Blood pressure is something that people should strive to control throughout their lives, but it’s particularly important for seniors and senior health. High blood pressure is a common problem, affecting  more than 50 percent of all Americans who are 60 years old or older.

What is High Blood Pressure?

When your heart beats and pumps blood throughout the body, a pressure is exerted against the walls of those arteries by the blood being pumped. That pressure is called blood pressure–and the higher your blood pressure, the greater your risk of developing a serious health condition. The medical term for high blood pressure is hypertension.  High blood pressure is a reading of 140/90 or higher. A good blood pressure reading is 120/80 or lower.

What Causes High Blood Pressure?

Years of living an unhealthy lifestyle can cause high blood pressure. Being overweight, having diabetes, smoking and eating a high-salt diet can all cause high blood pressure. Health conditions that can cause it include kidney disease, chronic pain, stress and Cushing’s syndrome.

What are the Symptoms?

High blood pressure very rarely causes symptoms. To know that you have it, you need to get your blood pressure checked and find out the reading.

Sometimes, severe high blood pressure can lead to fatigue, affected vision, abnormal heartbeat or pains in the chest.

What Does this Mean for Seniors?

Although high blood pressure is extremely common in seniors, it isn’t a natural part of normal, healthy aging. Seniors who don’t get high blood pressure under control run the risk of serious heart problems such as heart attack, congestive heart failure, arteriosclerosis (hardening of the arteries) and heart disease. Damage to the kidneys or kidney failure, blindness and stroke are also possible complications of high blood pressure.

Lifestyle Changes

Treating high blood pressure in seniors isn’t just about taking a medication–lifestyle changes are necessary to keep it under control. A regular exercise routine and a healthy diet–low in salt, fat and cholesterol and rich in whole grains, fruit and vegetables–are an essential part of high blood pressure treatment.

 Omaha Business Hall of Fame

More and more patients are turning to social networks such Twitter and Facebook for health information, according to a survey by the National Research Corporation.

In the survey of nearly 23,000 people in the United States, 41% said they use social media as a source of health care information. For nearly all of them – 94% – Facebook was their site of choice, with YouTube coming in a distant second at 32%. Eighteen percent of the respondentssaid they turned to MySpace or Twitter for health information.

One in four respondents said what they learned on these sites was “very likely” or “likely” to impact their future health decisions.

The respondents who used social media were 41 years old on average. People in households earning more than $75,000 were more likely to use social media for health care purposes than households earning less.

Another survey out this week found that one in four internet users living with a chronic ailment has gone online to find others with similar health condition.

“The internet enables people to help people in a way we couldn’t help each other before,” says Susannah Fox, author of the report by the Pew Internet and American Life Project. “The internet gives people access to not only information, but also to each other.”

Many of the patients who sought out other patients online have rare diseases.

“They say no one really knows what they’re going through except someone in the same situation,” Fox says. “Those personal tips can make all the difference in the world.”

 Most of the patients in the survey also consulted with their doctors.

 “The oft-repeated fear that patients are using the internet to self-diagnose and self-medicate without reference to medical professionals does not emerge,” according to Fox.

So are you more savy , that you are turning to the internet to find answers to your health concers?

Start Up Stretching

Regular stretching reduces pain, improves flexibility and quality of life

Flexibility, or the lack thereof, is probably the single most important factor affecting our quality of life as we age. Don’t assume that with aging you will automatically lose your flexibility. You can counterbalance the effects of aging so that your physiology is quite a bit younger than your chronology. When you stay flexible, you’ll be able to live with vibrancy, energy, and independence.

Over the years, we develop habitual ways of using our muscles to move and position ourselves. Poor posture and a lack of flexibility may be the result of a legitimate medical problem or may be the result of limited stretching and improper body alignment. When muscles get tight and stay tight, they cease to be elastic and they restrict movement. That sense of restriction, or stiffness, often leads to disuse. Disuse causes weakness and tightness, which in turn causes a vicious cycle of more disuse, weakness, and tightness.

You have to “lube your chassis” to ensure a smooth ride. Regular stretching activates fluids in your joints, thereby reducing the wear-and-tear caused by friction. Increased water intake is also believed to contribute to increased mobility for tissues and joints that have become less supple.

