Sexual Behavior Norms Among U.S. Adults with Dementia Living at Home

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Newswise — The majority of partnered, home-dwelling people in the U.S. with dementia are sexually active, according to a University of Chicago Medicine study out this week in the Journal of the American Geriatrics Society. In addition, people with cognitive impairment and dementia often have bothersome sexual function problems they don’t discuss with a doctor.

“Until now, most of what we knew on this topic came from studies or legal cases involving people with advanced dementia living in nursing homes,” said lead study author Stacy Tessler-Lindau, MD, MAPP, and UChicago Medicine professor of obstetrics/gynecology and geriatrics. 

“In the next 30 years, more than 80 million people in the U.S. will be 65 or older. A growing number of people with dementia live at home, cared for by a spouse who, like doctors and society more generally, don’t have the knowledge they need to manage the sexual aspects of life with a person with dementia,” she said. 

This study is the first to look at a nationally representative sample of this population.

The number of home-dwelling people with Alzheimer’s Disease (the most common type of dementia) is expected to grow to more than eight million by 2050.

Researchers found that of partnered people with dementia in their study, 59 percent of men and 51 percent of women were sexually active. More than 40 percent of partnered men and women ages 80 to 91 also reported being sexually active. But the likelihood of partnered sexual activity declined with lower cognitive scores for both women and men in the study.

“The lack of basic information about sexual behavior, function and desires in this growing population is a problem,” said Lindau, “because these aspects of life with dementia raise ethical, legal, clinical and even moral questions that we as a society are largely unprepared for.” 

For example, posited Lindau, can a person with dementia consent to sex or be deprived of sex because we’re not sure she can consent? Should a doctor treat a person with dementia for sexual dysfunction? Does a person with cognitive impairment have an obligation to fulfill “marital duty?”

The study’s authors looked at data from more than three thousand home-dwelling people in the United States between the ages of 62 and 91. In a previous study, Lindau and co-authors found later-life sexual activity to be positively associated with physical and mental health and was regarded by most men and women as an important part of life.  

The majority of people, across all cognition groups in the current study, reported positive attitudes about sex and that they were having sex less often that they would like. More than one in 10 partnered men and women reported feeling threatened or frightened by their partner; this rate was not higher among people with dementia.

“Physicians may be asked to determine whether a patient with dementia has the capacity to consent to sex and have to balance the obligation to protect the patient from harm with the obligation to protect the person’s autonomy,” Lindau said. “We now have normative evidence that should help counter negative bias and inform important decisions about sex for people with dementia.”

 More than one-third of men and one in 10 women in the study’s dementia group reported bothersome sexual problems, but only 17 percent of men and one percent of women with dementia talked to a physician about sex life changes that result from a medical condition like dementia.

According to Lindau, there are a growing number of FDA-approved treatments for sexual dysfunction, and many of these are targeted to older adults.

“Sometimes the person complaining about the patient’s sexual function problems is the partner, not the patient with dementia. Doctors need to be prepared for how to handle that,” she said.

Lindau is the director of WomanLab, a web-based platform for information about sex and aging that offers resources about sex and dementia.

The study is titled “Sexuality and Cognitive Status: A U.S. Nationally Representative Study of Home-Dwelling Older Adults.” Co-authors include William Dale, MD, PhD; Gillian Feldmeth, BS; Natalia Gavrilova, PhD; Kenneth M. Langa, MD, PhD; Jennifer A. Makelarski, PhD, MPH; and Kristen Wroblewski, MS.

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Seven Tips for Better Brain Health

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Newswise — Our brains change as we age: our memory gets foggier, our joints start to creak. Researchers at Jefferson who conducted cognitive studies with black participants suggest that being active socially, physically, and mentally (or cognitively) may actually prevent memory loss in those who start showing signs of forgetfulness. While this might sound familiar, the science suggests that the trick is to set achievable, or small goals, and to do them consistently, integrating them into everyday life.

