Personality psychologists describe openness as one of five major personality traits. Studies suggest that the other four traits (agreeableness, conscientiousness, neuroticism and extraversion) operate independently of a person’s cognitive abilities. But openness – being flexible and creative, embracing new ideas and taking on challenging intellectual or cultural pursuits – does appear to be correlated with cognitive abilities.

The new study, published in the journal Psychology and Aging, gave older adults a series of pattern-recognition and problem-solving tasks and puzzles that they could perform at home. Participants ranged in age from 60 to 94 years and worked at their own pace, getting more challenging tasks each week when they came to the lab to return materials.

“We wanted participants to feel challenged but not overwhelmed,” said University of Illinois educational psychology and Beckman Institute professor Elizabeth Stine-Morrow, who led the research. “While we didn’t explicitly test this, we suspect that the training program – adapted in difficulty in sync with skill development – was important in leading to increased openness. Growing confidence in their reasoning abilities possibly enabled greater enjoyment of intellectually challenging and creative endeavors.”

Researchers tested the cognitive abilities and personality traits of 183 older adults, randomly assigned to either an experimental group who participated in a cognitive intervention or a control group who did not. They were tested a few weeks before the intervention and afterwards. At the end of the program, those who had engaged in the training and practice sessions saw improvement in their pattern-recognition and problem-solving skills, while those in the control group did not. And those who improved in these inductive reasoning skills also demonstrated a moderate but significant increase in openness.

This study challenges the assumption that personality doesn’t change once one reaches adulthood, said Illinois psychology professor and study co-author Brent Roberts.

“There are certain models that say, functionally, personality doesn’t change after age 20 or age 30. You reach adulthood and pretty much you are who you are,” he said. “There’s some truth to that at some level. But here you have a study that has successfully changed personality traits in a set of individuals who are (on average) 75. And that opens up a whole bunch of wonderful issues to think about.”

~Medical News Today Article

Researchers at the University of Pittsburgh selected the records of 260 participants in the Cardiovascular Health Study who were in their mid-70s and who had no problems with memory, thinking or reasoning. The researchers then looked at fish consumption and found that 163 of these men and women ate fish regularly, with the majority of them including it in their meals one to four times a week.

Ten years later, three-dimensional MRI brain scans were obtained for each participant. The researchers then did a brain mapping analysis on these scans that measured gray matter, which is crucial to brain health. “This is a mathematical way of understanding the influence of fish intake on the brain,” says Cyrus Raji, M.D., the lead author.

Taking into account factors such as age, sex, physical activity, obesity and education, the researchers determined that people who ate fish weekly had large amounts of gray matter in areas of the brain that are related to Alzheimer’s and mild cognitive impairment, a subtle but measurable memory disorder. Although previous studies have linked eating fish to brain health, the researchers say this is the first study to establish a direct relationship between fish consumption, brain structure and Alzheimer’s risk.

“Specific areas of gray matter in the brain are smaller in people with Alzheimer’s because the disease slices away at these regions cell by cell,” says neuropsychologist James Becker, a senior author of the study. If you start out with stronger, larger brain cells, however, it will take longer before the disease destroys so many cells that behavior and thinking start to change, Becker says.

Many people say that Alzheimer’s is genetic and there’s nothing you can do about your genes, notes Becker. “That’s true. But even if you’re destined to develop Alzheimer’s you can delay the point at which the disease shows its face,” he says. “Look at it this way. If you drive a four-cylinder car and one of the cylinders blows, you’re in a lot of trouble. But if you drive an eight-cylinder car and a cylinder blows, you may not be in good shape but you can still get to where you’re going. This is the biological equivalent of building in an extra four cylinders so that even if something goes wrong you’ve still got a lot of oomph left.”

The researchers noted that regular servings of baked or broiled fish promote stronger brain cells in gray matter by making them larger and healthier; greater volume could reduce the risk for a five-year decline in mental skills by almost fivefold.

Although the study didn’t identify the specific kinds of fish participants ate, past research ties fatty fish such as salmon, mackerel and herring, which are rich in omega-3 fatty acids, to brain health. Scientists already know that eating these fish can protect the heart. It turns out that they also protect the brain. Fried fish, on the other hand, provides no such benefits. “Frying changes the chemical composition of the omega-3 fatty acids, causing them to break down so there’s less available,” says Becker.