It is easy to take your physical capabilities for granted, until there is a problem. Your long-term goal should be to maintain your range of motion so that you can continue to accomplish everyday tasks, pain-free. This goal is totally realistic if you are willing to commit to a regular schedule of careful stretching. The benefits of a stretching program will be readily apparent, and you will experience increased comfort as your body moves with fluidity and balance.

Stretching should be peaceful, both physically and mentally. Quiet your mind, breathe deeply, and r-e-l-a-x.

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Six Easy Stretches

To begin with, try walking for five to ten minutes beforehand to warm up the muscles. Warming up is extremely important to prevent injury to joints and muscles. For each stretch, hold it for 10 to 30 seconds and repeat one or two times.

Stretch One: In this stretch try sitting down with a chair in front of you.

Put one leg up on the chair and lean forward, keeping the back straight.

Stretch Two: For this interlace your fingers and extend them in front of you.

Put your head down and extend your arms further until you can feel the stretch in your back.

Stretch Three: For this sit with your arms up, fingers interlaced and palms

facing up. Slowly and gently lean to one side. Hold when you feel the stretch.

Then, lean to the other side and repeat it 2-3 times.

Stretch Four: For this bend the left elbow behind your head and use the right

hand to gently pull the left elbow in further until you feel a stretch in the back of your arm.

Switch sides and repeat.

Stretch Five: Clasp your hands together in front of you and round your

back towards the floor, pressing your arms away from your body to feel

a stretch in your upper back. Do all this in a slow manner.

Stretch Six: Now for this stand with hands on the wall for support in split stance-one

leg forward and one leg back .Press the back heel towards the floor and lean the body

forward until you feel a gentle stretch in your calf. Repeat the same with the other side

Depression is not a normal part of aging, but when older adults do have depression, it may be overlooked, according to the National Institute of Mental Health. Seniors may show different, less obvious symptoms and may be less inclined to experience or acknowledge feelings of sadness or grief. The winter months can be especially challenging because some seniors experience seasonal affective disorder (SAD), a depressive illness triggered when there is less natural sunlight.

The Geriatric Mental Health Foundation says that an elderly person who may be depressed should see a medical professional. Talk to a client’s family or doctor if you suspect a senior is depressed.

For others, keep the winter blues at bay by using these ideas to inspire ways you can cater to each client’s interests with your personal spin:  

• Eat something new – Tackle a new recipe or re-invent a traditional one. Invite family and friends once a week for dinner and take turns preparing meals. Host a potluck dinner or an evening with international cuisine.
• Exercise the mind – Try a jigsaw puzzle or solve riddles. Discuss our question of the week
• Indulge – Enjoy a healthy dessert or sip a hot drink.
• Go for a walk – Invite family members and friends for an evening stroll. During bad weather, complete laps inside a local mall or community center.

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TurkeyNoodle Soup

• 5 quarts water
• 1 cup celery, chopped
• 1/2 cup celery leaves, chopped
• 1 cup onion, chopped
• 7 chicken bouillon cubes
• 1 tablespoon salt
• 1/4 teaspoon black pepper, ground
• 1 bay leaf
• 1/2 cup fresh parsley, chopped
• 1 cup fresh peas or 1 cup frozen peas
• 1 cup carrot, sliced
• 1 cup cut green beans, fresh or frozen
• 4 cups fine egg noodles (8 Oz)
• 1/4 cup butter or 1/4 cup margarine
• 1/4 cup flour
• turkey carcass, from a 15-20 pound turkey

Directions:

In an eight quart kettle or Dutch oven place turkey bones, water — down through to and including the bay leaf.  Heat to boiling; reduce heat, cover and simmer for 1 hour.  Remove the bones to a platter and let cool.

Add the parsley through to green beans.  Heat to boiling; reduce heat and simmer for 10 minutes.  Meanwhile, scrape meat from carcass and return meat to soup pot. Add liquid if required.  Heat to boiling; add noodles and cook uncovered for 10 minutes.

Melt butter in a small frying pan; stir in flour.  Cook over low heat, stirring constantly, until the flour browns.  Stir into boiling soup.  When the soup returns to a boil; reduce heat and simmer for 5 minutes.  Serve hot.

