TUESDAY, Dec. 11 (HealthDay News) -- An intensive, home-based program to improve medical care for low-income seniors produced mixed results, a geriatrics team reports.

Failure to get better outcomes indicates the need for a new analysis of how Medicare pays for the care for older Americans, experts said.

"We were able to stabilize medical care for these people, who often have an up-and-down experience with medical care," said Dr. Steven R. Counsell, a professor of geriatrics at Indiana University and lead author of a report in the Dec. 12 issue of the Journal of the American Medical Association. "The main thing that did not change was physical function. The program did not prevent decline."

Some improvements were evident in the two-year course of the program, which included care management by nurse practitioners and social workers who collaborated with a primary-care physician and a geriatrics interdisciplinary team guided by protocols for common conditions of aging.

Better improvement in general health, vitality, social functioning and mental health were noted in the 474 older people, as compared to a group of 477 getting usual care in community-based medical centers. Emergency room visits decreased for the intervention group, but the death rate did not decline.

The program was run under Medicare, which placed limits on how it was financed, Counsell said. In general, Medicare pays for specific treatments of specific conditions, so that most of the efforts to coordinate care were not reimbursed, he said.

"But we were hoping that this kind of coordinated care would show improvement in many areas," Counsell said.

The program results indicate a need for a basic revamping of Medicare financing, said Dr. David B. Reuben, a professor of medicine at the University of California, Los Angeles, who wrote an accompanying editorial.

"Medicare, for the most part, pays for physical services," Reuben said. "If care is provided that doesn't fall into the category of one of those services, it isn't paid for. So, coordination of special services is not reimbursed."

The partial success of the program indicates that "a new model is achievable" under Medicare, Reuben said, "but the time is ripe for a thorough re-evaluation of how Medicare pays for services. It really needs to be freshened up. We can have fee for service, but we have places where we must fill in the gaps, and one of the big gaps is coordination of care."

Counsell said he and his colleagues are going through data collected in the program to determine whether it makes sense financially. "Armed with some further information and a cost analysis, we are looking at how much the program cost and how much was saved and who benefits the most," he said.

Elements of the program could be adapted for use with special populations, such as nursing home patients and those with chronic illnesses, Counsell said, working through organizations that deliver managed care to selected groups.

"There has to be a different infrastructure," Reuben said. "If the method of financing is good, good infrastructure tends to follow."

More information

Details on health care for the elderly is provided by the American Geriatrics Society  .

MONDAY, Dec. 10 (HealthDay News) -- Even when Alzheimer's disease robs them of the life they once knew, some people can still find love among the ruins.

And in most cases -- as highlighted by recent news on retired Supreme Court Judge Sandra Day O'Connor -- the spouse or child of the Alzheimer's patient grows to understand and accept the new relationship, experts say.

O'Connor's Alzheimer's-stricken husband John, 77, has found companionship with a woman in the nursing home where he now resides, according to recent news reports. The two spend time together, holding hands, even when Justice O'Connor is nearby, the reports said.

This type of relationship was also the focus of the recent film Away From Her, starring Julie Christie as a woman with Alzheimer's who gradually forgets her husband and forms a new bond with a fellow nursing home resident. Her husband gradually comes to accept the relationship, understanding that it gives his wife comfort and stability amid the confusion that Alzheimer's can bring.

Such an emotional journey is common for caregivers confronted with such a situation, said Donna Schempp, program director of the national advocacy group Family Caregiver Alliance, based in San Francisco.

Most spouses or children of people with Alzheimer's "have responded very positively" to these newfound relationships, which are not uncommon, she said. "Because if the person does not know who you are anymore, it's not a rejection," Schempp explained.

"And in the end, we want the person that we care about to be happy," she said. "Just behaviorally, and in other ways, they are going to be better if they are feeling cared about and nurtured, loved and appreciated."

Experts in Alzheimer's disease say many people are surprised to learn that patients continue to have rich emotional lives.

"People still have their personhood at the core of who they are," said Dr. Peter Reed, senior director of programs at the Alzheimer's Association. "So the effects [of the disease] do not diminish the individual's need for social interaction, it doesn't diminish their need for dignity and meaning in their life."

