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AARP report: 6 Pillars of Brain Health – lifestyle changes and community policies

Published in RINewstoday on April 4, 2022

The Washington, DC-based AARP releases its latest Global Council on Brain Health (GCBH) report citing strong scientific evidence that behavior changes and lifestyle habits can positively impact one’s brain health – yet many adults struggle to implement such simple changes.

In a new report released last month, “How to Sustain Brain Healthy Behaviors: Applying Lessons of Public Health and Science to Drive Change,” GCBH outlines how individuals age 50 and over, communities, and policymakers can all take steps to support brain health.

The World Health Organization predicts that the number of people living with dementia is expected to grow to 82 million by 2030 and skyrocketing to 152 million by 2050. The GCBH report notes to lower this expected trajectory it will take “effective behavior and cultural changes, initiated and driven by all the pertinent actors working in concert at all levels of society.”

The 38-page report and its recommendations are based on a review of the current state of science and the consensus of 20 experts from across the world in an array of disciplines, notes the report. GCBH is an independent collaboration of scientists, health professionals, scholars and policy experts from all over the world who are working in the area of brain health related to human cognition to promote brain health.

GCBH’s 38-page report, released March 15, 2022, provides tips to support brain-healthy behavior. Over the past six years, the GCBH has issued reports on broad topics taking a look at whether adults’ behavior and lifestyle style habits could affect their brain health as they grow older.

“While we encourage people to make good decisions, the GCBH recognizes that an effective strategy to enhance brain health must be framed broadly, and that individual choices are made in a larger social and environmental context… Simply putting research findings forward and expecting people to change their behaviors and sustain healthy lifestyles accordingly is unrealistic,” say the report’s authors. 

Calls for Supporting Positive Brain Health

In the latest GCBH report, the authors share what they have learned about how to persuade and motivate people to maintain brain-healthy lifestyles, and how community policies can be shaped to promote this vital goal. 

“We know what works to support brain health – this report focuses on how to make that happen,” says Sarah Lenz Lock, GCBH’s Executive Director. “Our experts have identified specific, practical tips to help older adults, communities and policymakers support the habits that are good for brain health. We show that change is possible, and why supporting brain health for an aging population makes good health and economic sense for communities and society as well as individuals,” Lock says.

“We describe why implementing programs designed to promote brain health for older adults makes good health and economic sense for communities and societies as well as individuals. GCBH experts advise individuals to set specific goals, be realistic about what they choose, and approach their goals step by step,” says the report’s authors. 

“We encourage community-based organizations to create opportunities for peer-to-peer coaching. And we urge policymakers to raise public awareness that people can take steps to help themselves. These and many other recommendations along with a framework for achieving change for individuals, community organizations and policymakers are provided in the final report approved by the GCBH Governance Committee,” they add. 

The GCBH report also calls for addressing the disparities in health and access to care that undermine the cognitive well-being of underserved communities including many African Americans and Hispanics.

Hearing loss, high blood pressure, obesity, and depression are among the health issues that may be linked to cognitive decline and should be properly managed with access to health care.

The Six Pillars of Brain Health

After a careful analysis of scientific findings, GCBH’s report notes that “evidence continues to mount” that people may be able to lower their risks for cognitive decline by engaging in healthy lifestyle behaviors, referred to as the six pillars of brain health.

Specifically put:

“Be social” and continue to maintain and expand your social network.  Keep tabs on family and friends and don’t isolate yourself from others. 

  • Find new interests and hobbies to “engage your brain” and to stimulate your thinking. 
  • Meditate, relax, and maintain a consistent schedule to “manage stress.”
  • Don’t forget the importance of “ongoing” exercise” and schedule at least 2.5 hours of moderate to vigorous exercise a week.  
  • Achieve “restorative sleep” by at least getting 7-8 ours of restful sleep daily.
  • Finally, “eat right” by choosing a nutritious, heart healthy diet to limit high blood pressure, of fish, poultry, nuts, low-fat dairy, vegetables, whole grains, fruits, and vegetable oils. 

The GCBH recommendations urge people to avoid smoking and not drink alcohol.  But if you drink, limit alcohol to more than one drink a day for women and two drinks a day for men.