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Holiday Card Project

Pressed Flowers/Leaves –

Pick fresh flowers or leaves from a walk. Remove any wilted petals and leaves. Try not to let flower parts overlap. Leaves should lay flat. Choose a heavy book and line the inside pages with 2 or 3 sheets of paper to protect the book. (Using paper towels might turn the whole thing to mush). Carefully lay the flowers/leaves on the paper, and cover with another 2 sheets. After closing the book I stack another couple of books on top. Or you can also place the book in your microwave and “cook” it for 30 seconds. You’ll have to repeat it a few times, checking to see if the flowers/leaves are almost dried. Then I let the book sit for at least another two weeks before opening.

Use the dried flowers and leaves to make holiday greetings for family and loved ones. Take a moment to arrange the flowers on your card, taking note of how and where you want to position them.  The pressed flowers can be mounted directly on the card itself, or you may want to adhere a background of fabric, or handmade paper to the card stock first before gluing the flowers down.  Hold the pressed flower, apply a very small amount of glue to the back of the flower, position it on the card, and gently press down.  Do the same with the stems and leaves.  Once you’ve finished adhering your pressed flowers/foliage, it’s a good idea to place the card under a heavy book for a few minutes.  The firm pressure will ensure that your pressed flowers will dry flat.

Hope you enjoy our holiday kick off of fun things to enjoy this  time of year!

Fight the flu

“A flu shot is your best protection against catching the flu,” says Randy Bergen, MD, pediatric infectious disease specialist at Kaiser Permanente. The flu virus changes often. The protection given by the flu vaccine only lasts for about a year, so you need to get a flu shot every year, preferably in the fall.

The Centers for Disease Control and Prevention recommends that children 6 months and older, and every adult, get vaccinated against the flu. Children and adults who have a chronic health condition or weakened immune system, adults 65 or older, or smokers who are between 19 and 64 should also get a pneumonia vaccine. When you come in for your flu shot, ask if you need a pneumonia vaccine.

Flu shots are safe and won’t give you the flu .

What to do if you get the flu

1.Don’t ask for antibiotics, which won’t help because the flu is caused by a virus.
2.Stay home to help avoid spreading the flu to others.
3.Wash your hands often and avoid touching your face.
4.Use home remedies or over-the-counter medications, but don’t give any cough or cold products to children 6 years old or younger.
Protect yourself and family

The flu is more serious than the common cold, so do everything you can to prevent it. A flu shot (or nasal spray) is your best defense. The vaccine is safe, won’t make you sick, and generally has few side effects.

The flu virus changes often, and the protection from the vaccine only lasts for about a year. That’s why you should get a flu shot every year, preferably in the fall.

Who should get a flu shot?
The CDC recommends everyone 6 months and older get a flu vaccination every year.

The flu shot helps prevent you from getting the flu and from spreading it to others. Even healthy people can develop serious complications or even die from the flu — so protect yourself and your loved ones by getting vaccinated.

Vaccination is especially important for:

*people 50 years and older
*children 6 months through 4 years old
*women who are or will be pregnant during flu season
*people with chronic medical conditions or weakened immune systems
*people who live in nursing homes and other long-term care centers
*health care workers
*people who live with or care for anyone at high risk for flu-related complications
*Complications of flu can include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes.

Why kids should get a flu shot
Children can spread the flu easily to adults and other children. Getting vaccinated also helps protect infants (who cannot receive a flu shot), pregnant women, the elderly, and people with chronic conditions.

Make sure your children get all recommended vaccinations on time. Check your child’s immunization record.

Flu shots will be available beginning in early fall 2011.  They are available from your health care provider or at local CVS drug stores & local Safeway stores! Do you have a primary care physician to help you if & when you do get the flu? Dr. Thomas Yatteau is a wonderful physician here  in Sonoma County who offers Concierge medicine.

 Dont forget  or delay- Get your flu shot today!

November is National Family Caregivers Month

Every day, more than 65 million family caregivers in the United States fulfill a vital role on the care team. November is National Family Caregivers Month, a great time to honor the family caregivers who devote their lives to caring for senior loved ones.

Family caregivers need support, which is why the Home Instead Senior Care^® network launched Caring for Your Parents: Education for the Family Caregiver^SM. This family caregiver support series addresses senior resistance to care and features a variety of topics such as choosing an in-home care provider, the signs of aging, long distance caregiving and communicating with aging parents. Materials and videos are available at www.caregiverstress.com.  Tell a family Caregiver about this valuable resource.

