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MATURE MARKET HEADLINES 2/01/2001

Clinical Trials Seek Alzheimer's Prevention

The National Institute on Aging (NIA) is sponsoring a new clinical trial to test the use of anti-inflammatory medications for the prevention of Alzheimer's disease (AD). Epidemiologic studies have suggested an association between the use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) and decreased risk of AD, but clinical trials are essential to determining whether such drugs can in fact prevent AD.

The Alzheimer's Disease Anti-Inflammatory Prevention Trial (ADAPT), launched January 30, 2001, is designed to test naproxen and celecoxib for their ability to prevent AD. These medications are known to reduce inflammation in joints and other parts of the body. The new study is being launched to help determine whether these drugs might also reduce inflammatory processes in the brain associated with Alzheimer's disease.

In order to increase participation and improve access, the ADAPT study is being conducted at four locations -- Boston, MA; Sun City, AZ; Baltimore, MD; and Rochester, NY. Study participants must be 70 years or older by the close of the study's enrollment period, and have a mother, father, sister, or brother who has (or had) serious age-related memory loss, dementia, senility, or AD. Participants cannot, themselves, have been diagnosed with dementia, senility, or AD. Participants will be asked to take a prescribed dose of naproxen, celecoxib, or a placebo (sugar pill) twice a day for 5 to 7 years. Study medication and all medical evaluations related to the study will be provided free of charge.

People interested in learning more about the Alzheimer's Disease Anti-Inflammatory Prevention Trial should call toll free 1-866-2stopAD (1-866-278-6723). For more information about Alzheimer's Disease, call NIA's Alzheimer's Disease Education and Referral Center toll free at 1-800-438-4380 or visit the ADEAR Center website at www.alzheimers.org
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Size Gets the Prize in Today's HMO Industry

Those of you who are searching for an HMO might want to follow the advice of an old fisherman, "Throw the small ones back". Based on the findings of a new study, Bigger is Better, when it comes to HMO profitability. Small HMOs lost $127 million, while large HMOs posted $528 million in profits, says Weiss Ratings Inc, a provider of independent financial ratings on health maintenance organizations (HMO).

This unequal distribution of profits, says Weiss, highlights the disparity between the small and large HMOs. The 373 small HMOs reviewed in the study had an aggregate loss of $127 million for the first half of 2000, with 52% posting a loss for the period. In contrast, the largest HMOs, just 35 companies, reported a combined net profit of $528 million. Overall, the HMO industry recorded aggregate net income of $370 million in the first six months of 2000, up from $91 million in the first half of 1999.

Medical expenses per enrollee rose 4.4% at small HMOs, eclipsing a corresponding 3.9% increase in healthcare revenues per enrollee and making profitability an elusive goal for most small HMOs. Comparing data from the first half of 2000 to the same period a year earlier, the study also points to a widening gap between small (those with less than 100,000 enrollees) and large HMOs (more than 500,000 enrollees).

While large HMOs also experienced a sharp rise in medical costs per enrollee (7.2% on average), they were able to more than offset the increase by boosting revenues at a quicker pace (7.8%). "HMOs have been pushing successfully for premium rate increases for several years now in an effort to get back to profitability. However, with medical costs rising at such a fast pace, quite a few HMOs, particularly the smaller companies, will continue to lose money," says Martin D. Weiss, PhD, chairman of Weiss Ratings.

In reviewing the industry’s financials for the first half of 2000, Weiss upgraded the ratings for 21 HMOs while downgrading 12. The Weiss ratings are based on an analysis of an institution’s capitalization, asset quality, earnings, liquidity, and stability. The latter category combines a series of factors including five- year trends, asset size and growth, strength of affiliate companies, and risk diversification.

Weiss issues safety ratings on over 16,000 financial institutions, including banks and thrifts, securities brokers, insurers, and HMOs. Consumers needing more information on the financial safety of an HMO can purchase a rating and summary analysis from Weiss Ratings at: 1-800-289-9222.
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Florida Governor Jeb Bush Plans Elder-Friendly State

Governor Jeb Bush (left) Announces Older Advocate Award Florida Governor Jeb Bush unveiled a series of elder-friendly initiatives to be included in his forthcoming budget and recommendations to the Legislature. "At the very least, we owe our elders two things. We must help fight the war against loneliness for those elders in the twilight of their lives, and we must provide an energetic and entrepreneurial Florida for those who are just entering their golden years."

The Governor's budget proposals for next year that include an additional $52.4 million to provide expanded options for elders to age in place - an increase of 15 percent over last year's budget. In addition, the Governor's budget provides $46 million to improve quality of care in nursing homes, and $30 million to provide prescription drugs to low income elders.