“Many people feel, ‘I’ve worked my whole life, retirement is my time to rest,’” said Joann Akpan, Clinical Research Coordinator at Jefferson, who helped participants set and keep goals for more active living as part of the study. “People don’t realize that our bodies and minds stop working as well when we don’t use them.”

Keeping brains, bodies, and social lives active – all three, if possible – may significantly help reduce memory loss.  In fact, study participants who set and met activity goals saw an 88 percent reduction in risk of memory loss compared to those who didn’t.

But finding ways to set and keep realistic goals isn’t easy. Only about 9 percent of people who set New Year’s resolutions ever complete them. We spoke with Akpan and study authors, Barry Rovner and Robin Casten, for seven tips on finding and setting effective activity goals that all older adults can stick to.

• Start with a script

If you’re helping a family member with memory loss, create a script you can follow to start the discussion and avoid landmines. (Use the tips and activity suggestions below to guide your scripting.)

“It can be difficult to talk to loved ones about their memory loss – it can be scary, they may get defensive, and not want to engage,” said Akpan. “A script offers a roadmap if you hit an obstacle and keeps you focused. Most importantly, allow time to listen after initiating a discussion.”

1. Find motivators

Ask questions that allow the person to reflect on his or her observations about their memory – acknowledging that your memory isn’t as strong as it used to be. That can be a strong motivator and a point of commonality.

“I would tell stories about me or others forgetting their keys, or appointments, and say, ‘do you ever notice things like that? How does that make you feel and what do you do about it?’” said Akpan.   “Realizing there’s a problem can be very motivating, especially if there are things that can help improve that memory.”

• Help family members come up with goals

Explore their interests, from their past or current life, and develop goals around those interests.  Don’t force activities that someone does not really want to pursue. No one is motivated by someone else’s goal.

“A key element of our study was that all of the goals were realistic goals that the participants wanted to achieve,” said Akpan. “They may seem small, or simple, but the key here is interest, which leads to commitment.”

• Start with goals attuned to the individual’s abilities; modify if needed

If the person is not moving around the house much, start with activities they can do in their chair such as phone calls to a friend or family member every week, and reading. If they are active, but don’t like exercise, incorporate extra movement into tasks they already do, such as taking a few extra laps around the grocery store with the cart or adding steps to their laundry routine.

“If a person is bored with a goal that may be too easy or too hard, modify it,” said Akpan.  “Increase or decrease the number of times it’s completed per week, add a new goal, or switch to a more complex or simple goal, depending on need, for example, switch to doing Sudoku puzzles instead of word-finds.”

• Bake routine into each goal

None of the goals should be one-offs. Instead of “do a jigsaw puzzle,” it should be “do one jigsaw puzzle every Tuesday.” Or “go to the senior center once a week.” Build the activities into regular daily or weekly routines. Consistency is key.  

• Break the goals into steps; create a checklist

For people with more advanced memory problems, checklists can be essential, although they can be useful motivation tools for anyone. Start your checklist with the goal at the top and below that, the six or seven simple steps that might go into achieving that goal. The participant would then check off the steps he or she has completed and feel accomplishment in the progress towards that goal.

For a social/physical goal like “take a walk with a friend,” the steps might include: 1) mark your calendar to call your friend 2) call and find a date and time that works 3) decide on a meeting location 4) mark your calendar with the date and time for the walk 4) call the night before to confirm 5) put on comfortable shoes, etc.

“Keep in mind that memory is an issue, so memory aids like calendars, refrigerator white boards, or leaving a jigsaw puzzle in plain view become much more important in helping a person achieve their goal,” said Akpan.

• Compassionately manage setbacks

A loved one may have a medical setback or admit that they have not met their goals. This is normal. Managing through these setbacks – with compassion and understanding – will go a long way.  What caused the setback and were the goals too daunting? Is there an opportunity to create smaller, more actionable steps that do not overwhelm?