The Perfect Turkey for your family Thangiving this year!

Three  Easy to follow reciepies you can create and enjoy!

Ingredients

• 1 (14 to 16 pound) frozen young turkey

For the brine:

• 1 cup kosher salt
• 1/2 cup light brown sugar
• 1 gallon vegetable stock
• 1 tablespoon black peppercorns
• 1 1/2 teaspoons allspice berries
• 1 1/2 teaspoons chopped candied ginger
• 1 gallon heavily iced water

For the aromatics:

• 1 red apple, sliced
• 1/2 onion, sliced
• 1 cinnamon stick
• 1 cup water
• 4 sprigs rosemary
• 6 leaves sage
• Canola oil

Directions

2 to 3 days before roasting:

Begin thawing the turkey in the refrigerator or in a cooler kept at 38 degrees F.

Combine the vegetable stock, salt, brown sugar, peppercorns, allspice berries, and candied ginger in a large stockpot over medium-high heat. Stir occasionally to dissolve solids and bring to a boil. Then remove the brine from the heat, cool to room temperature, and refrigerate.

Early on the day or the night before you’d like to eat:

Combine the brine, water and ice in the 5-gallon bucket. Place the thawed turkey (with innards removed) breast side down in brine. If necessary, weigh down the bird to ensure it is fully immersed, cover, and refrigerate or set in cool area for 8 to 16 hours, turning the bird once half way through brining.

Preheat the oven to 500 degrees F.

Remove the bird from brine and rinse inside and out with cold water. Discard the brine.  Place the bird on roasting rack inside a half sheet pan and pat dry with paper towels.

Combine the apple, onion, cinnamon stick, and 1 cup of water in a microwave safe dish and microwave on high for 5 minutes. Add steeped aromatics to the turkey’s cavity along with the rosemary and sage. Tuck the wings underneath the bird and coat the skin liberally with canola oil.

Roast the turkey on lowest level of the oven at 500 degrees F for 30 minutes. Insert a probe thermometer into thickest part of the breast and reduce the oven temperature to 350 degrees F. Set the thermometer alarm (if available) to 161 degrees F.

A 14 to 16 pound bird should require a total of 2 to 2 1/2 hours of roasting.

Let the turkey rest, loosely covered with foil or a large mixing bowl

for 15 minutes before carving.

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Make Ahead Mashed Potatoes

• 3 lbs potatoes (about 4 large)
• 1/2 teaspoon salt
• 2 tablespoons butter or 2 tablespoons margarine
• 2 (3 ounce) packages cream cheese, softened
• 2/3 cup sour cream
• 1/4 cup milk
• 3/4 teaspoon salt
• 1 tablespoon butter or 1 tablespoon margarine, melted
• 1/2 teaspoon paprika

Directions:

Prep Time: 15 minutes    Cook Time 1 hour

Place potatoes in a saucepan; add water to cover and 1/2 teaspoon salt.  Bring to a boil; cover, reduce heat to medium and simmer for 25 minutes or until pototoes are tender.  Drain.  Peel potatoes; place in a large mixing bowl, and mash with a potato masher.  Add 2 tablespoons butter, cream cheese, sour cream, milk and 3/4 teaspoon salt.  Mix until all ingredients are blended.  Spoon mixture into a lightly greased 12X8X2-inch baking dish.  Brush top of mixture with melted butter; sprinkle with paprika.  Bake immediately, or cover and refrigerate.  If refrigerated, let stand at room temperature for 30 minutes before baking.  Bake at 350F, uncovered for 30 minutes or until hot~

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Caramelized Butternut Squash

• 2 medium butternut squash (4 to 5 pounds total)
• 6 -8 tablespoons unsalted butter, melted and cooled
• 1/4 cup light brown sugar, packed
• 1 1/2 teaspoons kosher salt
• 1/2-1 teaspoon fresh ground black pepper

Directions:

Prep Time: 15 minutes    Cook Time: 55 minutes

Preheat the oven to 400°F.  Cut off the ends of each butternut squash and discard.  Peel the squash and cut in half lengthwise.  Using a spoon, remove the seeds.  Cut the squash into 1 1/4″ to 1 1/2″ cubes (large and uniform is best), and place them on a baking sheet.  Add the melted butter, brown sugar, salt and pepper.  With clean hands, toss all of the ingredients together and spread out in a single layer on the baking sheet.  Roast for 45 minutes to 55 minutes, until the squash is tender and the glaze begins to caramelize.  Turn the squash while roasting a few times with a spatula to be sure it browns evenly.  Serve hot.

