Loneliness Bodes Poorly For A Healthy Old Age

They're time-consuming, demanding and require birthday cards, but they may help keep you alive. Friends and family, that is.

Loneliness in older people can predict declines in health and an increased risk of death, according to findings just published online by the Archives of Internal Medicine. People over 60 who felt lonely had a 45 percent higher risk of death than those who weren't lonely, the six-year-long study found. In absolute terms, the risk of death was about 23 percent for the lonely people and 14 percent for those who weren't.


The lonely people in the study were also more prone to have limited mobility and face greater difficulty performing basic tasks like grooming and housekeeping. On that score, about a quarter of lonely people were likely to develop trouble compared to about 13 percent who weren't lonely.

While the connection between well-being and friendships isn't new, the latest findings look specifically at people who self-identified as lonely, regardless of the how extensive their social network was.
"It's about connectivity," lead researcher Carla M. Perissinotto tells Shots. "Someone can have multiple social contacts but still somehow felt that they're not connecting." Many people who said they were lonely, for example, were married or lived with someone else.

Perissinotto, a geriatrician, cited one of her patients, a 93-year-old woman who had difficulty eating. The woman kept losing weight because she lived alone and viewed eating as a social activity. To treat her, Perissinotto looked for ways to help the woman be with peers during mealtimes.

The data, which were collected every two years from 2002 through 2008 as part of the nationally administered Health and Retirement Study, looked at 1,604 cases to assess risk factors. The study only included people living in the community — not those in care facilities or retirement homes.
By asking about patient's feelings, Perissinotto says she hopes physicians can broaden their understanding of potential health risks and think creatively about addressing them. She says the study can't conclusively prove cause and effect, but sheds light on a significant health issue.

"We could be missing a big part of the puzzle if we choose to focus on traditional medical risk factors," Perissinotto says. "By asking these questions, I may be finding one more way of intervening with these patients."

An accompanying editorial notes that some of the predictive factors found in this study and some others published at the same time should get more attention. "Loneliness is a negative feeling that would be worth addressing even if the condition had no health implications," the authors of the editorial note.

Copyright 2012 National Public Radio. To see more, visit http://www.npr.org/.

Early Burdens: Eldercare Falls on Young Shoulders

Suzette Armijo, 30, of Phoenix, right, oversees care of her 86-year-old grandmother, Elizabeth Armijo, left, a retired National Park Service ranger. (Courtesy Suzette Armijo)

By JANE E. ALLEN (@JaneEAllenABC) , ABC News Medical Unit

May 4, 2012

At 30, Suzette Armijo cares for her widowed 86-year-old grandmother, a retired National Park Service ranger in the final stages of Alzheimer's disease, while holding down a fulltime job, a part-time job and raising a 4-year-old son.

"This was nothing that I had planned for," says Armijo, who moved her grandmother Elizabeth Armijo into a nearby six-bed assisted living home because veterans' benefits "wouldn't pay for her to live with me." Still, she says, "I have to do everything for her, aside from her bathing. There's always something new going on with her medically."

Besides her fulltime marketing job with a Phoenix retirement community, Armijo supplements her income with outside consulting because "I do have to pay a portion of Grandma's bills."

 

Although she doesn't know anyone else her age doing what she's doing, she comes to her caregiving out of love for a woman who took care of so many others: "I don't feel torn because I know this is the way my Grandma was," Armijo said Thursday. "She took care of her parents. She took care of my grandfather. She took care of my little brother who had cancer when he was little. I grew up seeing that."

Suzette Armijo is among a generation of young adult caregivers, the majority of whom are women, navigating tough turf without a roadmap. Few of their contemporaries shoulder equivalent responsibilities. Members of the so-called sandwich generation, squeezed by parental caregiving and child-rearing, are a good 20 to 30 years older. As they try to tap into resources to help an ailing grandmother, Mom or Dad, these 20-somethings and 30-somethings are often on a lonely road. Armijo said she's drawn some of her strength from establishing a local young advocates group through the Alzheimer's Association. "You have to find something for yourself, otherwise you lose your mind."