The Governor's Elder-Friendly Initiative includes the following. If this seems like a tall order, that's because it is. The key issue, then, is whether or not such an ambitious effort is likely to occur. From where I sit, the forecast seems favorable given the recent successes of the Bush administration. Several of the Governor's many accomplishments include eliminating the list of elders waiting for community care, and diverting 815 elders from nursing facilities to home care.
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AoA Initiative Empowers Family Caregivers

Citing the tremendous challenges experienced daily by millions of America's family caregivers, the Administration on Aging (AoA) has announced the availability of funds to meet the needs of those caring for older loved ones who are ill or who have disabilities.

In December 2000, Congress approved funds for the new National Family Caregiver Support Program (NFCSP), a key component of the newly reauthorized Older Americans Act signed into law on November 13, 2000. This program will provide critical support needed by families to assist them in maintaining their caregiver roles. The NFCSP also recognizes the unique needs of grandparents caring for grandchildren.

Funds will be awarded to State Agencies on Aging who will work in partnership with area agencies on aging to implement the formula grant provisions of the new program. The AoA will issue guidance to assist states in implementing this component, and will work closely with its national aging network to ensure that caregiver programs across the country are in full operation as soon as possible.

Other components of the NFCSP include competitive innovative grants to assist in the development of multifaceted systems of caregiver support; program evaluation, training and technical assistance, and a new program to support the family caregivers of Native American elders. Further details about the implementation of these provisions will be issued in the near future.

AoA's director, Dr. Takamura believes that, "The National Family Caregiver Support Program will permit states to develop systems of support to address the needs of our nation's caregivers. The types of services caregivers have told us they need the most include information, assistance, counseling, support, training and respite."
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Lifelong Management of Dental Caries

Tooth decay still plagues Americans despite great strides in dental health. More than two-thirds of adults age 35 to 44 years have lost at least one permanent tooth due to decay. About half of those age 75 and older have had root caries affecting at least one tooth.

Scientific research continues to feul remarkable progress in our understanding of the best ways to diagnose, treat, and prevent tooth decay. The National Institutes of Health (NIH) will sponsor a "Consensus Development Conference on Diagnosis and Management of Dental Caries Throughout Life".

The purpose of the conference is to reach agreement on diagnosis and management of dental caries throughout life. On the first two days, experts will present current scientific thinking about diagnosis, management, and preventtion of dental caries. Concerned voluntary organizations will be invited to make statements. On the third day, after considering the scientific evidence, the consensus panel will present its draft report and invite comments from the audience. Dr. Michael C. Alfano, Dean of the New York University College of Dentistry, will chair the independent, non-Federal panel.

The following key questions will be addressed by the panel. The consensus conference is open to the public. Activities will take place March 26-28, 2001 in the conference center of the William H. Natcher Building, National Institutes of Health, Bethesda, Maryland. Registration details are available via voice-mail: 301-592-2231 or e-mail: llambert@prospectassoc.com
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Vitamins and Nutrients: When to Say When

Darkly colored, carotene-rich fruits and vegetables such as carrots, sweet potatoes, and broccoli provide the body with half as much vitamin A as previously thought, says the latest report on Dietary Reference Intakes (DRIs) from the National Academies' Institute of Medicine.

This means people need to make sure they eat enough of these fruits and vegetables to meet their daily requirement for vitamin A, especially if they do not eat animal-derived foods, which serve as abundant sources of the nutrient for most people.

In addition to vitamin A, the report examines the nutritional value of the micronutrients vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc. It sets a daily maximum level of intake for vitamin A as well as for boron, copper, iodine, iron, manganese, molybdenum, nickel, vanadium, and zinc.

The new DRI report is the fifth in a series that updates and expands on the Recommended Dietary Allowances (RDAs) in the United States and Recommended Nutrient Intakes in Canada. Although DRIs are designed for use in the United States and Canada, they can provide guidance to researchers and policy-makers coping with malnutrition elsewhere in the world.

Based on national nutrition surveys, the report says that daily requirements for the nutrients it examined can be met, in almost all instances, without taking supplements. One exception, however, is that pregnant women usually need iron supplements to meet their increased daily requirements.

Below are highlights of the report's recommendations. The report identifies several gaps in what is known about these 14 micronutrients. For example, there is a dearth of studies designed specifically to estimate average nutrient requirements for healthy humans, especially infants, children, adolescents, the elderly, and pregnant women. In addition, there has been a lack of research aimed at studying the role of these micronutrients in reducing the risk of chronic diseases or detecting side effects from chronic overconsumption.