ENJOY & Happy Thaksgiving All !~

ScienceDaily (Jan. 10, 2011) — A large proportion of Medicare expenditures for nursing home residents with advanced dementia, a terminal illness, is spent on aggressive treatments that may be avoidable and of limited clinical benefit, according to a new study by the Institute for Aging Research, an affiliate of Harvard Medical School, published in the online version of the Archives of Internal Medicine on Jan. 10, 2011.

The study examined Medicare expenditures for 323 nursing home residents with advanced dementia in 22 facilities in the Greater Boston area as part of the Choices, Attitudes, and Strategies for Care of Advanced Dementia, or CASCADE, study. According to the findings, the largest proportion of Medicare expenditures was for hospitalizations (30.2%) and hospice (45.6%). Medicare expenditures rose by 65 percent in each of the last four quarters before death, primarily due to an increase in both acute care and hospice services. Acute care costs were lower among residents who had either a Do Not Hospitalize (DNH) order, lived on a special care dementia unit, or did not have a feeding tube.

“Our study demonstrates that a large proportion of Medicare expenditures in advanced dementia are attributable to acute and sub-acute services that may be avoidable and may not improve clinical outcomes,” says senior author Susan L. Mitchell, M.D., M.P.H., a senior scientist at the Institute for Aging Research.

An additional 10 percent of Medicare expenditures were for care in a rehabilitation facility after hospitalization. Dr. Mitchell calls the benefits of skilled nursing or rehabilitative care for these patients “questionable,” given that most of them are totally physically functionally and cognitively impaired.

Strategies that promote high-quality palliative care may shift expenditures away from aggressive treatments for dementia patients at the end of life and more toward a comfort care approach, say the researchers.

“The strong association between the lack of a DNH order and higher acute care expenditures supports the notion that advance care planning may be a key step toward preventing aggressive end-of-life care,” says Dr. Mitchell, an associate professor of medicine atHarvardMedicalSchool. Among cancer patients, advance planning lowers costs in the last week of life, and lower costs are associated with a higher quality of dying experience.

Both hospice and palliative care focus on quality of life or “comfort care,” including the active management of pain and other symptoms, as well as the psychological, social and spiritual issues often experienced at the end of life. Unlike hospice, however, palliative care services do not depend on life expectancy and may be used in conjunction with curative treatments.

Estimates peg 2010 total health-care expenditures for dementia at $172 billion, which will continue to rise as the number of people experiencing the end stages of this disease increases. Currently, more than 5 million Americans suffer from dementia, a number that is expected to increase to almost 13 million in the next 40 years. Total Medicare and Medicaid payments (nursing home care is generally paid for by Medicaid after individuals have exhausted their savings) for patients with dementia are roughly three times higher than they are for those without dementia.

Dr. Mitchell’s team looked at Medicare health services used by the nursing home residents over 18 months, culling data from hospital admissions, emergency department visits, primary care provider visits, and hospice enrollment. Roughly one-third of all Medicare costs for dementia were for hospitalizations, which Dr. Mitchell says are burdensome for many of these patients because, among other reasons, they involve a physical transfer and dementia patients often become even more confused and agitated in an unfamiliar environment. Previous studies by Dr. Mitchell and others have shown that most hospitalizations for patients with end-stage dementia are for conditions such as pneumonia that could be treated as effectively and at less cost in a nursing home setting.

Hospice payments accounted for close to half of all Medicare expenditures even though only 22 percent of the nursing home residents received hospice care. Hospice has been shown to benefit residents dying with dementia, but it is greatly underutilized with this population.

Dementia is a group of symptoms severe enough to interfere with daily functioning, including memory loss, difficulty communicating, personality changes, and an inability to reason. Alzheimer’s disease is the most common form of dementia.

A 2009 study by Dr. Mitchell in the New England Journal of Medicine was the first to rigorously describe the clinical course of advanced dementia and to label the disease a terminal illness similar to other incurable diseases, such as cancer.