Internet sites like AgingCare.com, which connects caregivers of elderly parents with others, may help this younger caregiving cadre find encouragement, empathy and tips on locating services.

"Other caregivers jump in and help," said Richard Nix, AgingCare.com's 49-year-old executive vice president. The National Stroke Association has launched a free, private Careliving Community with "more than 2,000 caregivers right now," said Taryn Fort, a spokeswoman for the Centennial, Colo.-based organization. Support groups for young caregivers have sprouted within some local chapters of the Alzheimer's Association, said Toni Williams, a spokeswoman for its public policy office in Washington, D.C.
Even the best-laid plans among 20-somethings can be thrown off course by a loved one's catastrophic illness and disability. After graduating from Purdue University in Indiana last May, Lauren Erickson spent six weeks in a competitive pre-medical enrichment program in Cincinnati. In September, she moved to Minneapolis to begin work as a hematology-oncology clinic assistant at Children's Hospitals and Clinics of Minnesota while studying for the Medical College Admission Test, which she hoped to take May 12.


Lauren Erickson, 23, left, moved back home to Prescott, Wis., from Minneapolis, to help care for her dad Jim Erickson, 71, right, following his stroke in March.

 

But on St. Patrick's Day, her father Jim Erickson, 71, suffered a massive stroke at home in Prescott, Wis., which left him unable to speak or move his right side. Because Erickson's mother, 61, was still recuperating from a Feb. 2 hip replacement, the couple's only child stepped in.

"I had to move home and help my Mom," Erickson, 23, said. As a result of new demands on her time, including a significant daily commute to Minneapolis, "I haven't opened an MCAT book or anything," Erickson said. She signed up to take the MCAT in July, but said her taking the test then will depend upon how her father is faring.

Even with a "very helpful" boyfriend and some free counseling through work, Erickson keeps wishing she could do more for her mother. "Through this whole process, I couldn't really break down or cry in front of her. I had to be the strong one." Still, she feels more rushed than ever about achieving her many life goals, including med school admission, "so that I can have my Dad present for all those events."
Having her father David Jenkins nearby was the only solution that Tara Leigh Adams, 28, found acceptable after he suffered a major stroke in November 2010. Adams, married and teaching second grade in Greenville, S.C., raced to her hometown of Charlottesville, Va., to help her 65-year-old father, a widower since Adams was a child.


Tara Leigh Adams, 28, right, a wife, expectant mother and second-grade teacher, moved her father David Jenkins, 65, seated, from Virginia.
 
"I think from the start I kind of, in my heart, knew that was just the way. I always knew he had to be near me," said Adams, who is expecting her first child in October. Aides help her father while she's at work, but once she walks back in the front door, she takes over everything, including getting him to the restroom.
Friends just don't understand, she said. "A lot of people my age look and say 'why do you do this? Why not a nursing home?'"

But for Adams, "there's no other option for me that would ever be as good."

Adams, who calls her husband the "rock that I lean on" said there is no substitute for "waking up and telling my Dad how much I love him in the morning."

VA Benefits

VA benefits are often confusing, as is the process for applying for them. Many people believe they are not entitled to benefits because they did not serve long enough in the military or they did not go overseas during a war. Both of those assumptions may be incorrect. A veteran, or surviving spouse of a veteran, may qualify for some sort of VA benefit if the veteran served 90 days of active duty and one of those days was during a declared state of war. The veteran did not have to be overseas, or even see combat, if one of those 90 days was during a declared state of war.

There are two types of VA benefits: compensation and pension. Compensation is for veterans who have a service connected disability or injury. The disability or injury is rated as a percentage of loss (10%, 20%, etc., up to 100%), and the percentage can increase after a claim is filed.