The Brain-Heart Connection is examined in GCBH’s report.  Hypertension is a serious risk to brain health that can lead to stroke, mild cognitive impairment, or dementia. With knowledge of this, the report notes that people can lower blood pressure by increasing physical activity and reduce overeating, excess drinking, smoking and even reducing sodium (salt) intake.

The GCBH report provides simple, easily obtainable steps to make successful behavioral changes to improve brain health.  Specifically, people can:

Set a goal, identify a specific action you want to take on.

Be thoughtful and realistic about the goals you choose.

Find something that is fun and choose what is enjoyable for you.

Re-purpose some of your free time.

Rethink your environment to reduce the temptations and encourage better choices.

Celebrate the wins.

Learn from the setbacks.

Involve friends and family with common goals to reinforce healthy choices; and

Pick a good start time. 

While brain health behavior changes can be achieved by individuals, these changes require the support health care providers, employers, and community organizations.  Health care providers can help their patients improve their lifestyle habits and make healthy choices to reduce risks and alleviate the symptoms of disease. Employers can promote healthy behaviors too by creating healthier work environments, offering wellness initiatives, health screenings, immunizations, supporting healthy sleep by minimizing shift work, not requiring employees to respond to emails 24/7 and respecting vacations and breaktimes.  These all can promote better brain and mental health, says the GCBH report.

Mission-driven organizations, like AARP, the Arthritis Foundation, and the Heart Association, can also provide individuals with needed information and tools to access their own wellness and motivate a person to make positive behavior changes.

Finally, policymakers can set goals to improve the public’s brain health with a focus on building equity, fighting the sigma of dementia, and implementing best practice to improve brain health from around the world. They can also become aware of how public policies in other areas, such as the built environment, nutrition, and education, can have a lifelong impact on brain health. Some specific examples of successful public health policies include seat-belt laws and smoking cessation requirements.

“A chasm remains between what researchers are discovering about brain health and how little this knowledge has been applied for the public good. Progress will require the combined actions of individuals and communities, reinforced by public policies that facilitate healthy lifestyles,” says the report’s authors. “By applying lessons of public health and science, we can improve brain health for the benefit of individuals, communities and countries around the world,” they say, noting that this report lays out the steps needed to achieve this goal.

The full report on “How to Sustain Brain Healthy Behaviors” is available by going to https://www.aarp.org/content/dam/aarp/health/brain_health/2022-03/gcbh-behavior-change-report-english.doi.10.26419-2Fpia.00106.001.pdf.

To obtain all of the GCBH’s past reports on brain health, go to https://www.aarp.org/health/brain-health/global-council-on-brain-health/resource-library/.

To see how staying socially active impacts brain health, go to https://thriveglobal.com/stories/spumoni-s-where-everybody-knows-your-name-study-says-being-socially-active-may-improve-cognitive-functioning-2/

National Aging Coalition pushes to bring back House Aging Committee in DC

Published in RINewsToday on March 28, 2022

In 1992, aging advocacy groups fought unsuccessfully to keep the House Select Committee on Aging  (HSCoA) from being eliminated. The House had pulled the plug on funding for the HSCoA as a cost-cutting measure and to stream-line the legislative process at the end of the 102nd Congress without much notice in the Democratic rules package adopted in Jan.1993 during the beginning of the 103rd Congress.

As the dust settled after the dissolving of the HSCoA, Congressman Michael Bilirakis (R-FL), a former committee member, stated in an article, “Congress Eliminates Committee on Aging,” published March 31, 1993, in the Tampa Bay Times,” I honestly don’t’ think other committees would cover all aging issues.” AARP agreed with Bilirankis’s assessment. “Seniors need a specific forum,” said Tom Otwell, spokesperson for AARP. “The population is getting older, and issues are certainly not going away,” he said. 

During its 18 years of existence, its Congressional oversight on a myriad of aging issues included Social Security, Medicare, nursing homes, aging bias and elderly housing. This oversight influenced the introduction and passage of major legislation enhancing the quality of life of America’s seniors. 

Thirty years later, the Washington, DC-based Leadership Council on Aging Organizations (LCAO), representing 69 national aging advocacy groups, recognized the opportunity to bring back the HSCoA by endorsing H. Res. 583, a resolution introduced in the 117th Congress by Congressman David Cicilline (D-RI) to reestablish the HSCoA when introduced Aug. 10, 2021.  The Rhode Island Congressman has also introduced this resolution during the last three congresses.