Akpan had some participants give her empty stares, while others broke down in tears over the fear of losing their memory. “Both are normal and natural responses and participants were usually very honest when they didn’t complete their goals,” she recalls “The key is to make each step do-able not to over-challenge. Sometimes a participant would have a medical set-back, which would throw the routine and we’d often have to start the process from the beginning, which is ok.”

SIDEBAR:

A Menu of SuggestionsTry to have one goal in each area and complete each at least once per week.

Mental Health (Brain): Activities that make you focus, think, or reflect

• reading

• writing

• playing cards

• Sudoku puzzles, jigsaw puzzles, word-find games

• memory matching games

Physical Health (Body): Simple activities that get the blood flowing

Loved ones don’t have to become Olympic athletes, in fact you might want to check with their doctor first to ensure any physical goals are not too strenuous.

• Start at the person’s baseline and if mobility is an issue, start small. Maybe stretching every morning, or walking around the apartment five times or down the stairs and then taking the elevator up is a good start.
• Add legs to the usual routine. For example, take a few extra trips up and down the stairs to get the laundry.
• Line dancing classes (very popular among study participants) at the local senior center can accomplish both physical and social goals.

Social Health: Simple positive human interaction is key to improving mood, reducing stress and creating positive feelings

• Visit a senior center or church group
• Text or call a niece or nephew once a week.

Spanish minister would prefer separatists free

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BARCELONA, Spain (AP) — The Latest on Catalan separatists in Spain (all times local): 6:40 p.m. Spanish Foreign Minister Josep Borrell says that he would prefer for jailed Catalan separatist leaders to be free while awaiting a trial for their role in last year's push for independence from Spain.

(1 of 6) Pro-Independence demonstrators fill-up La Diagonal, one Barcelona's main avenues, during the Catalan National Day in Barcelona, Spain, Tuesday, Sept. 11, 2018. Catalan authorities have made a call to flood the streets of Barcelona later on Tuesday to demand freedom for Catalan politicians in jail and in support of independence from Spain. September 11, called "Diada," marks the fall of the Catalan capital to Spanish forces in 1714.

September 11, 2018

Nine politicians and activists remain in prison on preliminary charges of rebellion and abuse of power, while others, including former Catalan president Carles Puigdemont, avoided jail by fleeing overseas.

Speaking to reporters in Strasbourg on Tuesday, Borrell said: "I personally would have preferred for the judge to take other precautionary measures that weren't preventive jail, but that's what the judge did and one must respect his independence."

A veteran Socialist politician from Catalonia who presided over the European Parliament, Borrell is an advocate of Spain's territorial unity. Catalan separatists say that the prosecuted leaders are "political prisoners" or "in exile." Central authorities reject the term and say that they are being dealt with according to the country's laws.

5:30 p.m.

Tens of thousands Catalans have issued a collective roar along a main artery of Barcelona to demand independence for the wealthy northeastern region from Spain.

Organizers said 470,000 people had signed up online for Tuesday's "Diada" march, on Catalonia's national day, but many more were expected to join the rally.

With the official slogan "Let's Make the Catalan Republic" written in pink-colored t-shirts and signs, protesters went silent at 5.14 p.m., which on a 24-hour clock is 1714 — the year when Barcelona fell in the Spanish War of Succession.

Shouts of "independence" and "freedom" followed, sweeping along a six-kilometer (3.7-mile) -long stretch of the city's Diagonal avenue.

In a giant symbolic wall, protesters toppled the image of a king of spades card, in an apparent rejection of the Spanish monarchy.

2:25 p.m.

The Catalan leader says the focus of the Day of Catalonia holiday must be on freeing the high-profile separatists who are awaiting trial for their part in the bid by the region to break away from Spain last year.

Quim Torra says that while maintaining the goal of secession for Catalonia, his government will dedicate all its efforts into drumming up public protests before the trials of the separatists expected to start before the year's end.

Torra says "I will not accept (guilty) sentences and I will appeal to all free-minded citizens to not accept them either."

Torra, however, adds that his government has ruled out openly defying the justice system by releasing the prisoners from their jails, which are in Catalonia and run by his regional administration.