Pension is a benefit for a veteran or an un-remarried surviving spouse who is either unable to work due to disability or is age 65 or older. This benefit requires that a veteran have been on active duty for 90 days with one day during a declared state of war, and with a discharge other than dishonorable. It is a benefit based on income, assets and need. Along with pension, a veteran or surviving spouse may qualify for additional money if they are housebound or in need of aid and attendance.

First, the dates of the declared states of war are as follows:

Mexican Border Period: May 9, 1916 – April 5, 1917

World War I: April 6, 1917 – November 11, 1918

World War II: December 7, 1941 – December 31, 1946

Korean Conflict: June 27, 1950 – January 31, 1955

Vietnam Era: August 5, 1964 – May 7, 1975 (begins February 28, 1961 if in the Republic of Vietnam at that time)

Persian Gulf: August 2, 1990 – date yet to be determined

The maximum available pension resource is the maximum pension a veteran or surviving spouse can receive depending on need. The maximum monthly pension rates for VA for 2010 are:

Veterans Benefits:

$985 – Basic Pension – Veteran without a Spouse

$1,291 – Basic Pension – Veteran with a Spouse

$1,204 – Housebound Pension – Veteran without a Spouse

$1,510 – Housebound Pension – Veteran with a Spouse

$1,644 – Aid and Attendance – Veteran without a Spouse

$1,949 – Aid and Attendance – Veteran with a Spouse

Surviving Spouse Benefits:

$660 – Basic Pension – Widow/Widower

$807 – Housebound Pension – Widow/Widower

$1,056 – Aid and Attendance – Widow/Widower

The maximum available pension resource is reduced by income. Income, for VA purposes, is gross household income less any out-of-pocket medical expenses, also referred to as unreimbursed medical expenses. Examples of these expenses include Medicare premiums, other health insurance premiums, in home care, hygienic supplies, adult day care, nursing home or assisted living expenses, etc…any medical expense that is incurred and not reimbursed.

If the VA counted income is more than the maximum available pension resource, the VA will not pay any benefits to the veteran or surviving spouse. For example, a veteran without a spouse who has $1500 per month in gross household income and unreimbursed medical expenses of $500 per month would receive no benefit ($1500 – $500 = $1000, which is greater than $985).

If the VA counted income is less than the maximum available pension resource, then take the maximum available pension resource and subtract the VA counted income, and that is the pension amount. For example, a veteran who is married and needs assistance, with $1500 per month in gross household income and $3000 per month in unreimbursed medical expenses would receive $1949 per month, because his or her VA counted income is $0. However, if the unreimbursed medical expenses were $1000 per month, the veteran would get approximately $1449 per month ($1949 {maximum pension} – $500 {VA counted income, which is $1500 – $1000} = $1449).

“Housebound” is when a person is substantially confined to his/her house/immediate premises for reasons that are likely to continue through his/her lifetime. “Aid and attendance” is when a person is unable to perform their activities of daily living without the assistance of another person (i.e. dressing/undressing, transferring, bathing, etc.).

The VA will also consider a veteran’s/surviving spouse’s assets before determining pension entitlement. Assets that are not considered include the home, vehicle, personal possessions, assets in an irrevocable trust, or certain types of annuities. The general guidelines for the VA in determining pension eligibility based on assets is $80,000 for a married couple and $50,000 for a single veteran or surviving spouse. However, there is no exact resource limit. The VA will review the age of the applicant, the costs of care and the illnesses of the applicant.

Unlike ALTCS (or Medicaid), there are no look back periods related to VA benefits. The VA does not penalize the veteran or surviving spouse for transferring or gifting assets.

We have tried to give you a brief overview of compensation and pension benefits available through the VA. The VA offers many more benefits, such as reduced pharmacy costs, burial plots, nursing home benefits and others. Each benefit has its own set of eligibility criteria. There is a lot of misinformation in the public domain! Please be sure to get correct information by contacting the Arizona Department of Veteran’s Services, any other veteran’s service organization or an attorney with experience in this area.

By The Kile Law Group