“There’s a growing awareness that what we eat can affect our brain,” says Scott Small, M.D., a Columbia University neurologist who was not involved in the research. “This interesting paper is a critical first step in pointing out a link between eating fish and reducing the risk of cognitive decline.”

By: Nissa Simon  From: AARP Bulletin

“She couldn’t remember names, where she’d been or what she’d done that day,” Ms. Atkins recalled in an interview. “Initially, I was not too worried. I thought it was part of normal aging. But over time, the confusion and memory problems became more severe and more frequent.”

Her mother couldn’t remember the names of close relatives or what day it was. She thought she was going to work or needed to go downtown, which she never did. And she was often agitated.

A workup at a memory clinic resulted in a diagnosis of early Alzheimer’s disease, and Ms. Katz was prescribed Aricept, which Ms. Atkins said seemed to make matters worse. But the clinic also tested Ms. Katz’s blood level of vitamin B12. It was well below normal, and her doctor thought that could be contributing to her symptoms.

Weekly B12 injections were begun. “Soon afterward, she became less agitated, less confused and her memory was much better,” said Ms. Atkins. “I felt I had my mother back, and she feels a lot better, too.”

Now 87, Ms. Katz still lives alone in Manhattan and feels well enough to refuse outside assistance.

Still, her daughter wondered, “Why aren’t B12 levels checked routinely, particularly in older people?”

It is an important question. As we age, our ability to absorb B12 from food declines, and often so does our consumption of foods rich in this vitamin. A B12 deficiency can creep up without warning and cause a host of confusing symptoms that are likely to be misdiagnosed or ascribed to aging.

A Vital Nutrient

B12 is an essential vitamin with roles throughout the body. It is needed for the development and maintenance of a healthy nervous system, the production of DNA and formation of red blood cells.

A severe B12 deficiency results in anemia, which can be picked up by an ordinary blood test. But the less dramatic symptoms of a B12 deficiency may include muscle weakness, fatigue, shakiness, unsteady gait, incontinence, low blood pressure, depression and other mood disorders, and cognitive problems like poor memory.

Labs differ in what they consider normal, but most authorities say a deficiency occurs when B12 levels in adults fall below 250 picograms per milliliter of blood serum. Like all B vitamins, B12 is water-soluble, but the body stores extra B12 in the liver and other tissues. Even if dietary sources are inadequate for some time, a serum deficiency may not show up for years.

If the amount of B12 in storage is low to begin with, a deficiency can develop within a year, even more quickly in infants.

Recommended dietary amounts of B12 vary: 2.4 micrograms daily for those age 14 and older, 2.6 micrograms for pregnant women and 2.8 micrograms for nursing women. Barring circumstances that impair B12 absorption, these are levels easily obtained from a well-balanced diet containing animal protein.

In its natural form, B12 is present in significant amounts only in animal foods, most prominently in liver (83 micrograms in a 3.5-ounce serving). Good food sources include other red meats, turkey, fish and shellfish. Lesser amounts of the vitamin are present in dairy products, eggs and chicken.

Those at Risk

Natural plant sources are meager at best in B12, and the vitamin is poorly absorbed from them. Many strict vegetarians and all vegans, as well as infants they breast-feed, must consume supplements or fortified breakfast cereals to get adequate amounts.

Certain organisms, like the bacterium Spirulina and some algae, contain a pseudo-B12 that the body cannot use but may result in a false reading of a normal B12 level on a blood test. Despite claims to the contrary, laver, a seaweed, and barley grass are not reliable sources of B12.

In animal foods, B12 is combined with protein and must be released by stomach acid and an enzyme to be absorbed. Thus, chronic users of acid-suppressing drugs like Prilosec, Prevacid and Nexium, as well as ulcer medications like Pepcid and Tagamet, are at risk of developing a B12 deficiency and often require a daily B12 supplement.

Stomach acid levels decline with age. As many as 30 percent of older people may lack sufficient stomach acid to absorb adequate amounts of B12 from natural sources. Therefore, regular consumption of fortified foods or supplementation with 25 to 100 micrograms of B12 daily is recommended for people over 50.

Synthetic B12, found in supplements and fortified foods, does not depend on stomach acid to be absorbed. But whether natural or synthetic, only some of the B12 consumed gets into the body. Treatment to correct a B12 deficiency typically involves much larger doses than the body actually requires.