Alzheimer's typically causes an individual to forget all but those they see near them regularly, he added. "So, people learn familiarity with the people around them," Reed said, and with that, "they become more comfortable."

The persistence of emotional needs after declines in memory makes some sense on a neurological level, another expert said.

"The Alzheimer's pathology starts in the memory and learning areas of the brain and then spreads," said Dr. Gary Kennedy, director of geriatric psychiatry at the Montefiore Medical Center in New York City. "The direction and extent of the spread varies tremendously from one person to the next. For some, their thinking and memory are largely gone, but their emotional expressiveness may be relatively intact."

Emotions may often be less guarded as Alzheimer's advances, with people showing less reticence to express affection, he added. "In some instances, emotional expressiveness may be augmented by the illness -- in other words, inhibitions may be taken away," Kennedy said.

Sexuality can enter the mix as well, and that's where relationships between Alzheimer's-affected patients get more complicated, Schempp said.

Depending on a person' level of cognition, "there's a kind of moral-ethical issue as to when someone can be consensually involved," she noted. "Some nursing homes just categorically say no, other nursing homes work on it on a case-by-case basis. Some nursing homes say no because the families object, and some nursing homes say yes because the families are OK with it."

Schempp said that, in her experience, the adult children of Alzheimer's patients typically have a tougher time accepting this new love than spouses do.

"It's harder for the children -- it's an abandonment, and they feel committed to both parents. How could my mother or father do this?" she said.

That's where educating yourself about the progression of the disease really becomes valuable, she said.

"In our experience, so many people know so little about dementia and yet they are caring for someone with dementia," Schempp said. "It just goes back to the incredible need that we have for people to get informed. It takes a lot of information to really be able to navigate how you care for someone with dementia."

In the end, allowing a loved one to find his or her own peace amid the ravages of Alzheimer's may be the best course to take, Kennedy said.

"As Sandra Day O'Connor and others say, they are just thankful that there is a moment of happiness that comes into their loved one's life," he said.

More information

Find out more about caring for those with Alzheimer's or other illnesses at the Family Caregiver Alliance  .

MONDAY, Dec. 10 (HealthDay News) -- The majority of Americans in Medicare aren't getting screened for colorectal cancer, a major killer, even though the screening is free, a new study finds.

In fact, the percentage of enrollees in Medicare, the federal health insurance program for older Americans, getting screening tests such as colonoscopies has declined since the program began paying for them, the study said.

An assessment of 153,469 Medicare members identified in 1998 found that 29.2 percent of them were screened for colorectal cancer between 1991 and 1997, when Medicare began paying for screening tests. Only 25.4 were screened between 1998 and 2004, after screening was covered by Medicare, the study found.

Failure to get those tests costs lives, said study author Dr. Gregory Cooper, interim chief of gastroenterology at University Hospitals Case Medical Center in Cleveland.

"We know that the survival curve is strongly related to the state at which the cancer is diagnosed," he said. "For the mostly fairly healthy people in this cohort, early detection would bring a benefit."

Colorectal cancer is the third leading cause of cancer deaths in the United States. The American Cancer Society estimates that 147,000 new cases will be diagnosed in this country this year, with 57,000 deaths.

The new study, published online Dec. 10 in the journal Cancer, looked at a variety of screening tests. They included barium enemas, methods of detecting fecal blood, and colonoscopy, which is regarded as the most definitive test. By detecting polyps before they become malignant, a colonoscopy can help prevent cancer. Colonoscopies are recommended every 10 years for adults, starting at age 50.

The public, doctors and the Medicare system itself are all responsible in different ways for failures to screen for colorectal cancer, said Dr. Otis W. Brawley, chief medical officer of the American Cancer Society.

"Many physicians do not have a preventive mindset as yet," Brawley said. "People go to the doctor overwhelmingly because they are hurt and have a medical problem. No one goes to the doctor with a preventive intention."

Medicare does allow for an initial patient visit with a new doctor, "but it is designed to be all discussion, not for physical examinations," Brawley said. "During that discussion, they [patients] may be told that they have this benefit, but it is up to them to ask for it."

And there's something about colorectal cancer that makes people shy away from discussing it, Brawley said.

"Prostate cancer screening has not been shown to save lives, and people ask for it," he said. "Colon cancer screening has been shown to save lives, and people don't ask for it."