H. Res. 583 would reestablish the HSCoA without having legislative jurisdiction, this being no different when the initial permanent committee previously existed. The 214-word resolution would authorize a continuing comprehensive study and review of aging issues, such as income maintenance, poverty, housing, health (including medical research), welfare, employment, education, recreation and long-term care. These efforts assisted the House’s 12 Standing Committees in the creation and advocacy for legislation they drafted. At press time, the resolution has been referred to the House Rules Committee for consideration.

According to the Congressional Research Service, it’s quite simple to create an ad hoc (temporary) select committee in the House chamber. All it takes is a simple resolution that contains language establishing the committee – giving a purpose, defining membership, and detailing other issues that need to be addressed. Salaries and expenses of standing committees, special and select, are authorized through the Legislative Branch Appropriations bill. 

Calling for co-sponsor support

While supporting Cicilline’s proposal, LCAO went one step further by calling on House lawmakers three weeks ago, in correspondence, to become co-sponsors. LCAO asked its members to co-sponsor the bill in order to drive the House Democratic Caucus to approve it and bring it to the House floor for a vote. As a House committee, it only needs the House’s approval, where there is now a majority of Democrats.

The time is ripe for the HSCoA to be reestablished, say LCAO. “Every day, 12,000 Americans turn 60. By 2030, nearly 75 million people in the U.S. – or 20% of the country – will be age 65 and older. As America grows older, the need for support and services provided under programs like Social Security, SSI, Medicare, Medicaid, and the Older Americans Act also increases,” noted in correspondence signed by 30 Coalition members.

LCAO stressed that the HSCoA worked effectively in partnership with the House’s 12 Standing Committees with jurisdiction over aging programs and services. “The House Aging Committee, which flourished in the 1970s under chairperson Claude Pepper, partnered and magnified the work of the standing committees in a team effort and a bipartisan manner, holding many joint hearings with them and helping to pass the end of mandatory retirement 359-2 in the House and 89-10 in the Senate, as well as protecting Social Security, exposing nursing home abuses and setting transparency standards, expanding home health care benefits as a way older persons could often delay or avoid the need for being forced into nursing homes and so much more. Ways and Means, Education and Labor, Energy and Commerce and Space, Science and Technology were just some of the Committees who benefited from the partnership and appreciated the House Aging Committee’s help in reaching senior citizens,” stated LCAO. 

As seniors now settle into living in a post-pandemic world, passage of H. Res. 583 becomes even more important. “Historically, the HSCoA served as a unique venue that allowed the open, bipartisan debate from various ideological and  philosophical perspectives to promote the consensus that, in turn, permeated pandemic, and the coronavirus continues to take its toll, exacerbating the problem of social isolation and family separation across generations.  Addressing the needs of older Americans in a post-pandemic world will require vigilant oversight and action,” noted LCAO.

Op Ep tells the story and the need for passage of Cicilline’s resolution 

Robert Weiner, former Clinton White House spokesman and Chief of Staff of the HSCoA under Congressman Claude Pepper,(D-FL) and Ben Lasky, senior policy analyst at Robert Weiner Associates News and Public Affairs, recently penned an op-ed for the Miami Herald which calls for the passage of Rhode Island Congressman David Cicilline’s H. Res. 583, to reestablish the HSCOA. With threats of Social Security “reforms” (cuts) and the mishandling of Covid in nursing homes which led to hundreds of thousands of deaths, the Committee is needed once again.

Weiner and Lasky say the largest part of Pepper’s congressional legacy, especially as he grew older, was chairing the HSCoA, which featured banning mandatory retirement (with Colonel Sanders as a witness), protecting nursing homes, expanding home health care, and protecting Social Security with solvency through 2034.

“Pepper’s bill that banned mandatory retirement passed 359-2 in the House and 89-10 in the Senate,” they said.

They argue, “The elderly are now threatened with Social Security reforms,” (meaning cuts). Senior citizens also disproportionately died from Covid in nursing homes in Florida, New York and around the country. More than 200,000 have died in nursing homes. Forbes called ‘The Most Important Statistic’ the fact that 42% of US Covid deaths in the first five months of the pandemic happened in nursing homes and assisted living facilities. That number later went down to around 33%. When standards, distance standards, vaccines, and transparency started to kick in (under pressure in many facilities), it got a little better but for many it was too little too late. Tens of thousands died because health care workers failed to follow the transparency, staffing, and safety standards that Pepper had passed into law in nursing homes.”