Free B12 from both natural and synthetic sources must be combined with a substance in the stomach called intrinsic factor to be absorbed through the gut. This factor is lacking in people with an autoimmune disorder called pernicious anemia; the resulting vitamin deficiency is commonly treated with injections of B12.

Although most doctors are quick to recommend injections to correct a B12 deficiency, considerable evidence indicates that, in large enough doses, sublingual (under-the-tongue) tablets or skin patches of B12 may work as well as injections for people with absorption problems, even for those with pernicious anemia.

Most often, a daily supplement of 2,000 micrograms is recommended for about a month, then lowered to 1,000 micrograms daily for another month, then lowered again to 1,000 micrograms weekly. Sublingual B12 or B12 patches, or even B12 lollipops, can be helpful for people who require a supplement but cannot swallow pills.

Others at risk of developing a B12 deficiency include heavy drinkers (alcohol diminishes B12 absorption), those who have had stomach surgery for weight loss or ulcers, and people who take aminosalicylic acid (for inflammatory bowel disease or tuberculosis) or the diabetes drug metformin (sold as Glucophage and other brands). Patients who take the anticonvulsants phenytoin, phenobarbital or primidone are also at risk.

Large doses of folic acid can mask a B12 deficiency and cause permanent neurological damage if normal levels of B12 are not maintained. Supplements of potassium impair B12 absorption in some people.

Although a B12 deficiency can raise blood levels of the amino acid homocysteine, a risk factor for heart disease and stroke, supplements of B12 have not reduced cardiovascular risk.

And while high homocysteine levels are linked to Alzheimer’s disease and dementia, lowering them with B12 supplements has not been shown to improve cognitive function. However, in one study, among women with a poor dietary intake of B12, supplements of the vitamin significantly slowed the rate of cognitive decline.

By Jane Brody

Who hasn’t struggled occasionally to come up with a desired word or the name of someone near and dear? I was still in my 40s when one day the first name of my stepmother of 30-odd years suddenly escaped me. I had to introduce her to a friend as “Mrs. Brody.”

But for millions of Americans with a neurological condition called mild cognitive impairment, lapses in word-finding and name recall are often common, along with other challenges like remembering appointments, difficulty paying bills or losing one’s train of thought in the middle of a conversation.

Though not as severe as full-blown Alzheimer’s disease or other forms of dementia, mild cognitive impairment is often a portent of these mind-robbing disorders. Dr. Barry Reisberg, professor of psychiatry at New York University School of Medicine, who in 1982 described the seven stages of Alzheimer’s disease, calls the milder disorder Stage 3, a condition of subtle deficits in cognitive function that nonetheless allow most people to live independently and participate in normal activities.

One of Dr. Reisberg’s patients is a typical example. In the two and a half years since her diagnosis of mild cognitive impairment at age 78, the woman learned to use the subway, piloted an airplane for the first time (with an instructor) and continued to enjoy vacations and family visits. But she also paid some of the same bills twice and spends hours shuffling papers.

Dr. Ronald C. Petersen, a neurologist at the Mayo Clinic College of Medicine in Rochester, Minn., described mild cognitive impairment as “an intermediate state of cognitive function,” somewhere between the changes seen normally as people age and the severe deficits associated with dementia.

While most people experience a gradual cognitive decline as they get older (only about one in 100 lives long without cognitive loss), others experience more extreme changes in cognitive function, the neurologist wrote in The New England Journal of Medicine in June. In population-based studies, mild cognitive impairment has been found in 10 percent to 20 percent of people older than 65, he noted.

Dr. Petersen described two “subtypes” of the condition, amnestic and nonamnestic, that have different trajectories. The more common amnestic type is associated with significant memory problems, and within 5 to 10 years usually — but not always — progresses to full-blown Alzheimer’s disease, he said in an interview.

“Subtle forgetfulness, such as misplacing objects and having difficulty recalling words, can plague persons as they age and probably represents normal aging,” he wrote. “The memory loss that occurs in persons with amnestic mild cognitive impairment is more prominent. Typically, they start to forget important information that they previously would have remembered easily, such as appointments, telephone conversations or recent events that would normally interest them,” like the outcome of a ballgame would a sports fan.

The forgetfulness is often obvious to those who are affected and to people close to them, but not to casual observers.

The less common nonamnestic type, which is associated with difficulty making decisions, finding the right words, multitasking, visual-spatial tasks and navigating, can be a forerunner of other kinds of dementia, Dr. Petersen said.

