBut hardly anyone has been allowed inside skilled nursing facilities since the start of the pandemic, except for staff members and the occasional state health official, or family members in certain circumstances. In California and beyond, facilities are beginning to open up in counties with low transmission rates, since federal rules changed in September to allow for more lenient visiting policies.
At the same time, outbreaks continue to plague some senior facilities, despite improved testing of staff and other safety measures. On Wednesday, Santa Cruz County health officials reported a major outbreak at the Watsonville Post-Acute Center, which has infected 46 residents, killing nine of them, and infecting 15 staff members.
California officials are pressing nursing homes and senior centers to give residents who want to vote the opportunity. The Department of Public Health on Oct. 5 sent a letter to all those facilities, explaining they have an obligation to inform and assist residents with voting, including what actions are permissible for staffers to undertake in helping voters. It also includes advice about maintaining a safe environment through the election by limiting nonessential visitors, properly using protective gear such as gloves and handling ballots as little as possible.
In years past, civic groups such as the League of Women Voters would stop by to give presentations on what’s on the ballot. Candidates for local office would hit nursing homes to make pitches. “In the context of a pandemic, we just can’t do it this year,” said Michelle Bishop, voter access and engagement manager with the National Disability Rights Network.
Before the pandemic, nursing homes and assisted living facilities also often served as polling places. Residents could easily access voting booths, often set up in a lobby or community room. That was especially important because nursing homes are likely to be accessible to people with mobility problems, Bishop said.
Otherwise, facilities would often organize bus trips and outings to polling places.
In California, the last day to register to vote online or by mail is Oct. 19, though voters can register in person up to and including Election Day. All registered voters will receive a ballot in the mail, and those postmarked by Nov. 3 will still be counted in California for 17 days after the election. Advocates say it’s important for newer residents at skilled nursing facilities to make sure they’ve registered at their new address or have plans to get their ballot delivered to them from their former homes.
Other states are also sending ballots to all registered voters by mail this year on various time frames. All states permit seniors or people who have trouble reaching polling stations to request an absentee ballot.
Once they have a ballot in hand, some older adults need help from family or staff at their facilities to complete it correctly and send it back to election officials. The federal directive to relax visiting rules could ease some of that pressure, but the situation varies by facility. For people whose relatives cannot help them, it may fall to staff members to set up calls and video chats between residents and their families, or provide the assistance to residents themselves.
Some states don’t allow nursing home staffers to help with ballots to avoid influencing votes. Even if they can assist, employees may be stretched too thin to help. In a year when nursing home staff members are spending an extra hour each day putting on protective gear, there isn’t always extra time to make sure every resident is registered and voting, said Dr. Karl Steinberg, chief medical officer for Mariner Health Central, a nursing home management company in California.
“There’s a perennial workforce shortage in nursing homes and it’s been exacerbated by this” pandemic, Steinberg said. “This year with all the chaos, there may be less staff time available to help people with voting.”
Tracy Greene Mintz, whose business, Senior Care Training, trains senior care workers, is responsible for staffing at 100 nursing homes in California. She said she started ringing alarm bells about voting rights in August.
“Elected officials do not care about nursing homes, period,” Greene Mintz said. “They assume residents don’t vote and don’t make contributions.”
She asked the California Department of Public Health, which surveys skilled nursing facilities every six weeks about COVID-19 infection control, to add a question on how facilities were planning for elections. The department declined.
So she set up webinars with facility administrators and the Los Angeles County Registrar-Recorder/County Clerk to go over information on how to submit and track absentee ballots.
She has also urged state officials to provide a statewide plan that facilities could use as a blueprint. She wrote one herself that was emailed out by a trade group, the California Association of Health Facilities.
Still, California is in better shape than some other states, said Raúl Macías, a lawyer with the Democracy Program at the Brennan Center for Justice, a law and public policy institute. Elsewhere, residents may have to apply for an absentee ballot, and sometimes must provide a reason they can’t vote in person.
California also has the Voter Bill of Rights, which allows individuals to designate someone to help them fill out and drop off their ballot. In some states, such as North Carolina, assistance can come only from designated bipartisan voting assistance teams, which may be harder to recruit during a pandemic, Macías said.
No matter the state, state and county elections officials and facility administrators should draft voting plans, said Bishop, of the Disabilities Rights Network. It will help staff know the proper way to assist residents without influencing their votes, and residents know their voting rights.
“There is a bit of a gray area on whose responsibility this is,” Bishop said. “It’s one of the years when we start asking ‘Whose responsibility is it?’ Who cares? We have to get it done.”
If they can’t get access to ballots or need help, California residents can contact the state’s long-term care ombudsman program, which can investigate complaints, help them resolve the issue and take the problem to the Department of Public Health if it can’t be fixed.
This KHN story first published on California Healthline, a service of the California Health Care Foundation.
