July 27th, 2012

Table of Contents:

American Diabetes Association “Superfoods” (Nutrition)

Exercise May Ease Leg Cramps (Successful aging)

Keeping Your Brain Sharp (Build a "Super Noggin")

Relax into Yoga (New DVD)

Most Assisted-Living Residents Are White Women (NCHS report)

Super Thoughts (On eating and superfoods!)

American Diabetes Association “Superfoods”

by American Senior Fitness Association

The ADA recommends that persons with diabetes focus on nutrient-dense foods that have a low glycemic index. As recently reported by HealthDay, an affiliate of the National Institutes of Health, these ADA "superfoods" include:

  • Various types of beans (for example, pinto beans and kidney beans);
  • High-fiber citrus fruits (for example, lemons, oranges and grapefruit);
  • Berries;
  • Sweet potatoes;
  • Tomatoes;
  • Dark green, leafy vegetables (for example, spinach, kale and collard greens);
  • Nuts;
  • Whole grains;
  • Non-fat yogurt and milk;
  • Fish that are high in omega-3 fatty acids (for example, salmon).
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    Exercise May Ease Leg Cramps

    by American Senior Fitness Association

    Nighttime leg cramps are a problem for many older adults. In his Daytona Beach News-Journal column "To Your Good Health," Paul Donohue, MD, advises that performing leg exercises before going to bed may offer some relief. In addition to stretching exercises, Dr. Donohue notes that stationary cycling may be beneficial. If it is the calves that usually cramp, he suggests this pre-bedtime exercise:

  • Stand on a stair with both heels projecting off the stair. (Hold on to stair railing for balance support.)
  • Lower the heels, and hold that position for ten seconds.>
  • Repeat ten times.
  • Also perform this exercise three times, spaced out, during the day.
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    Keeping Your Brain Sharp

    by American Senior Fitness Association

    The following article was written by Lynn Wallen, PhD, the Vice President for Research and Development of Super Noggin TM. She and several other Super Noggin staff members have successfully completed the American Senior Fitness Association’s in-depth "Brain Fitness for Older Adults" professional education program. We know that you will enjoy Dr. Wallen’s informative report, below:

    If you are one of the "worried well," concerned about staying mentally sharp as you age, here is good news for you! There are things you can do to be proactive about your brain health.

    Brain fitness is a topic of great interest right now, not only because 10,000 Baby Boomers turn 65 every day, but also because of new and exciting discoveries in neuroscience.

    Probably the most surprising finding is that it is possible to grow new neurons — a type of brain cell — throughout life in a process called neurogenesis. This is a revolutionary discovery because neurons are not like other cells in the body. Unlike skin cells or blood cells or muscle cells, brain cells do not divide and reproduce themselves. That is why scientists used to think that once our brains were developed in childhood, we had all the brain cells we would ever have. The only change would be that they would gradually die off as we aged, unable to be replaced.

    But now we know that new neurons can develop from neural stem cells. The neural stem cells act like seeds from which new neurons develop in a part of the brain called the hippocampus. This part of the brain is involved with learning and memory, so if we could choose any place for new neurons to grow, we’d probably pick the hippocampus.

    In addition to growing new brain cells, we can also strengthen the connections between existing brain cells and even re-wire those connections in response to our experiences. This ability of the brain to adapt and change is called neuroplasticity. Neuroplasticity allows us to compensate for loss of function due to injury or illness and allows us to adjust to certain disabilities.

    For example, studies show that a part of the brain devoted to vision will alter itself to respond to touch in blind people who learn Braille.

    Or, a right-handed person whose right arm ends up in a cast for many months can learn to do things with his left hand that he could not do — or thought he could not do — with his left hand before. The brain is amazingly adaptable and plastic.

    We can use what we know about neurogenesis and neuroplasticity to keep our brains active and growing. Only thirty percent of how well (or badly) we age is governed by our genes. The other seventy percent is under our control through lifestyle choices we make every day. And what is the number one lifestyle choice? To stay active.

    Regular physical exercise is the keystone to physical health. Everyone knows this. But not many know that physical exercise is also necessary for brain fitness because the condition of your brain is closely tied to the fitness of your body. People who do not move enough are not pumping blood and oxygen to their brains to the degree necessary to support the growth of new brain cells.