Hundreds of thousands of pro-independence Catalans are expected in Barcelona's streets later on Tuesday.

12:45 p.m.

Separatist authorities are calling for people to take to the streets of Barcelona to mark the Day of Catalonia, in the first of a series of mass mobilizations demanding independence from Spain.

The traditional Sept. 11 march marking the "Diada," when the Catalan capital fell to Spanish forces in 1714, is expected to draw hundreds of thousands of secession sympathizers Tuesday.

It comes nearly one year after a banned referendum on secession led to an ineffective independence declaration. Catalan separatist leaders and activists who pushed it, defying Spain's constitutional protection of territorial integrity, are either awaiting trial in prison or fled the country.

Catalan President Quim Torra, who came to power after secessionists won a regional election, wants the new center-left national government to agree to a binding independence referendum.

Tata Power to offer suite of services in rooftop solar drive

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MUMBAI (Reuters) - India’s Tata Power Company Ltd plans to offer a range of services from advice and financing to installation and maintenance as it strives to increase its share of the market for rooftop solar panels, a senior executive said on Tuesday.

A boy dusts off a solar panel installed on the rooftop of his house on the outskirts of Ahmedabad October 27, 2014. REUTERS/Amit Dave/File Photo

Tata Power Solar, the renewable energy arm of Mumbai-headquartered Tata Power, is currently India’s biggest rooftop solar panel supplier.

But with a market share of just 6 percent, it sees plenty of scope for growth and aims to leverage its position as an integrated solar power company - with a presence in manufacturing, engineering, construction and maintenance - to offer customers an end-to-end service.

“We will give the benefit of low cost solar panels to our consumers and also help them (save money...) with other value-added services,” Praveer Sinha, Chief Executive Officer and Managing Director of Tata Power, told Reuters.

Ashish Khanna, CEO of Bangalore-headquartered Tata Power Solar, added the services would include consultancy, sourcing of solar panels, installation and maintenance of rooftop structures as well as low cost financing and liaising with distributors.

He said the company would offer low cost financing through Tata group’s financing arm, Tata Capital.

India has plans to install up to 175 gigawatts (GW) of renewable energy capacity by 2022, out of which 40 GW is expected to come from rooftop solar panels. So far, however, the pace of rooftop installations has been just around 6 percent of the target, according to government figures.

Tata Power Solar is also planning to launch a dealer network to better take on its myriad of competitors, which include Chinese companies.

It plans to have 58 master dealers across nine states, with each having five third-party sales people under them, said a senior executive who did not want to be named as he is not authorised to speak to the media.

Russia starts biggest war games since Soviet fall near China

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MOSCOW (Reuters) - Russia began its biggest war games since the fall of the Soviet Union on Tuesday close to its border with China, mobilizing 300,000 troops in a show of force that will include joint exercises with the Chinese army.

China and Russia have staged joint drills before but not on such a large scale, and the Vostok-2018 (East-2018) exercise signals closer military ties as well as sending an unspoken reminder to Beijing that Moscow is able and ready to defend its sparsely populated far east.

Vostok-2018 is taking place at a time of heightened tension between the West and Russia, and NATO has said it will monitor the exercise closely, as will the United States which has a strong military presence in the Asia-Pacific region.

Russia’s Ministry of Defence broadcast images on Tuesday of columns of tanks, armored vehicles and warships on the move, and combat helicopters and fighter aircraft taking off.

In one clip, marines from Russia’s Northern Fleet and a motorized Arctic brigade were shown disembarking from a large landing ship on a barren shore opposite Alaska.

This activity was part of the first stage of the exercise, which runs until Sept. 17, the ministry said in a statement. It involved deploying additional forces to Russia’s far east and a naval build-up involving its Northern and Pacific fleets.

The main aim was to check the military’s readiness to move troops large distances, to test how closely infantry and naval forces cooperated, and to perfect command and control procedures. Later stages will involve rehearsals of both defensive and offensive scenarios.