Dementia Patients Face Burdensome

 Transitions in Last 90 Days

ScienceDaily (Sep. 28, 2011) — A new study in the Sept. 29, 2011, edition of the New England Journal of Medicine reports that nearly one in five nursing home residents with advanced dementia experiences burdensome transitions in the last 90 days of life, such as moving to a different facility in the last three days of life or repeat hospitalizations for expected complications of dementia in the last 90 days of life.

Such patterns of transitions are burdensome, particularly since the overwhelming majority of family members state the main goal of care is comfort,” said study co-author Joan Teno, professor of health policy and practice at the Warren Alpert Medical School of Brown University and a palliative care physician. “These transitions reflect the inefficiency of our health care system. Similar outcomes could be achieved by keeping these patients in the nursing home setting.”

An important reason for the prevalence of burdensome transitions might be embedded in the way Medicare pays nursing homes, said Brown health economist and lead author Pedro Gozalo. Nursing homes can earn higher payments for patients who have been transferred to a hospital for three days and they may qualify for skilled nursing services paid by Medicare rather than Medicaid upon their return. The current incentives under Medicare and Medicaid encourage nursing homes to send patients to the hospital, he said.

What makes the transitions burdensome, especially for patients with cognitive impairment, Teno said, is that they are often unnecessary, raise the risk of medical errors, and interrupt continuity of care for patients who can experience significant stress and disorientation when they are suddenly removed from familiar surroundings and people. When the patients become upset, their families experience more stress.

Because these financial incentives, market conditions, and the culture of end-of-life care vary by state, so do the rates of burdensome transitions. The authors, who also include researchers fromHarvardUniversityandDartmouthCollege, found that the overall percentage of patients experiencing at least one burdensome transition was 19 percent. State-level rates varied from 2.1 percent inAlaskato 37.5 percent inLouisiana.

“These burdensome transitions are not only bad for the patient, they also drain the federal treasury, hastening the day when the Medicare trust fund runs out of money,” said economist Jonathan Skinner from Dartmouth College, a co-author on the study.

Blacks and Hispanics were also more likely than whites to experience burdensome transitions, the authors found.

 Amiss before dying

To reach these conclusions, the team analyzed federal databases of nursing home and Medicare records accumulated between 2000 and 2007. In all, they found 474,829 patients who were older than 66, had advanced cognitive impairment, and lived in a nursing home 120 days before their death. Of these, 90,228 residents experienced at least one burdensome transition, defined as either a transfer in the last three days of life, returning to a different nursing home than the one they lived in before they went to the hospital, or multiple hospitalizations in the last 90 days of life.

Often these hospitalizations occur even though the condition prompting the hospitalization — pneumonia, urinary tract infection, or dehydration — could easily be treated in a properly equipped and staffed nursing home.

These variations were particularly wide across different geographic areas. InMcAllen,Texas, 25.8 percent of patients had multiple hospitalizations for urinary tract infections, pneumonia or dehydration, compared to only 1.1 percent of patients inGrand Junction,Colo.

The regional rate of burdensome transitions also correlates with other indicators of poor end-of-life care, Gozalo noted. Compared to patients living in the health care markets with the lowest rates of burdensome transitions, those who lived in the regions with the highest rates were three times more likely to have a feeding tube inserted, more than twice as likely to be in the intensive care unit in the last 30 days of life, and more than twice as likely to have developed an advanced pressure ulcer.

Ultimately, Teno said, all of these problems are signs of care gone awry. The best care for a patient with advanced cognitive impairment near the end of life is often to maximize comfort. The burdens of hospitalization usually outweigh the benefits.

“Our research calls for efforts to reform health care payment that create incentives to improve advance care planning and care coordination,” Gozalo said. “Current reform efforts like accountable care organizations that bundle both the hospital and post-acute care payments could begin to address some of these perverse incentives. We need financial incentives to make sure that people are getting the right care in the right place at the right time.”

In addition to Gozalo, Teno, and Skinner, other authors include Susan Mitchell of the Hebrew Senior Life Institute for Aging Research, Julie Bynum at Dartmouth Medical School, and Denise Tyler and Vincent Mor of the Brown University Program in Public Health.

The National Institute on Aging funded the research.

Burdensome transitions in the last three months of life. Nationally, about 19 percent of nursing home patients with advanced dementia experience a burdensome transition — transfer to another nursing home, unnecessary hospitalizations — in their last three months. The percentages vary widely among the states. (Credit: Brown University)