    And the news just keeps getting worse and worse for the couch potatoes. Here is what the neuroscientists currently tell us about neurogenesis: The only way to grow new neurons is through physical exercise. Mental exercise and cognitive stimulation will strengthen the connections between brain cells you already have, but only moving can grow new neurons. One experiment suggests that the exercise has greatest benefit if it is voluntary.

    In studies of mice, those who had a running wheel in their cage produced a 15 percent growth in their hippocampus — the part of the brain that processes memory. Mice love to run on their wheels and will spend several hours a day doing it if they can. The sedentary mice in cages without a running wheel did not increase their brain size, and — here’s the interesting part — a group of mice that were forced to do exercise did not increase their gray matter either. These mice were thrown into a pool of water and had to swim around until they found a way to get out of the water. Mice don’t like to swim. It appears that you have to choose to do the exercise to get the brain benefits.

    The 15 percent growth in the hippocampus occurred in young mice. What happened when senior citizen mice were put through the same experiment? They had even better results: Three times the number of new cells in the hippocampus. No one knows why the old mice did so much better. But the evidence was there.

    In addition to the brain-boosting power of exercise, there are many other benefits to staying active. This list is published by the National Institute on Aging:

  • Increased self-esteem and self-confidence
  • Reduced anxiety and stress
  • Improved mood; may alleviate depression
  • Improved sleep
  • Increased energy
  • Decreased risk of heart disease
  • May improve cholesterol levels
  • Slowed rate of bone loss with age
  • More efficient use of insulin
  • Lowered risk of certain cancers
  • Improved cardiovascular health
  • Helps control weight and prevent obesity; increases calorie burning efficiency.
  • So get moving every day! It’s not only good for your body, it’s the best brain booster available.

    This article is based on Step One of "Ten Steps to Brain Fitness," a workshop in the Super Noggin TM brain fitness series developed by LEAF Ltd., a nonprofit organization dedicated to promoting cognitive wellness. Lynn Wallen, Vice President for Research and Development, is the designer of the Super NogginTM program. For more information, visit www.SuperNoggin.org

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    Relax into Yoga

    by American Senior Fitness Association

    Yoga therapists Kimberly Caron of Oregon Health & Science University and Carol Krucoff of Duke Integrative Medicine have developed a user-friendly yoga plan for older adults that is demonstrated in their new DVD "Relax into Yoga." The program is described as follows by its producer, PranaMaya:

    Based on the pioneering "Yoga for Seniors" teacher training — offered at Duke Integrative Medicine and the Kripalu Center for Yoga and Health — these practices combine the best of modern, evidence-based medicine with the ancient wisdom of the yoga tradition. Kimberly and Carol’s extensive experience working in medical settings with older adults and people with health challenges has helped them create safe, effective and enjoyable practices that are accessible to virtually anyone who can breathe.

    DVD highlights include:

  • 4 Main Practices for varied levels of mobility: In bed, in a chair, standing and lying down;
  • 3 Special Practices to build strength and stability, improve balance and promote relaxation;
  • Safety guidelines and large English subtitles for easy viewing.
  • Buyer’s Guide:

  • Audience — No Yoga experience necessary;
  • Style — Easy movement;
  • Intensity — Gentle physical exercises and breath work;
  • Props — Sturdy chair, Yoga mat, blanket and/or cushion.
  • For more information, visit www.yoga4seniors.com.

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    Most Assisted-Living Residents Are White Women

    by American Senior Fitness Association

    The National Center for Health Statistics (NCHS) recently released a report detailing an analysis of 2010 data on U.S. residential care facilities with at least four beds. Residential care (also called assisted-living) facilities provide housing and support services for persons who cannot live independently but who do not require nursing home care.

    Of the 733,000 persons residing in such facilities in 2010, more than half were 85 years old and older, 91 percent were white, and 70 percent were female. Approximately 40 percent needed assistance with three or more activities of daily living (for example, dressing). Over 75 percent had two or more of the ten most prevalent health conditions (for example, hypertension).