The ultimate responsibility lies with the patient, Cooper said. "If the physician doesn't bring it up, often the patient has to remind them," he said.

The new study findings are troubling, in light of research published in the Journal of the American Medical Association last December that found that since Medicare began paying for colon-cancer screenings, more patients' tumors are being diagnosed at an early, more curable stage.

The new findings also don't reflect a federal report released in March that found that national goals for colorectal cancer screenings are on target with the Healthy People 2010 initiative.

More information

Colorectal cancer screening is explained by the U.S. National Cancer Institute.

WEDNESDAY, Nov. 5 (HealthDay News) -- In a finding that uncovers the biological underpinnings of "senior moments," new research shows that communication between different parts of the brain begins to break down as a person grows older.

"We wanted to see how the brain changes in cognition in normal aging," said lead researcher Randy Buckner, a professor of psychology at Harvard University. "We were interested in normal aging, aging that isn't accompanied by even the earliest signs of Alzheimer's disease."

Buckner noted that it's sometimes tough even for neurologists to understand the difference between normal aging and Alzheimer's. "There are subtle changes in how brain areas communicate and coordinate with each other," he said. "As we age, we see that communication between these areas changes."

The report appears in the Dec. 6 issue of Neuron.

In the study, Buckner's team used a brain-imaging technique called functional magnetic resonance imaging (fMRI) to study the brains of 55 adults aged 60 and over, and 38 adults aged 35 and younger. To guarantee that none of the older subjects were in the early stages of Alzheimer's, the researchers checked for the presence of amyloid in the brains of those volunteers. If that telltale sign was detected, the person was not included in the study.

Among the adults they observed, they found that in the younger people, regions of their brains communicated easily with one another. However, this was not so with the older people.

In older people, the white matter of the brain that connects various brain areas had started to deteriorate, a chemical fact that would account for the lack of communication that affects cognitive function, Buckner said.

When these changes start isn't clear, Buckner said. "They appear to start slowly in the seventh and eighth decade of life," he said. "We also don't know what factors cause these changes to accelerate."

The cognitive changes caused by deterioration of white matter are subtle, Buckner said. "The changes in the crosstalk of brain regions are correlated with mild cognitive changes," he said. "People who have these changes are aging gracefully."

These shifts affect people differently, and not all the older people showed the alterations, Buckner said. Interestingly, some networks, such as the visual system, remained intact.

It may be possible to slow even this normal process of aging, Buckner said. "Maybe we can find ways to age even more gracefully," he added.

Buckner believes living right may help. "There are indications that staying cardiovascularly fit and healthy helps our brains age gracefully," he said. "We now have a way to study aging and to understand the factors that might help all of us age optimally."

The study points out the differences between healthy brain aging and Alzheimer's, one expert said.

"It's interesting that the normal process of brain aging is different from what we see in pre-clinical Alzheimer's," said Paul Sanberg, director of the University of South Florida Center of Excellence for Aging and Brain Repair. "One can tease away what is related to aging, and what is related to a disease."

It's important in developing therapies for Alzheimer's to be able to tell the difference between normal aging and disease, Sanberg said, because "it helps us make sure that we are affecting the right problems."

In addition, knowing how the brain ages normally might make it possible to create cognitive enhancers, Sanberg said.

Another expert noted that Buckner's group looked for signs of Alzheimer's in fewer than 20 percent of the older adults in the study.

"Since one can expect 20 to 30 percent of people in their 80s to develop Alzheimer's and Alzheimer's takes decades to develop, 20 to 30 percent of the aged 'normal' subjects were probably actually on their way to Alzheimer's disease," said Greg M. Cole, associate director of research at the Geriatric Research Education and Clinical Center of the Greater Los Angeles Veterans Administration Medical Center.

However, the study is a significant advance and the authors are correct in that they are seeing age-related changes that are not caused by Alzheimer's per se, said Cole, who is also the associate director of the UCLA Alzheimer's Disease Research Center.

"Many of the old subjects retain measures of connectivity on a par with the younger group, so these changes are not necessarily an inevitable outcome of aging," Cole added. "Whatever the cause of the declines, we'd all like to know the secrets of the group that stays in the younger performance range."

More information

For more information on Alzheimer's disease, visit the Alzheimer's Association  .