The Millstone Times April 2019

As We Age

Slowed Walking in Seniors May Signal Alzheimer’s Danger

ADVICE FOR THE AGING COMMUNITY GREY MARKET RISKS AND HOW THEY WILL IMPACT YOU AND YOUR FAMILY By Sheli Monacchio

Seniors who walk more slowly may have higher amounts of a protein linked to Alzheimer's in their brains, a small, new study suggests. Researchers found a modest associ- ation between higher levels of amyloid plaques -- dense deposits of a protein known as beta amyloid -- and slower walking speeds among older adults. "These results suggest that subtle walking disturbances, in addition to subjective memory concerns, may sig- nal Alzheimer's disease, even in people who are fully asymptomatic and have a walking pace within the normal range," said study author Natalia del Campo, scientific manager of the Centre of Ex- cellence in Neurodegeneration in Tou- louse, France. "Taking into account physical param- eters that are not conventionally looked at in Alzheimer's disease, such as gait speed, may help optimize the early iden- tification of patients at risk," added del Campo, who is also a postdoctoral fellow at the Gerontopole Research Centre in Toulouse. The study was published online Dec. 2,2015 in the journal Neurology. More than 5 million Americans have Alzheimer's, an incurable, fatal disease that destroys memory, language, think- ing and reasoning skills, according to the Alzheimer's Association. Increasingly, clinical research is focusing on spotting early signs of the disease that may go un- considered prior to diagnosis. The cross-sectional study, which al- lowed researchers to look at participants at one specific point in time, only estab- lishes an association between brain am- yloid levels and walking speed, but not a cause-and-effect relationship between the two, del Campo noted. The research team analyzed 128 peo- ple (average age 76) who did not have a formal diagnosis of dementia but were considered at high risk because of mem- ory problems. Brain scans measured am- yloid plaque levels in their brains, with 48 percent registering a level often asso- ciated with dementia. Additionally, participants underwent thinking and memory skills testing, with 46 percent classified as having mild cog- nitive impairment, a condition that can lead to Alzheimer's. Walking speed was measured using a standard test timing how fast participants walked 13 feet at their usual pace, and all but two tested within normal range. The researchers found an associa- tion between slower walking speed and

amyloid buildup in several areas of the brain, including a region known as the putamen, which is involved in motor function. Amyloid levels accounted for up to 9 percent of the difference in walking speed between faster and slower walkers, according to the study. One expert said the findings make sense. "The way you walk is influenced by systems of the brain that set the pace, so when this part of the brain isn't work- ing properly, it may have an impact on gait or speed," said Dr. Joseph Masdeu, director of neuroimaging and the Nantz National Alzheimer Center at Houston Methodist Neurological Institute in Tex- as. "So, I'm not surprised by these find- ings." But Masdeu, who wasn't involved in the study, cautioned that older adults who happen to walk more slowly than others shouldn't panic. "You absolutely cannot tell somebody who is beginning to have difficulties walking that they have more amyloid in their brain," he said. "This is just a small contributor and many other systems can affect it, and many are age-related." Masdeu and del Campo noted that several possible explanations exist for the observed link between brain amyloid levels and walking speed. "It is possible that amyloid accumula- tion and slow gait speed co-occur as the result of a common lifestyle factor such as a deficient diet through childhood or adulthood, low physical activity or smoking," del Campo said. "It may also be explained by . . . diabetes or [high blood pressure]. We know that these are risk factors for dementia and poor motor function." Dr. Eric Reiman, a spokesman for the American Federation for Aging Re- search, agreed with del Campo and Mas- deu that more research is needed. "This interesting study provides ad- ditional support for the idea that slower walking speed may be associated with the early stages of Alzheimer's disease," said Reiman, who is also executive di- rector of Banner Alzheimer's Institute in Phoenix. "As the authors note, there are a number of factors that contribute to reduced walking speed in older adults. "Additional studies are needed to clarify the extent to which slower walk- ing speed could be used to help in the early detection and tracking of Alzhei- mer's, the prediction of subsequent clin- ical decline and the evaluation of investi- gational disease-modifying treatments," he added.

According to The Institute on Aging, in the year 1900 only 100,000 Americans reached the age of 85. By 2050, the 85+ year-old age group will reach 19 million, which is 5 percent of the total population. These numbers are scary when you look at the amount of qualified individuals there are to care for these folks as they age. Wages are increasing, which means costs will have to rise in many industries. Some families do not have the funds to pay for a licensed, bonded Certified Home Health Aide. Families are taking the word from friends about “this great aide we had for my mom when she needed it.” The problem with “this great aide” is she may not be licensed or skilled for that matter; we are her employer and by law, required to deduct taxes and workman’s compensation from

her wages. There is no background check, so we don’t even knowwho we have in our home and if they have previous reports of abuse or theft on their license. Homeowner’s insurance is not enough to protect us if an aide falls on our property being that we are considered their employer. We must be aware of the risks when we go to apply for Government benefits such as Veteran’s Aide and Attendance which now has a three- year look back and Medicaid which has a five year look back. With look backs like this, we will have to present statements of all transactions in order to receive these benefits. How can we successfully “prove” where our health care out of pocket expenses are going when someone is not claiming the income? We need to look at the big picture of what you get through a licensed, bonded, accredited agency. Including Certified Home Health Aides with active licensure and supervision by an RN which is the regulation. We will have an opportunity to have a substitute aide to come assist our loved one if the current aide falls ill or has car trouble and we will have a legal record of payments that were paid in out-of-pocket costs with a tax statement at the end of the year. The financial advantages are what makes the grey market intriguing to a family, but the other risks involved are just not worth those few dollars an hour or per day we may be saving. Not only are there risks to families and the individuals who are receiving care, there are also risks to aides joining the grey market as opposed to working for a licensed agency or long term care setting such as Assisted Livings or Skilled Nursing Facilities. With no supervision and policies and procedures, the Home Health Aide or Certified Nursing Assistant also risks not learning the regulation changes and will risk losing their license or the chance of renewing their license (if they have one). They will directly be held liable for things that may not even be their fault in the home. If you are thinking about hiring assistance for yourself or a family member, remember to look for a licensed, bonded, accredited agency to avoid potential care issues and legal issues in the future.

Caring Connections of New Jersey is a non- profit organization whose primary mission is to educate seniors and their families on the options that are available in their local community. Visit our website at www.caringconnectionsnj.org or call (609) 960-2265 for assistance.

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