They continue, “Once vaccines became widely available in 2021, a majority of nursing home workers remained unvaccinated for six more months. Nursing homes and assisted living facilities were let off the hook by governors from Ron DeSantis (R-FL) to Andrew Cuomo (D-NY) for hiding their number of Covid deaths.”

Weiner and Lasky assert, “Older voters vote Democratic and Republican. It’s close. In 2020, while Joe Biden won the popular vote by 7 million, Donald Trump won the senior vote 52% to 47%. It’s not a matter of party. Seniors’ quality of life is not political.”

They conclude, “With Pepper’s legacy as the guide, pandemic deaths, nursing homes, home care, Social Security, and Medicare would be improved by Sunlight of Oversight.”

For the benefit of America’s seniors, House Speaker Nancy Pelosi and her leadership team must consider giving H. Res 583 their political support and blessing, calling for a vote in House Rules Committee, if passed allowing for swift consideration on the floor.  As Weiner remembers, “the last HSCoA was so well received and successful because of the strong relationships and bonds to the Standing committees and successful outreach to seniors.” The former HSCoA staff director notes that during his tenure membership grew from 29 to 50 members. “After the committee began, in just a few years, everyone wanted to be on it.” 

AARP’s Otwell’s observations that the nation’s population is getting older, and the issues are not going to go away  and that “Seniors ‘need a specific forum” are true even 29 years later. House lawmakers must pass H. Res. 583 for America’s seniors to give them this specific forum that they deserve.

To read the Miami Herald Op Ed, go to www.miamiherald.com/opinion/op-ed/article259629314.html

Medicare slow to fix equity issue for seniors’ access to at-home COVID test kits

Published on Feb. 7 in Rhode Island News Today

Today home test kits were made available in a variety of ways – but, for Medicare recipients, it was a different story, being forced to go thru a different purchasing and payment process than those having private insurance, or no insurance. That process required the oldest and most at-risk population to take more than several steps, put up their own money, do a lot of paperwork, to seek reimbursement.

The White House made changes in testing so that at-home tests are now fully covered by health insurances. Those insured can pick up their test kits in a store and have them paid for at the time of purchase by their insurance, at no cost to the person. They aren’t required to visit their physician or get a prescription to obtain the free test. They have a limit of 8 test kits per month.

But, when the program began, this was not the plan for those insured through the government’s Medicare and Medicare Advantage plans.

Red Tape… Upfront Charges for COVID-1

Jane, a 65-year old Medicare beneficiary from Warwick went through the steps to get a kit after a relative she had seen found out she was exposed to COVID.  Before Medicare announced easing up on the purchasing process of COVID-19 test kits, she expressed frustrations to this writer about the regulatory hoops she faced because she was on Medicare – purchasing the test kits and getting reimbursed for the upfront charges. “First, I had to request a prescription from my physician and say that I had either been exposed to someone who had COVID, or I was having symptoms, myself,” recalls the frustrated Medicare beneficiary.  “Once my physician sent the prescription over to CVS, I was notified that it would take a couple of days before I could pick up the kits and that I would only be given two kits per prescription”, she fumed, knowing that sometimes it takes 4 or 5 days of testing to test positive, but was only eligible to receive two, and she might have to go through the whole process again in a few days.

“Three days later CVS finally left me a message saying these kits were in. I used the drive-up window for pickup and the cashier asked me for $46,” Jane remembered.  “When questioning this charge, a pharmacist came to the window to assist and told me that I had to pay for the kits upfront and then seek reimbursement,” she added.

Paying for the kits, Jane went home, and called Blue Cross, her Medicare supplement company and was told she needed to request a copy of the prescription which took hours to finally request with the back and forth phone calls to her busy doctor’s office. It was almost two weeks later she finally got a copy of the receipt detailing her $46 payment for the kits. She was then able to upload the copy of the prescription and a copy of her receipt to a BCBS reimbursement screen on her computer (or she could have printed the form out and mailed the whole package in). At press time, Jane is still waiting for her reimbursement, being told it will take from 4 to 6 weeks to receive a check.