Your guide to Medicare open enrollment: How to shop, switch, and compare plansPublished: Oct. 12, 2020 at 5:02 a.m. ET
Part A, part B, part D…You just want a health plan. Here’s help navigating the Medicare maze
As with most health care plans, Medicare plans have an annual open enrollment period. During this time, current Medicare users get a chance to evaluate their coverage and potentially make changes.
Medicare has one main open enrollment window from Oct. 15 to Dec. 7 each year. However, there’s also a Medicare Advantage open enrollment period annually from Jan. 1 to March 31.
What is Medicare open enrollment?Open enrollment is the health care user’s chance to evaluate the plan they have, take a look at what’s on the market and update their coverage for the coming year. Open enrollment is for consumers who already have Original Medicare or Medicare Advantage.
See: What are Medicare Advantage plans, and are they worth the risk?
During the main open enrollment period, from Oct. 15 to Dec. 7, any changes you make will take effect on Jan. 1. During the Medicare Advantage open enrollment period, any changes you make will take effect on the first of the month after the plan receives your request.
What you can changeThere are several things you can alter during open enrollment. From Oct. 15 to Dec. 7, you can do the following things:
Also see: The Medicare enrollment process is failing seniors and needs to be modernized
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Comparing Original Medicare and Medicare AdvantageIf you have an Original Medicare plan — you’re enrolled in Medicare Part A and Medicare Part B — open enrollment is the time when you might consider switching to a Medicare Advantage Plan. For some people, purchasing a Medicare Advantage Plan feels simpler.
“Some people prefer the sense of a one-stop shop,” says Deborah Gordon, author of “The Health Care Consumer’s Manifesto: How to Get the Most for Your Money.” “Like, ‘I cannot deal with A, B, D, I just want a health plan.’”
Here’s what you should know:
There are five different types of Medicare Advantage Plans:
Health Maintenance Organization, or HMO, plans: This kind of plan requires you to see an in-network provider unless it’s an emergency situation. Most require you to get a referral to see a specialist.
Preferred Provider Organization, or PPO, plans: This kind of plan allows you to see both in-network and out-of-network health care providers, although it typically is more expensive to go out of network.
Private Fee-for-Service, or PFFS, plans: This kind of plan allows you to see any Medicare-approved health care provider as long as they accept the plan’s payment terms and agree to see you, and you may also have access to a network of providers. You can see doctors that don’t accept the plan’s payment terms, but you might pay more.
Special Needs Plans, or SNPs: This kind of plan provides benefits to people with certain diseases, such as cancer, or health care needs, such as living in a nursing home. It also provides benefits to people with a limited income.
Medical Savings Account, or MSA, plans: These combine a high-deductible insurance plan with a medical savings account that can be used for health care costs.
Choosing between Medicare Advantage Plans will require you to understand your health care needs and think about what each type of plan offers. If you have a chronic health condition and you love your doctors, you’ll want health coverage that they accept. If you take prescription drugs, some plans may result in lower out-of-pocket costs than others.
Read: The COLA increase for next year doesn’t look good
Here are some questions to ask:
Do you have to get a referral? Some plans require you to get a referral from your primary care physician to see a specialist. If that’s not your preference, you’ll want to choose a plan with more freedom.
What benefits do they include? Do you need vision and dental coverage? Look for a plan that offers the benefits you want.
How much will your drugs cost? If you’re taking regular prescription drugs, compare costs within each plan to make sure you understand what you’ll be paying.
Are your doctors covered? If you like your providers, find out whether they’re included in the networks of the plans you’re considering.
What’s their rating? Each Medicare Advantage Plan comes with a star rating that ranges from one star to five stars. “I talked to a consumer in Massachusetts who essentially [won’t consider] any plan below a four-star plan,” Gordon says.
For additional help, try the Medicare Plan Finder on Medicare’s website.
How to switch Medicare Advantage PlansIf you’re already in a Medicare Advantage Plan, you can switch to a different Medicare Advantage Plan during either open enrollment period: Oct. 15 to Dec. 7, or Jan. 1 to March 31. After you join a new plan, you’ll be automatically unenrolled from your old plan once your new one starts.
If you have questions about Medicare coverage, you can find lots of information at Medicare.gov, or you can call 1-800-MEDICARE (1-800-633-4227).
More Medicare basics from NerdWallet:
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Jeff Sodoma, MPA, Esq. is a lawyer based in Virginia Beach, Virginia
Hello, there! Welcome to my blog. I will use this blog as a platform for my writing. I will write about topics in the legal world, certainly, as well as everything else under the sun, because I have many interests (and viewpoints). All views expressed in this blog, unless otherwise noted, are mine alone. One of my interests is music--my wife believes that I should go on "Beat Shazam" because I know so many songs--and I will be, from time to time, analyzing song lyrics and how they relate to the legal world.