    This fascinating compilation of demographic facts is certain to be of interest to health-fitness professionals who serve elderly clientele. The full report follows:

    Residents Living in Residential Care Facilities: United States, 2010

    Christine Caffrey, Ph.D.; Manisha Sengupta, Ph.D.; Eunice Park-Lee, Ph.D.; Abigail Moss; Emily Rosenoff, M.P.A.; and Lauren Harris-Kojetin, Ph.D.

    Key findings

    Data from the 2010 National Survey of Residential Care Facilities

    • The majority of residents living in residential care facilities in 2010 were non-Hispanic white and female. More than one-half of all residents were aged 85 and over.
    • Nearly 2 in 10 residents were Medicaid beneficiaries, and almost 6 in 10 residents under age 65 had Medicaid.
    • Almost 4 in 10 residents received assistance with three or more activities of daily living, of which bathing and dressing were the most common.
    • More than three-fourths of residents have had at least 2 of the 10 most common chronic conditions; high blood pressure and Alzheimer’s disease and other dementias were the most prevalent.

    Persons living in state-regulated residential care facilities (RCFs)—such as residents of assisted living communities—receive housing and supportive services because they cannot live independently but generally do not require the skilled level of care provided by nursing homes. The ability to provide a comprehensive picture of the long-term care industry has been hampered by a lack of data on RCFs (1–4). Previous estimates of the number of residents in RCFs vary depending on how RCFs are defined (5–7). A recent NCHS data brief (5) reported that for each day in 2010, 733,300 persons were residents of RCFs nationwide. Using data from the first nationally representative survey of RCFs with four or more beds, this report presents national estimates of these RCF residents by selected resident characteristics.

    Keywords: assisted living, long-term care

    In 2010, the majority of residents were non-Hispanic white, female, and aged 85 and over.

    • Nine in ten residents were non-Hispanic white (91%), and seven in ten residents were female (70%) (Figure 1)./li>
    • More than one-half of residents were aged 85 and over (54%), and more than one-quarter of residents were aged 75–84 (27%). The remaining one-fifth of residents were about evenly split between those aged 65–74 (9%) and those under age 65 (11%).
    • The median length of stay among all current residents at the time of interview was 671 days, or about 22 months (data not shown).

    Figure 1. Selected characteristics of residential care residents: United States, 2010

    NOTE: Estimates may not add to 100% due to rounding.
    SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

    Nearly 2 in 10 residents were Medicaid beneficiaries.

    • Medicaid paid for at least some of the RCF services for 19% of residents (Figure 2).
       
    • Younger residents were more likely to have Medicaid than older residents. Almost 6 in 10 residents under age 65 had Medicaid (56%) compared with 39% of residents aged 65–74, 16% of residents aged 75–84, and 10% of residents aged 85 and over.
       
    • In 2010, the mean national total monthly charge per resident for residential care was $3,165 (data not shown).

    Figure 2. Residential care residents with Medicaid, by age: United States, 2010

    NOTES: All age cohorts are significantly different from each other at p < 0.05. Cases with missing data are excluded; see "Data sources and methods" section for detail.
    SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

    Almost 4 in 10 residents received assistance with three or more activities of daily living.

    • About three-quarters of all residents received assistance with bathing (72%), over one-half received assistance with dressing (52%), more than one-third received assistance with toileting (36%), one-quarter received assistance with transferring (25%), and more than one-fifth received assistance with eating (22%) (Figure 3).
       
    • Thirty-eight percent of RCF residents received assistance with three or more of these activities of daily living (ADLs), an additional 36% received assistance with one or two of the ADLs, and 26% did not receive assistance with any ADL

    Figure 3. Residential care residents receiving assistance with activities of daily living: United States, 2010




    Activities of daily living.
    2Includes 2% who receive assistance with a toileting device, such as ostomy, indwelling catheter, chairfast, or similar devices.
    3
    Comprises 12% confined to a bed or chair and 13% receiving assistance with transferring.
    NOTE: Cases with missing data are excluded; see "Data sources and methods" section for detail.
    SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

    Almost three-fourths of residents had ever been diagnosed with at least 2 of the 10 most common chronic conditions.

    • The 10 most common chronic conditions among residents were high blood pressure (57%), Alzheimer’s disease or other dementias (42%), heart disease (34%), depression (28%), arthritis (27%), osteoporosis (21%), diabetes (17%), chronic obstructive pulmonary disease and allied conditions (15%), cancer (11%), and stroke (11%) (Figure 4).
       