In general, Dr. Reisberg said, “mild cognitive impairment lasts about seven years before it begins to interfere with the activities of daily life.”

The Correct Diagnosis

Distinguishing mild cognitive impairment from the effects of normal aging can be challenging. Typically, new patients take a short test of mental status, provide a thorough medical history and are checked for conditions that may be reversible causes of impaired cognition. Problems like depression, medication side effects, vitamin B12 deficiency or an underactive thyroid can mimic the symptoms of mild cognitive impairment.

Other tests, like an M.R.I. or CT scan of the brain, can look for evidence of a stroke, brain tumor or leaky blood vessel that may be impairing brain function.

It is natural, Dr. Petersen said, for patients and their families to want to know whether and how quickly the disorder might progress. While patients decline by about 10 percent each year, on average, certain factors are associated with more rapid progression. Among these are the presence of a gene called APOE e4, more common among patients with Alzheimer’s disease; a reduced hippocampus, a region of the brain important to memory; and a low metabolic rate in the temporal and parietal regions of the brain.

Amyloid plaques in the brain, while a hallmark of Alzheimer’s disease and a predictor of progression, have also been found at autopsy in people with perfectly normal cognitive function.

Preserving Cognitive Function

Despite a number of clinical trials that tested various medications, no drug to treat mild cognitive impairment has been approved by the Food and Drug Administration. But experts like Dr. Reisberg and Dr. Petersen suggest several approaches that may slow the decline in cognitive function.

Although studies did not show that medications like donepezil (brand name Aricept) and memantine (Namenda), both used to treat Alzheimer’s disease, change the ultimate course of mild cognitive impairment, Dr. Reisberg said they can be useful temporary treatments that may stabilize patients for a few years.

Although the drugs are not approved for this condition, licensed physicians can prescribe approved medications “off label.” “Clinicians have to work with what we have,” Dr. Reisberg said.

There are people who think they are having memory problems, but tests do not show anything definitive. Some may be in Stage 1 of Alzheimer’s disease, Dr. Reisberg said, and perhaps could benefit from early treatment with the drugs.

It is also important to reduce cardiovascular risk factors like smoking, elevated cholesterol and high blood pressure; keep blood sugar at normal levels; minimize stress (which in animal studies can cause the hippocampus to shrink); and avoid anticholinergic drugs that can interfere with brain chemicals important to memory. These include Demerol to treat pain, Detrol to treat a leaky bladder, tricyclic antidepressants, Valium, and over-the-counter medications with Benadryl (diphenhydramine), like Tylenol PM, Dr. Petersen said.

Some cognitive rehabilitation exercises, like computer games that enhance focus, may be helpful, Dr. Petersen said, but there have been few good studies to demonstrate a benefit. Compensatory techniques, like taking notes, creating mnemonics and making structured schedules, can be useful aids, he added.

But most promising is regular physical exercise, which in animal studies was found to reduce the accumulation of amyloid in the brain. An Australian study in patients with memory problems showed that brisk walking for 150 minutes a week improved cognitive function.

As a result, it’s not uncommon for older adults to be overmedicated and to experience adverse reactions to the ever-lengthening list of medications they take.

Ask Questions

A person’s age can impact the effectiveness and side effects of the medications he or she takes.

When taking a new medication, ask your doctor or pharmacist these important questions:

1. When and how should I use this new drug?
2. What is the purpose of the medication?
3. What should I do if I miss a dose?
4. Will the drug interact with other medications, vitamins or supplements I’m taking?
5. Is a generic or lower-cost brand name medication available?
6. What side effects, reactions or warning signs should I watch for?

To lower the chances of overmedication and dangerous drug reactions, the American Geriatrics Society Foundation for Health in Aging recommends that people age 65 and over be cautious about using the following types of drugs:

Important: If you are taking any of these medications, talk to your doctor or health care provider before stopping their use.

1. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Be cautious of: long-lasting NSAIDS such as piroxicam (sold under the brand-name Feldene) and indomethacin (Indocin).

The concern: NSAIDs are used to reduce pain and inflammation, but in older adults these medications can increase the risk of indigestion, ulcers and bleeding in the stomach or colon; they can also increase blood pressure, affect your kidneys and make heart failure worse. If NSAIDS are needed, better choices include the shorter-acting ibuprofen (Motrin) and salsalate (Disalcid).