Russia also staged a major naval exercise in the eastern Mediterranean this month and its jets resumed bombing the Syrian region of Idlib, the last major enclave of rebels fighting its ally President Bashar al-Assad.

CLOSER CHINA-RUSSIA TIES

The location of the main training range for Vostok-2018 5,000 km (3,000 miles) east of Moscow means it is likely to be watched closely by Japan, North and South Korea as well as by China and Mongolia, both of whose armies will take part in the maneuvers later this week.

Analysts say Moscow had to invite the Chinese and Mongolian militaries given the proximity of the war games to their borders and because the scale meant the neighboring countries would probably have seen them as a threat had they been excluded.

The exercise - which will involve more than 1,000 military aircraft, two Russian naval fleets, up to 36,000 tanks and armored vehicles and all Russian airborne units - began as President Vladimir Putin held talks with Chinese President Xi Jinping in the Russian port city of Vladivostok.

Relations between Moscow and Beijing have long been marked by mutual wariness with Russian nationalists warning of encroaching Chinese influence in the country’s mineral-rich far east.

But Russia pivoted east towards China after the West sanctioned Moscow over its annexation of Ukraine’s Crimea region in 2014 and trade links between the two, who share a land border over 4,200 km long, have blossomed since.

Russia broadcast footage of some of 24 helicopters and six jets belonging to the Chinese air force landing at Russian air bases for the exercise. Beijing has said 3,200 members of the People’s Liberation Army (PLA) will join in.

Some experts see the war games as a message to Washington, with which both Moscow and Beijing have strained ties.

“With its Vostok 2018 exercise Russia sends a message that it regards the U.S. as a potential enemy and China as a potential ally,” wrote Dmitri Trenin, a former Russian army colonel and director of the Carnegie Moscow Center think tank.

“China, by sending a PLA element to train with the Russians, is signaling that U.S. pressure is pushing it towards much closer military cooperation with Moscow.”

Putin, who is armed forces commander-in-chief, is expected to observe the exercises this week alongside Defence Minister Sergei Shoigu, who is overseeing them.

Shoigu has said they are the biggest since a Soviet military exercise, Zapad-81 (West-81) in 1981

Record U.S. job openings, quits rate boost wage growth outlook

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WASHINGTON (Reuters) - U.S. job openings surged to a record high in July and more Americans voluntarily quit their jobs, pointing to sustained labor market strength and confidence that could soon spur faster wage growth.

FILE PHOTO: The sign on a Taco Bell restaurant advertises "Now Hiring Managers" in Fitchburg, Massachusetts, U.S., June 12, 2018. REUTERS/Brian Snyder/File Photo

The Labor Department’s monthly Job Openings and Labor Turnover Survey, or JOLTS, released on Tuesday also suggested a further tightening in labor market conditions, with employers appearing to increasingly have trouble finding suitable workers.

While the tightening labor market could boost wage gains, some economists warned that worker shortages could over time negatively impact economic growth. The JOLTS report cemented expectations the Federal Reserve will raise interest rates at its Sept. 25-26 policy meeting. The Fed has raised rates twice this year.

“The economic expansion is on a collision course with a lack of workers to man the shop floors, work the restaurants and stores at the shopping malls across America,” said Chris Rupkey, chief economist at MUFG in New York. “No workers, no growth, it’s that simple.”

Job openings, a measure of labor demand, increased by 117,000 to a seasonally adjusted 6.9 million in July. That was the highest level since the series started in December 2000. The jobs openings rate was 4.4 percent, unchanged from the previous month and an all-time high first touched in April.

The current level of job openings means there is a job for every one of the 6.2 million people who were unemployed in August. Hiring was little changed at 5.7 million in July, keeping the hiring rate at 3.8 percent for a second straight month.

There were 46,000 unfilled jobs in the finance and insurance industry in July. Nondurable goods manufacturing had 32,000 vacancies. The job opening rate in the overall manufacturing industry climbed to a record high of 3.8 percent in July from 3.6 percent in June.

