**AoA Update**

**Volume 2Issue 4****Administration on Aging****April 1997**

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### Robyn Stone Leaves AoAAoA Aids Elderly Victims of Disasters Alzheimer’s Disease Grants Moving to AoA Testing New Ways to Aid Alzheimer’sDisease Patients and Their FamiliesCelebration Marks 25th Anniversary of theNutrition Program1997 Poverty Guidelines IssuedNIA Study Suggests Way to ReduceElderly’s Disability

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## Robyn Stone Leaves AoA

Acting Assistant Secretary for Aging, Robyn I. Stone, hasannounced her departure from the Administration on Aging,effective April 7. Dr. Stone will assume responsibilities asProfessor at the Institute for Health Care Policy and Researchwithin Georgetown University’s Public Policy Institute.

Dr. Stone said that she hopes "to build on what I havelearned during my tenure at the Department of Health and HumanServices and AoA, and to work toward the development of policiesand programs that will move us successfully into the twenty-firstcentury." Dr. Stone said she, "appreciated theopportunity to see the tremendous work accomplished by this greataging network."

Deputy Assistant Secretary for Aging, William Benson, willserve as Acting Principal Deputy Assistant Secretary for Agingupon Dr. Stone’s departure.

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## AoA Aids Elderly Victims of Disasters 

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Some 50,000 elderly are affected by the twindisasters

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**R**obyn I. Stone, Acting AssistantSecretary for Aging, has announced release of some $500,000 fordisaster relief assistance for older victims hit by the OhioRiver Valley floods and tornadoes in early March. The disasterrelief funds, made available from Supplemental Contingency Fundsappropriated for disaster response, will be used, in conjunctionwith other federal relief efforts, to assist older residents ofArkansas, Indiana, Kentucky, Ohio, Tennessee, and West Virginiawhose lives have been disrupted by flooding and tornadoes.

In many areas, critical access routes have been cut off andkey services, such as home-delivered meals and in-home servicesfor the frail elderly, have been interrupted. 

Estimates indicate that some 50,000 older persons have beenaffected by the disasters, with elderly residents being hardesthit in Kentucky.

Illinois will use $27,000 of previously-authorized funds sothat older persons can be provided services in five southernIllinois counties that have been declared Federal Disaster Areasby President Clinton.

The Administration on Aging (AoA), through its NationalDisaster Relief Initiative, has been working closely with thestates through Federal Emergency Management Agency offices, aswell as the State Offices on Aging and Area Agencies on Aging,since the flooding and tornadoes occurred, to identify victimsand assist them in applying for services and benefits.

Disaster relief funds will provide assistance to individualolder victims. Some gap-filling services also will be provided,including transportation, homemaker, chore, and relocationassistance, in accordance with the needs identified by eachcommunity.

Older persons with physical or mental impairments, as well asthose who are frail or have chronic health problems, are amongthe most vulnerable during normal times. In times of disaster,the assistance provided by the AoA could help many older disastervictims to avoid becoming dependent.

Individual funding levels for the five states are: Kentucky,$270,000; Ohio, $60,000; $50,000 each to Arkansas, Indiana, andTennessee; and $20,000 to West Virginia.

For additional information on the AoA’s Disaster ReliefInitiative, please contact:Greg Wilder AoA Region VII Palace Building 1150 Grand AvenueSuite 600 Kansas City, MO 64106 (816) 374-6015

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***Alzheimer’s DiseaseGrants Moving to AoA***

Alzheimer’s disease is a progressive, degenerative braindisorder which affects some 4.3 million Americans. The disease,marked by progressive, irreversible declines in memory,performance of routine tasks, time and space orientation,language and communication skills, abstract thinking, and theability to learn and carry out mathematical calculations,eventually renders its victims unable to care for themselves.

It is estimated that Alzheimer’s disease costs thisnation between $90 and $100 billion each year in direct outlaysfor nursing care and indirect costs, such as patients’ lostproductivity and that of family members who care for them. Unlessviable treatments are found, it is estimated that the number ofpersons with Alzheimer’s disease or related disorders willdouble in the next 20 years and that all of them will eventuallyneed full-time care.

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*Alzheimer’s costs this nation between$90 and $100 billion each year in direct and indirect costs.*

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Early diagnosis has several advantages, since new medicationcan be used to treat the cognitive decline associated with thedisease and gives patients, and their families, time to makesuitable living arrangements, handle legal matters and create anongoing support network.

Early diagnosis is also important since 20 percent ofsuspected cases are, in fact, a different disease--oftensomething that can be treated or reversed. Similar symptomsresulting from tumors, strokes, severe depression, the sideeffects of medication or infectious diseases often can be treatedsuccessfully.

If the disease is diagnosed as Alzheimer’s, two types ofcaregiving strategies are needed--one to help persons affected byAlzheimer’s disease to maintain as much independence indaily activities for as long as possible; the other to preventdisturbing behavior, which eventually affects 70 to 90 percent ofpatients.