    • More than one-quarter of RCF residents had ever been diagnosed with 4–10 of the most common chronic conditions (26%); one-half of residents had ever been diagnosed with 2–3 of the most common chronic conditions; 18% had ever been diagnosed with one of these chronic conditions; and the remaining 6% had never been diagnosed with these conditions (Figure 4).

    Figure 4. Most common chronic conditions of residential care residents: United States, 2010

    1Chronic obstructive pulmonary disease.
    NOTE: Cases with missing data are excluded; see "Data sources and methods" section for detail.
    SOURCE: CDC/NCHS, National Survey of Residential Care Facilities, 2010.

    Summary

    In 2010, residential care residents were mostly female, non-Hispanic white, and aged 85 and over, and had a median length of stay of about 22 months. For about 20% of residents—or 137,700 persons—Medicaid paid for at least some long-term care services provided by the RCF. This estimate is similar to that found in a recent study (3). Almost 40% of all residential care residents received assistance with three or more ADL limitations, and over 40% had Alzheimer’s disease or other dementias. These findings suggest a vulnerable population with a high burden of functional and cognitive impairment.

    Residential care is an important component of the U.S. long-term care system. This report presents national estimates of people living in RCFs, using data from the first-ever national probability sample survey of RCFs with four or more beds. This brief profile of residential care residents may provide useful information to policymakers, providers, and consumer advocates as they plan for the future long-term care needs of older as well as younger adults. In addition, these findings serve as baseline national estimates as researchers continue to track the growth of and changes in the residential care industry.

    Definitions

    Length of stay: Derived from the month and year in which the resident first moved into the RCF and the month and year of the interview.

    Medicaid beneficiary: A resident who, during the 30 days before the interview, had any of his or her long-term care services at the RCF paid by Medicaid.

    Charges: The total charge for the month prior to the interview, including the basic monthly charge and any charges for additional services.

    Assistance with activities of daily living (ADLs): Refers to receiving any assistance in the five ADLs (bathing, dressing, transferring, using the toilet, and eating) that reflect a resident’s capacity for self-care. A summary variable was created with three categories: no limitations, 1–2 limitations, and 3–5 limitations. For residents confined to a bed or chair, the question about whether the resident received assistance with transferring was not asked in the survey. For the current analyses, the 12% of residents chair-ridden or bedridden were defined as receiving assistance in the transferring and summary ADL variables. The 2% of residents who receive assistance with a device to use the toilet, such as an ostomy, catheter, or chairfast device, were defined as receiving assistance in the toileting and summary ADL variables.

    Most common chronic conditions: Includes the 10 most common chronic conditions that residents were ever diagnosed as having by a doctor or other health professional, based on the RCF staff respondent’s reference to the resident’s medical record or personal knowledge of the resident. A summary variable was created with four categories: no conditions, one condition, 2–3 conditions, and 4–10 conditions.

    Data sources and methods

    Resident data from the 2010 National Survey of Residential Care Facilities (NSRCF) were used for these analyses. To be eligible for NSRCF, RCFs must be licensed, registered, listed, certified, or otherwise regulated by the state; have four or more licensed, certified, or registered beds; and provide room and board with at least two meals a day, around-the-clock on-site supervision, and help with personal care such as bathing and dressing or health-related services such as medication management. These RCFs also serve a predominantly adult population. RCFs licensed to exclusively serve the mentally ill or developmentally disabled populations were excluded. Nursing homes also were excluded unless they had a unit or wing meeting the above definition and their residents could be separately enumerated.

    The 2010 NSRCF used a stratified two-stage probability sample design. The first stage was the selection of RCFs from the sampling frame representing the universe of RCFs. For the 2010 NSRCF, 3,605 RCFs were sampled with probability proportional to facility size. Interviews were completed with 2,302 RCFs, for a first-stage, facility-level weighted response rate of 81%, which was weighted for differential probabilities of selection. In the second stage of sampling, 3–6 current residents were selected depending on RCF bed size. All data collected on sampled residents came from interviews with RCF staff who answered questions by referring to the residents’ records or their own knowledge of the residents; residents were never interviewed. The second-stage, resident-level weighted response rate was 99%. A detailed description of NSRCF sampling design, data collection, and procedures is provided both in a previous report (8) and on the NSRCF website.