Because of the increased risk of bleeding, don’t use NSAIDs together with aspirin, clopidogrel (Plavix), dabigatran (Pradaxa), dipyridamole (Persantine), prasugrel (Effient), ticlopidine (Ticlid) or warfarin (Coumadin).

If you take NSAIDs regularly and have a history of ulcers, or are 75 years of age or older, you may need to protect your stomach against bleeding with a prescription medication such as misoprostol (Cytotec) or a proton pump inhibitor such as omeprazole (Prilosec).

How can we be sure my symptoms aren’t the result of a stroke, mental illness or another treatable condition?

There is no definitive test for Alzheimer’s disease, and it can be misdiagnosed in patients suffering depression, memory deficits because of normal aging, arterial blockages or even certain vitamin deficiencies. Doctors generally rule out other possibilities, then apply criteria developed by various medical organizations to arrive at the diagnosis.

What stage of Alzheimer’s disease am I in? What comes next?

Clinicians classify the progressive deterioration of brain function in Alzheimer’s disease into seven stages. By the last stage, patients require round-the-clock care. In the first, second and third stages of this slow moving illness, symptoms are minimal, and many patients work and live independently.

What can I do to preserve my health and mental abilities for as long as possible?

Although there are no treatments to halt or cure Alzheimer’s disease, recent studies have suggested that exercise, a healthy diet and mental stimulation may delay the onset of disabling symptoms.

What physical symptoms should I anticipate?

Patients typically complain of problems with memory and organizational ability, but Alzheimer’s disease also attacks the brain’s motor centers, resulting in problems with balance, coordination, bladder and bowel control, and certain reflexes, including the ability to swallow. Patients and their caregivers should prepare for mental and physical disabilities.

Should I undergo brain neuroimaging?

Imaging of the brain occasionally can help differentiate Alzheimer’s disease from other potential causes of dementia in new patients; however, imaging is rarely useful for determining the severity of the disease.

My children are worried about inheriting this illness. Would it be useful for our family to undergo genetic testing?

Scientists have identified several gene mutations associated with an increased risk of developing Alzheimer’s disease, but the predictive value of each mutation is low. As a result, genetic testing is useful only for individuals who have several close relatives suffering from early-onset forms of the disease.

What drugs are currently available for Alzheimer’s disease, and how well do they work?

Two types of drugs are currently prescribed for treatment of Alzheimer’s disease. Cholinesterase inhibitors, such as donepezil and galantamine, regulate acetylcholine, a neurotransmitter influential in learning and memory. The only NMDA receptor antagonist on the market, memantine, tamps down excessive brain activity. Both types have been shown to delay brain deterioration for a brief period (6 to 12 months) in about half the people treated.

My family is afraid to let me drive. Would you refer me for a driving evaluation so we can have an objective opinion of my ability?

Driving is often a focal point of familial controversy. Diagnosis of Alzheimer’s disease doesn’t always require that a patient immediately stop driving. An objective medical evaluation can be helpful in clarifying the extent of a new patient’s disability.

What can I do to make things easier on my family?

Because Alzheimer’s erodes cognitive ability, it’s important for patients to plan for a day when they can no longer take care of their affairs. Newly diagnosed patients should execute medical and durable powers of attorney that authorize spouses or other family members to deal with banks, insurance companies, doctors and others on their behalf.

BY IRENE M. WIELAWSKI

AMD occurs when the macula—the central portion of the retina that is important for reading and color vision—becomes damaged. There are two forms of AMD-wet and dry. All cases begin as the dry form, but 10 percent to 15 percent progress to the more serious wet form, which can result in sudden and severe central vision loss. Without treatment, central vision can be lost over time, leaving only peripheral, or side, vision.

In its early stages, AMD may not cause any noticeable symptoms. As the disease advances, symptoms may occur in one eye or both, and can include blurred vision, difficulty reading or recognizing faces, blind spots developing in the middle of the field of vision, colors becoming hard to distinguish and distortion causing edges or lines to appear wavy, according to research by the AMD Alliance and the University of Michigan Kellogg Eye Center.

If a person develops any of these symptoms, an eye exam is crucial and early diagnosis and treatment is essential to help avoid severe vision loss. A retina specialist should be consulted if there is a diagnosis of wet AMD, to ensure the most appropriate care.

Approximately 15 million people in the United States have AMD, and more than 1.7 million Americans have the advanced form of the disease. About 200,000 new cases of wet AMD are diagnosed each year in North America. Due to the aging baby boomer population, the National Eye Institute estimates that the prevalence of advanced AMD will grow to nearly 3 million by 2020.