The study was sponsored by the U.S. Department of Health and Human Services; the National Institutes of Health; the Centers for Disease Control and Prevention; Health Canada; the Institute of Medicine; the Dietary Reference Intakes Private Foundation Fund, including the Dannon Instituteand the International Life Sciences Institute; and the Dietary Reference Intakes Corporate Donors' Fund, which includes contributions from Roche Vitamins Inc., Mead Johnson Nutrition Group, Nabisco Foods Group, U.S. Borax, Daiichi Fine Chemicals Inc., Kemin Foods Inc., M&M/Mars, Weider Nutrition Group, and the Natural Source Vitamin E Association.

Copies of Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc will be available later this year from the National Academy Press.
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Falls Cause 315,000 Hip Fractures Annually

11 million senior citizens fall each year, according to the American Academy of Orthopaedic Surgeons. Ninety percent of the 350,000 annual hip fractures that occur in the U.S. are the result of falls. By the year 2050, the number of hip fractures is expected to reach 650,000 per year. That's about 1,800 hip fractures a day. The Academy attributed this increase to the aging U.S. population.

A hip fracture is a break of the upper thighbone (femur), the bone that fits into the hip socket. Ninety percent of hip fractures are among persons 65 and older. Women over 65 have a 1-in-5 chance of breaking their hip during their lifetime. The aging Baby Boomer who may be caring for a parent with a broken hip also is in danger because the incidence of hip fractures starts to increase at age 45.

Falls are the leading cause of injuries to older people in the U.S. The number of falls and the severity of injury increase with age. Treatment of the injuries and complications associated with falls costs the U.S. more than $20.2 billion annually.

Falls can occur anytime, any place and to anyone while doing everyday activities such as climbing stairs or getting out of the bathtub. Although some risk factors for falls, such as heredity and age, cannot be changed, several risk factors can be eliminated or reduced. Research shows that simple safety modifications at home-where 60 percent of seniors' falls occur-can substantially cut the risk of falling.

The American Academy of Orthopaedic Surgeons has developed Prevent Injuries America! guidelines to help people reduce their risk. The American Academy of Orthopaedic Surgeons is a not-for-profit organization that provides education programs for orthopaedic surgeons, allied health professionals and the public. For a free brochure on preventing falls and hip fractures call the Academy's public service telephone number (800) 824-BONES.
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Hot Climates Create Stress in Elder Hearts

If you're over 65 and planning a winter vacation in a sunny climate, be aware that a hot environment puts a strain on an older heart, says a Penn State specialist in the study of the human body's response to heat stress.

"If you exercise vigorously in the heat, the strain is even greater. And, if you have heart disease and exercise vigorously in the heat, you may be in a dangerous situation," says Dr. W. Larry Kenney, professor of physiology and kinesiology at Penn State's Noll Physiological Research Center.

The Penn State researcher has studied the effects of chronological age, fitness, and gender on cardiovascular responses to heat stress for more than 15 years. He says, "Our research has shown that when older people have serious problems associated with the heat, it's usually a cardiovascular problem. People die because heat puts a greater strain on their hearts to pump blood."

Heat waves kill more people each year than hurricanes, tornadoes or volcanoes. And, persons over 65 years of age are 10 to 12 times more likely to die during extended periods of hot weather, he says. In laboratory studies, Kenney and his research group have shown that, when exposed to high temperatures, young subjects pump more blood to the skin to cool the body. The hearts of older subjects -- even healthy, fit, active subjects -- pump less blood to the skin and do so under more strain, that is, the heart works much harder. Often, in heat waves, the oldest old will get dizzy when they stand up quickly and may even fall and break bones.

Young people's cardiovascular systems slow blood flow to the skin and muscles to make sure there is more flow to the brain to maintain consciousness. Older subjects cut flow to the gut and liver. "These results indicate that the combination of heat stress and a big meal could lead to problems for older persons because the meal increases blood flow to the gut, making less blood flow accessible for the elderly to shift to the brain," Kenney says.

Kenney and his research group have explored endurance training, estrogen replacement therapy, heat acclimation and hydration as counter measures to heat's effect on older people. They have found that regular exercise is effective and can increase skin blood flow and cardiac output. Hormone replacement therapy, too, can be beneficial for women; although, the benefit disappears if the women take combination therapy, estrogen and progesterone, rather than estrogen alone. Heat acclimation and hydration also can help to mitigate heat's effects on the older heart.

Kenney suggests the following hot weather exercise strategy for older men and women. Many illnesses and diseases (diabetes, hypertension) can lower your ability to exercise in the heat. Ask your physician about these effects.
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