    Differences among subgroups were evaluated using chi-square and t-tests. If chi-square tests were statistically significant, a post hoc t-test procedure was used to make pairwise comparisons. Significant results from the post hoc procedure are reported here. All significance tests were two-sided using p < 0.05 as the level of significance. The difference between any two estimates is reported only if it is statistically significant. Lack of comment regarding the difference between any two statistics does not necessarily suggest that the difference was tested and found to be not statistically significant. Data analyses were performed using the statistical package SAS-callable SUDAAN version 10.0 (9). Cases with missing data were excluded from the analyses on a variable-by-variable basis. The percentage of weighted cases with missing data varied between 0.01% and 2.5%. Because estimates were rounded, individual estimates may not sum to totals.

    About the authors

    Christine Caffrey, Manisha Sengupta, Eunice Park-Lee, Abigail Moss, and Lauren Harris-Kojetin are with the Centers for Disease Control and Prevention’s National Center for Health Statistics, Division of Health Care Statistics. Emily Rosenoff is with the Department of Health and Human Services, Assistant Secretary for Planning and Evaluation’s Office of Disability, Aging, and Long-Term Care Policy.

    References

    1. Spillman BC, Black KJ. The size of the long-term care population in residential care: A review of estimates and methodology. Prepared for U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Disability, Aging, and Long-Term Care Policy. Washington, DC: The Urban Institute. 2005.

       
    2. Spillman BC, Black KJ. The size and characteristics of the residential care population: Evidence from three national surveys. Prepared for U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Disability, Aging, and Long-Term Care Policy. Washington, DC: The Urban Institute. 2006.

       
    3. Polzer K. Assisted living state regulatory review 2011. Washington, DC: National Center for Assisted Living. 2011.

       
    4. MetLife Mature Market Institute. Market Survey of Long-Term Care Costs. Westport, CT. 2010.

       
    5. Park-Lee E, Caffrey C, Sengupta M, et al. Residential care facilities: A key sector in the spectrum of long-term care providers in the United States. NCHS data brief, no 78. Hyattsville, MD: National Center for Health Statistics. 2011.

       
    6. Mollica R, Sims-Kastelein K, O’Keeffe J. Residential care and assisted living compendium: 2007. Prepared for U.S. Department of Health and Human Services, Assistant Secretary for Planning and Evaluation, Office of Disability, Aging, and Long-Term Care Policy. Washington, DC: RTI International. 2007.

       
    7. Stevenson DG, Grabowski DC. Sizing up the market for assisted living. Health Aff 29(1): 35–43. 2010.

       
    8. Moss AJ, Harris-Kojetin LD, Sengupta M, et al. Design and operation of the 2010 National Survey of Residential Care Facilities. National Center for Health Statistics. Vital Health Stat 1(54). 2011.

       
    9. SUDAAN, release 10.0 [computer software]. Research Triangle Park, NC: RTI International. 2008.

    Citation: Caffrey C, Sengupta M, Park-Lee E, et al. Residents living in residential care facilities: United States, 2010. NCHS data brief, no 91. Hyattsville, MD: National Center for Health Statistics. 2012.

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    Super Thoughts

    by American Senior Fitness Association

    These authors have entertaining thoughts to share — some serious, some humorus — on the topic of eating and on certain "superfoods" in particular:

    "Nothing would be more tiresome than eating and drinking if God had not made them a pleasure as well as a necessity."

       — Voltaire

    "There is a lot more juice in grapefruit than meets the eye."

       — Author Unknown

    "It’s difficult to think anything but pleasant thoughts while eating a homegrown tomato."

       — Lewis Grizzard

    "The colors of a fresh garden salad are so extraordinary, no painter’s pallet can duplicate nature’s artistry."

       — Dr. SunWolf, www.professorsunwolf.com

    "Hey yogurt, if you’re so cultured, how come I never see you at the opera?"

       — Attributed to Stephen Colbert

    "Don’t eat anything your great-grandmother wouldn’t recognize as food."

       — Michael Pollan

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