The greatest risk factor for AMD is age. Other risk factors include gender (women tend to be at greater risk), race (Caucasians are more likely to lose vision from AMD) and family history. Living a healthy lifestyle can help reduce the risk of developing AMD. Several risk factors can be managed with your healthcare provider’s help, including obesity and smoking.

By Senior.com

Ronald Fleming keeps a bed pallet on the floor next to the back door of his Houston home. The Texas Elder Abuse and Mistreatment Institute is making an effort to help Fleming get what he needs for a better life.

When caseworker Karen Edward arrives at her client’s northwest Houston home, the 74-year-old woman is sitting outside her front door complaining of vision problems and feeling sick to her stomach.

“Do you need care?” Edward asks. “Did you take your insulin?”

“No,” Clara replies in a faint voice.

It takes about 15 minutes for Edwards to persuade Clara, a diabetic, to get out of the midafternoon heat and indoors to take her medicine. Clara lifts her weak body from an old lawn chair and shuffles into her home of 49 years.

Loose electrical wires hang outside the front door of the three-bedroom house. The lawn has gone from lush green grass to dry dirt.

Inside, the carpet is worn and the walls need painting. Two weeks ago, neither was fully visible because they were covered floor-to-ceiling with Clara’s belongings. She had so much clutter, she couldn’t get around without falling.

Self-neglect common

Clara, who asked that her last name not be published, was referred to the Adult Protective Services agency about a month ago. Edward determined that Clara had fallen into self-neglect — the most common form of mistreatment among the elderly and a risk factor for early death, according to geriatric research.

In the Houston area, more than 60 percent of 1,500 cases handled each month by Adult Protective Services deal with elderly people who no longer can protect and provide for themselves, APS officials said.

People tend to dismiss odd behavior in the elderly as eccentricity, or they don’t want to get involved in someone else’s affairs, experts say. But self-neglect is likely to increase as baby boomers grow older, they say, making intervention and prevention more important than ever.

“We’re trying to educate the public and people dealing with the elderly about the services available to them,” said James Booker, director of Region 6 of APS, which oversees Harris County and 12 surrounding counties.

Focus of TEAM

In many self-neglect situations, the person just needs a little help to stay independent, Booker said. Most of the clients are women and most live alone, he said.

Self-neglect can be physical, medical or both. Some elderly people can’t cook, clean house or bathe themselves. Some don’t eat properly; some lack running water or air-conditioning. Their houses might be filthy and in disrepair.

Others lack access to medical care. They may have stopped taking their medicine or they haven’t seen a doctor in years and they’ve developed a serious illness, such as cancer or diabetes.

The breakdown in their ability to plan and carry out tasks can be caused by issues such as a stroke, dementia or depression, according to researchers.

To address self-neglect, Region 6 has collaborated with the University of Texas Health Science Center at Houston and Baylor College of Medicine for the past 15 years. The partnership is called the Texas Elder Abuse and Mistreatment Institute, or TEAM, which consists of clinical care, education and research. Region 6 is the only APS agency in the state to use such a multidisciplinary approach.

Worst case recalled

Self-neglect is a focus of the team because it is a factor in so many untreated medical disorders, said Dr. Carmel Dyer, a geriatric specialist at UT-Health Science Center and founder of TEAM.

“That’s why the risk of death is so high,” she said, noting that the mortality rate is substantial during the first year after a report of self-neglect.

Sabrina Pickens, a geriatric nurse practitioner and researcher at UT-Health Science Center, said the worst case of self-neglect she had seen involved an elderly man who lived in a garage apartment.

Neighbors reported that he poured his urine out the window. He had not bathed in six months. His hair and beard were matted, and his toenails had grown into his shoes. The man agreed to go to the hospital for a checkup. Doctors discovered he had untreated throat cancer, and he died within a month, Pickens said.

Caseworkers say the problem cuts across all socioeconomic backgrounds, but surfaces more often among the poor. In Texas, it’s mandatory to report any signs of abuse or neglect of child, a person 65 years or older, or a disabled adult.

APS investigates every report. When one is validated, caseworkers conduct a 52-question assessment and determine how to best help the client. The agency provides short-term assistance such as food, rent payments or transportation. It also will pay for medicine, home repairs and cleaning.