But job openings in the retail trade industry fell by 85,000. There were also decreases in education and federal government job vacancies in July.

WORKER SHORTAGES

The scarcity of workers was also corroborated by a survey of small businesses published on Tuesday. The NFIB survey found that job openings at small businesses hit a 45-year high in August. A record number of businesses reported they could not find qualified workers to fill open positions.

According to the NFIB, job openings were mostly prevalent in construction, manufacturing and wholesale trade. There was also a dearth of truck drivers.

“Looming shortages of qualified workers could prove detrimental to business expansion plans in coming months,” Dante DeAntonio, an economist with Moody’s Analytics in West Chester, Pennsylvania. “In the meantime, the increasing tightness in the labor market is spurring more workers to re-enter the workforce as well as leave their jobs in search of better opportunities.”

The worker shortages, especially for truck drivers, are already contributing to bottlenecks in the supply chain, which could slow the vibrant economy. The economy grew at a 4.2 percent annualized rate in the second quarter, almost double the 2.2 percent pace set in the January-March period.

Growth this year is expected to top 3 percent.

The Labor Department’s JOLTS report also showed the robust labor market is giving Americans confidence to quit their jobs for other positions. The quits rate increased to 2.4 percent in July, the highest level since April 2001, from 2.3 percent in June. Fed officials look at the quits rate as a measure of job market confidence.

The increase in job mobility supports economists’ optimism that job growth may be finally on a faster path. The government last week reported a surge in annual wage growth in August, with average hourly earnings increasing 2.9 percent, the largest gain since June 2009, from 2.7 percent in July.

Wage gains have largely remained moderate even as the unemployment rate has dropped to near an 18-year low of 3.9 percent.

“Workers are leveraging the tighter labor market to find new opportunities and employers are poaching workers from other firms,” said Nick Bunker, an economist at job search website Indeed in Washington. “The next question is how more quitting will translate into higher wage growth.”

(Graphic - U.S. labor market by sector: tmsnrt.rs/2drejuZ)

(Graphic - U.S. employment: tmsnrt.rs/1T9hBxK)

UN report recommends building national leadership for broadband

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GENEVA, Sept. 11 (Xinhua) -- A latest UN broadband commission report released on Tuesday recommends building national leadership for broadband and, for the first time, calls for national strategies for promoting the safe use of Artificial Intelligence (AI).

In its latest report, The State of Broadband: Broadband Catalyzing Sustainable Development, the Broadband Commission for Sustainable Development says that a growing number of governments now benchmark the status of broadband in their national broadband plans, while at least 15 countries now have strategies in place for promoting the safe use of AI.

The report highlights the critical role that broadband connectivity plays for the world's people, from accessing online health services to receiving social security payments via mobile phones to receiving life-saving disaster warnings.

To boost broadband, the commission recommends building national leadership for broadband; promoting Internet training and stimulating consumer and business demand; monitoring developments of communication and information technologies (ICT) to inform policy; reviewing universal service measures; strengthening digital skills and literacy; supporting local e-Businesses and entrepreneurs; adapting legal frameworks; and reducing taxes and duties on telecom products and services.

The commission, however, also raises concerns for the growing inequalities in access to broadband and how connectivity is used within and between countries, sexes and regions.

According to the report, though almost half of the world's people uses the Internet, most of them are in urban and densely populated areas and the challenge remains to connect those living in rural and remote areas. Last year, ITU said the scale of infrastructure that must be built or upgraded to bridge the digital divide and deploy emerging technologies is considerable, meaning that about 450 billion U.S. dollars would be needed to connect the next 1.5 billion people.

Meanwhile, the report also warns that big data and AI technologies are falling "into the hands of a largely unregulated extractive industry, creating another digital divide," and that "too few organizations have the AI tools and expertise needed to turn big data into useful insights for good, and the potential benefits of the data currently do not reach everyone."

The commission thus calls for responsible use of data as the key to achieving sustainable development, which presents both genuine opportunities and daunting challenges.