Informal caregivers of Alzheimer’s patients often sufferboth physically and emotionally from fatigue, insomnia, increasedcardiovascular risk, depression, and problems associated withimpaired socialization. Caregivers need information about what toexpect as the disease progresses, emotional support in groupsettings, home visits from professionals, and individual andfamily counseling.

To help alleviate medical and emotional problems, caregiversalso need skills training in ways to cope with the disease,behavior management techniques and assistance in resolvingday-to-day problems.

Respite care, in the form of a substitute caregiver in thehome for brief periods of time, adult day care centers orinstitutional care of the Alzheimer’s patient for a week ortwo, can give caregivers the opportunity to renew themselves, toattend to business matters, and to have needed social outlets.

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### **Testing New Ways to Aid Alzheimer’sDisease Patients and Their Families**

In fiscal year (FY) 1992, $3.9 million was awarded to 11states for Alzheimer’s Disease Demonstration Grants toStates (ADDGS). The next year, grants were awarded to four morestates. These 15 state grants are funded through FY 1997. Elevenof the grantees are State Units on Aging; two, state healthdepartments; one, a state mental health department; while anotheris located in a state department of human resources.

These projects carry out diverse activities. The grantees,according to Acting Assistant Secretary for Aging, Robyn I.Stone, "...have been very creative in their approaches toleveraging community resources to expand services to familieswith Alzheimer’s disease."

The major services offered through the projects are caregiversupport, training and assistance, respite care, care management,public education and information dissemination. Recently, greateremphasis has been placed on working closely with health careproviders for early diagnosis and improved care planning."The grantees," Dr. Stone says, "have beenespecially successful in their outreach efforts to rural,low-income and minority individuals."

The l5 grantees will be formally transferred from the HealthResources and Services Administration to the AoA on October 1,1997. The AoA has formed a management team, composed of keyofficials, to develop and implement plans for the transfer andfor continued program support.

The Acting Assistant Secretary for Aging has a long-standingworking relationship with the Alzheimer’s DiseaseAssociation. Other AoA staff have worked with theAlzheimer’s Disease Education and Referral Center, theNational Institute of Adult Day Care, and other national agingorganizations with a special interest in Alzheimer’s andcaregiver issues.

This Older Americans Month theme of "Caregiving:Compassion in Action" was selected, "To paytribute," Dr. Stone says, "to America’scaregivers, a large portion of whom are caring for persons withAlzheimer’s disease and to encourage support and assistancefor caregivers coping with long-term care needs."

The AoA will continue to build on the expertise gained fromthe ADDGS in order to stimulate innovative approaches forbuilding new linkages with health care providers, communityorganizations, and the private sector. In addition, thisdemonstration approach will enable further development of newmodels for assisting family caregivers to anticipate futureneeds, disseminate public information, provide outreach forlow-income and minority groups, and enhance knowledge and skillstraining about how to cope with the disease. The grant funds willenable ongoing experimentation and refinement of innovativeprogram models that can be implemented in more states andcommunities to serve the rapidly growing number of persons withAlzheimer’s disease and their caregivers.

Additional information is available from: Irma TetzloffAdministration on Aging 330 Independence Ave. Washington, DC20201 (202) 619-3268 

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### Celebration Marks 25th Anniversary of theNutrition Program

Health and Human Services Secretary, Donna E. Shalala, was theguest of honor at a breakfast celebration held March 21 tocommemorate the silver anniversary of the Elderly NutritionProgram (ENP).

Some 150 guests attended the breakfast, including SenatorCharles E. Grassley, Chairman of the Senate Special Committee onAging; Senator Paul Wellstone; Representative Matthew G.Martinez; Mary Ann Keffe, Acting Undersecretary for Food,Nutrition, and Consumer Services, U.S. Department of Agriculture;Enid Borden, Executive Director of the National Association ofMeals Programs; and Toby Felcher, Past-President of the NationalMeals on Wheels Foundation, who represented the NationalAssociation of Nutrition and Aging Services Programs. Members ofthe aging network and older Americans also attended the receptionwhich featured four sample "Morning Meals" that will beserved to elderly home-delivered meals recipients under a pilotprogram to be undertaken, later this year, by the AoA and GeneralMills Foodservice.

President Bill Clinton sent a message to the AoA, in which hepraised the ENP, saying,

"Often these meals are the only real source of nutritionand contact with others that a vulnerable older person will haveduring the day. Whether it be through a hot prepared mealdelivered by a volunteer to a senior at home, or through a seniorcenter or congregate dining site that promotes healthy living andnutritional screening, these nutrition programs providecamaraderie, promote positive health practices, and link olderpersons to other essential community services."

The President ended his message by saying,

"I ask all Americans to join me in observing thissignificant anniversary and in paying tribute to the dedicatedservice providers and volunteers who have worked so hard toimprove the quality of life for millions of older Americans overthe past 25 years. This anniversary offers us a wonderfulopportunity to renew our nation’s commitment to theseimportant nutrition programs and to the older Americans theyserve."