Once the immediate needs are met, the caseworker refers the client to social service providers for long-term help before closing the case.

Clients have the right to refuse help if they have decision-making capacity, said Angela Goins, an APS supervisor. The biggest challenge is getting them to understand the consequences of their behavior and that assistance is in their best interest, she said.

Clara refused help the first time APS received a referral about her.

Home decluttered

In the most recent referral, Edward, who wasn’t assigned to the first case, managed to gain Clara’s trust over several visits. Clara eventually agreed to let a crew clean her house and cart away many of the belongings she had been hoarding, a common problem in self-neglect cases.

APS paid for the cleaning, which took six days. It also paid for some electrical repairs because one side of Clara’s house had no electricity.

“She’s helped me a lot, caring and checking on me,” said Clara, feeling better after taking her insulin. “I would have been lost without her.”

When caseworkers suspect there’s a serious mental capacity or other medical issue, they call in a doctor or nurse from TEAM to visit the client’s home and do a geriatric assessment. If the assessment shows the client lacks capacity, TEAM can petition the Harris County Probate Court to appoint a legal guardian.

Only a handful of cases reach that point, APS officials said. TEAM also can get a court order to force the client to go to the hospital for treatment.

“We have to make sure their rights aren’t breached, but we also cannot abandon them,” Dyer said

By RENÉE C. LEE

All travelers, including senior citizens, should see a doctor for a pre-travel visit, ideally 4–6 weeks before they travel, although even a last-minute visit can be helpful.

The doctor should be told about illnesses the traveler has and medicines he or she is taking, since this will influence medical decisions. In addition to providing vaccines, medicine, and advice for keeping healthy, a doctor can conduct a physical exam to assess a senior’s fitness for travel.

Seniors should consider their physical limitations when planning a trip. Seniors with heart disease, for example, might choose an itinerary that does not involve strenuous activities. Seniors may also have a hard time recovering from jet lag and motion sickness, so they should take these factors into account when planning a trip.

Before travel, seniors should have information about their destination that could affect their health, such as the altitude and climate. They should be aware of whether the destination is prone to natural disasters, such as earthquakes and hurricanes, since seniors may have more problems in those extreme situations.

Vaccines

Before travel, seniors should be up-to-date on routine vaccines, such as measles/mumps/rubella and seasonal flu. Some of these may be considered “childhood” vaccines, but their protective effect decreases over time, and the diseases they protect against are often more common in other countries than in the United States. More than half of tetanus cases are in people over 65, so seniors should consider getting a tetanus booster before they travel.

Seniors should also receive other vaccines recommended for the countries they are visiting. These may include vaccines for hepatitis, typhoid, polio, or yellow fever. Recommended vaccines are listed by country on CDC’s destination pages.

Use of some vaccines may be restricted on the basis of age or chronic illnesses. Yellow fever vaccine, for example, should be given cautiously to people older than 60 years, and it should not be given at all to people with certain immune-suppressing conditions. Seniors should discuss their detailed travel plans with their doctors and, if necessary, alternatives to vaccination.

Medication

A doctor may prescribe medicine for malaria, altitude illness, or travelers’ diarrhea; seniors should make sure the doctor knows any other medications they take, to watch out for possible drug interactions. Travelers’ diarrhea is common and may be more serious in seniors, so seniors should also follow food and water precautions.

In addition to medicine prescribed specifically for travel, seniors are likely to take other medicines regularly, such as medicines for high blood pressure, diabetes, or arthritis. They should plan to pack enough medicine for the duration of the trip, plus a few days’ extra in case of travel delays. Counterfeit drugs may be common overseas, so seniors should take only medicine they bring from the United States.

Prescription medicine should always be carried in its original container, along with a copy of the prescription, and all medicine should be packed in carry-on luggage, in case checked luggage gets lost.

Injury Prevention

Although exotic infections make the headlines, injury is the most common cause of preventable death among travelers. Seniors can minimize their risk of serious injury by following these guidelines:

• Always wear a seatbelt.
• Don’t ride in cars after dark in developing countries.
• Avoid small, local planes.
• Don’t travel at night in questionable areas.

In addition, seniors should consider purchasing supplemental travel health insurance in case of injury or illness overseas. Many health plans, including Medicare, will not pay for services received outside the United States. Seniors who are planning travel to remote areas should consider purchasing evacuation insurance, which will pay for emergency transportation to a qualified hospital.

Written by Mike Tennant