It’s better late than never, says Jane, when she heard that Medicare would now cover free over-the-counter COVID-19 tests. “Not everyone can put out $46 and wait two months to get it back, home health tests were made available in a variety of ways – but, for Medicare recipients, there was a different process. More concerning was all the steps I had to take to complete the process they had originally intended for us to do. How many people would really complete all those steps?” she says. “We talk a lot about equity, but seniors need equitable healthcare processes, too.”

Just days ago, the Centers for Medicare & Medicaid Services (CMS) announced that beneficiaries in either Original Medicare or Medicare Advantage will be able to get over-the-counter COVID-19 tests at no cost starting in early spring, estimated to be in April. Under the new CMS initiative, Medicare beneficiaries will be able to access up to eight over-the-counter COVID-19 tests per month for free. Tests will be available through eligible pharmacies and other participating entities. This policy will apply to COVID-19 over-the-counter tests approved or authorized by the U.S. Food and Drug Administration (FDA). A prescription will not be required.

CMS Unveils New Medicare Benefit

According to CMS, this new initiative will enable payment from Medicare directly to participating pharmacies and other participating entities to allow Medicare beneficiaries to pick up tests at no cost. This is the first time that Medicare has covered an over-the-counter test at no cost to beneficiaries.

CMS’s announcement follows last month’s announcement that the Biden-Harris Administration would be requiring commercial health insurance companies to cover at-home COVID tests for free.

Until the new benefit kicks in, Medicare beneficiaries can access free tests through a number of channels established by CMS, too. Now, they can request four free over-the-counter tests for home delivery at covidtests.gov. Or beneficiaries can access COVID-19 tests through health care providers at over 20,000 free testing sites nationwide. Many cities and towns are also giving out free test kits at drive-up handout programs as the state receives supplies.

CMS’s Feb. 3 statement noted that Medicare beneficiaries can also access lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist, or other authorized health care professional at no cost. In addition to accessing a COVID-19 lab test ordered by a health care professional, people with Medicare can also already access one lab-performed test without an order, also without cost sharing, during the public health emergency, says CMS.

In addition, CMS says that Medicare Advantage plans may offer coverage and payment for over-the-counter COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits. Medicare beneficiaries covered by Medicare Advantage should check with their plan to see if it includes such a benefit.

Finally, all Medicare beneficiaries with Part B are eligible for the new benefit, whether enrolled in a Medicare Advantage plan or not.

“AARP applauds today’s announcement that will guarantee access to at-home over-the-counter COVID-19 tests at no cost for Medicare’s 64 million beneficiaries and we thank [Health and Human Resources]Secretary Becerra and CMS Administrator Brooks-LaSure for their diligence in addressing this issue. Expanded access to no-cost testing will help protect seniors who have been hit hardest by the pandemic and ensure they can remain connected with their loved ones and community.,” says AARP Executive vice president and Chief Advocacy and Engagement Officer Nancy LeaMond in a statement issued with CMS’s Feb. 3rd announcement of the new Medicare benefit.

“Every American should have an easy way to get at-home COVID tests. We know that people 65 and older are at much greater risk of serious illness and death from this disease – they need equal access to tools that can help keep them safe. The cost of paying for tests and the time needed to find free testing options are barriers that could discourage Medicare beneficiaries from getting tested, leading to greater social isolation and continued spread of the virus, adds LeaMond.

Successfully Advocating the Seniors

Last month, Senators Sherrod Brown (D-OH) and Debbie Stabenow (D-MI) along with 17 of their  Senate colleagues including Rhode Island Democratic Senators Reed and Sheldon Whitehouse wrote to HHS Secretary Becerra and  CMS Administrator Brooks-LaSure urging them to expand Medicare coverage of free at-home rapid COVID-19 testing.

Aging groups also joined the Senators in pushing Medicare to offer the new testing kick benefit.  “It is clear that regular testing is a crucial part of managing the spread of COVID-19. That’s why AARP has been calling for coverage of at-home tests, says AARP’s LeaMond, noting that the nation’s largest aging advocacy group “will continue to watch for details about when and how at-home COVID tests are made available to those in Medicare.”

Thankfully CMS quickly heeded their calls.

For more information, please see these Frequently Asked Questions, https://www.cms.gov/files/document/covid-19-over-counter-otc-tests-medicare-frequently-asked-questions.pdf (PDF)

Stay tuned for free N95 masks to be made available to all coming up soon.