At the breakfast ceremony, Secretary Shalala announced theagreement between the AoA and General Mills Foodservice tosupport the innovative "Morning Meals on Wheels" pilotbreakfast program (*AoA Update*, Vol. 2, Issue 3). 

Secretary Shalala said that, "As we look forcost-effective ways to better serve our growing number of olderconsumers, in particular those who are homebound,these types of partnerships are critical. This alliance will worktoward maintaining adequate nutrition and nutrition services forolder Americans to prevent premature or unnecessaryinstitutionalization and hospitalization."

Brian Graff, Manager of Marketing Services forGeneral Mills, stressed his company’s commitment to thecommunity by expanding services through the "Morning Mealson Wheels Program."

Since 1980, the demand for home-delivered mealshas grown rapidly. At that time, 22 percent of all ENP meals werehome-delivered. Today the figure has risen to 49 percent, and 41percent of the nation’s home-delivered meals programs havewaiting lists.

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**1997 Poverty GuidelinesIssued**

Secretary of Health and Human Services, Donna E. Shalala, hasissued the 1997 annual update of poverty guidelines whichappeared in the March 10 edition of the *Federal Register.*

The Secretary’s guidelines vary by family size and areupdated annually to account for changes in the cost of living, asmeasured by changes in the annual value of the Consumer PriceIndex. The 1997 poverty guidelines represent income standardsexpressed in 1996 dollars. The guidelines provide guidanceconcerning the definition of "greatest economic need"as set forth in Part 412, Section 102 of the Older Americans Act,as Amended.

Although the Secretary’s guidelines are based on thepoverty definition approved by the Office of Management andBudget (OMB) as the federal government’s statistical measureof poverty, OMB’s thresholds are adjusted by the Secretarybefore being converted into poverty guidelines. TheSecretary’s guidelines also include higher poverty levelsfor Hawaii (115 percent) and Alaska (125 percent).

**1997 DHHS Poverty Guidelines**

**(in dollars)**

| Size of family units* | Contiguous        states & DC | Alaska | Hawaii |
|-----------------------|------------------------------------|--------|--------|
| 1                     | 7,890                              | 9,870  | 9,070  |
| 2                     | 10,610                             | 13,270 | 12,200 |
| 3                     | 13,330                             | 16,670 | 15,330 |

*For each additional family unit, add $2,720for contiguous 48 states and the District of Columbia (DC),$3,400 for Alaska and $3,130 for Hawaii.

For information about how the poverty guidelines are used in aparticular program, contact the federal, or other, officeresponsible for the program. For general information, contact:Gordon Fisher Office of the Assistant Secretary for Planning andEvaluation Room 438F Humphrey Building Department of Health andHuman Services Washington, DC 20201 (202) 690-6141

For information about Older Americans Act programs, contact:Carol Crecy Administration on Aging 330 Independence Ave.Washington, DC 20201 (202) 619-0011

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**NIA Study Suggests Way toReduce Elderly’s Disability**

A new study by National Institute on Aging (NIA) researchersshows that a small number of diseases and conditions, that canlead to hospitalizations, are responsible for a large proportionof severe disability in older persons. The conditions are:

- stroke
- hip fracture
- congestive heart failure
- pneumonia
- coronary heart disease
- diabetes, and 
- dehydration

Targeting these conditions for intensive treatment andrehabilitation, the researchers say, could help reduce disabilityamong a substantial number of older people and improve theirability to function independently.

The study, which appeared in the March issue of the *Journalof the American Medical Association,* finds that people age 85and older, with sudden, severe disability, were treated lessintensively in the hospital than their younger counterparts.Research findings, the researchers say, coupled with earlier datathat suggested that other variables, not age, are related to thesuccess of treatments and therapies, suggest that physicians areimproperly using age as a criterion for treatment.

The researchers found that, once in the hospital, the oldestpatients received less intensive care. Medicare charges showedthat advancing age was associated with quicker discharge andlower Medicare charges for each hospital admission, reflectingless intensive treatment. Medical technologies used in intensivecare wards, pharmacological treatments, surgery, andrehabilitation procedures have been shown to have similarbenefits for older people as they do for younger people forsurvival and quality of life.

Advancing age, in and of itself, therefore should not be usedto determine how aggressively an older person should be treated,the study researchers say. The research points to the potentialneed to make use of various procedures more frequently andintensively in older patients, and says that the time ofhospitalizations may be the best time to reduce disability.

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AoA Update

**RobynI. Stone**Acting Assistant Secretary for Aging

**JudySatine**Director, Executive Secretariat

**JuneB. Faris**Editor

**AoAUpdate**Administrationon AgingU.S. Department of Health & Human ServicesWashington, DC 20201(202) 619-0724TDD: (202) 401-7575 FAX: (202) 260-1012 E-mail: AoA_ESEC@Ban-Gate.AoA.DHHS.GOVInternet Web Site:http://WWW.AoA.DHHS.Gov

 

AoA Update Executive SecretariatAdministration on AgingU.S. Department of Health and Human Services330 Independence Avenue, SWWashington, DC 20201