Over 65 and not worried about heat? You should be (AP)

CHICAGO � This week's heat wave may be uncomfortable, but you're healthy, active and feel just fine. So what if you're over 65? Think again. Feeling good doesn't mean you're safe.

There are changes in an older person that raise the risk for heat stroke and other problems. An older body contains far less water than a younger one. Older brains can't sense temperature changes as well, and they don't recognize thirst as easily.

Blistering summer heat is an underappreciated killer, claiming by some estimates as many as 1,000 U.S. lives each year � more than any other type of weather.

One federal study found 40 percent of heat-related deaths were in people 65 and older. Those numbers could be lower if more heeded heat warnings aimed at seniors. Yet research has shown many people over 65 don't think the warnings apply to them � because they don't think they're "old."

Don Worden is 79 and an avid tennis buff who prefers playing doubles on outdoor courts along Chicago's lakefront � even in oppressive 90-degree temperatures like those hitting the Midwest this week.

"I don't pay too much attention to those" warnings, Worden said. "I stay in pretty good shape, and I don't feel they apply to me."

Worden said he drinks a lot of water and would stop a match if he started feeling effects from the heat, "but that hasn't happened."

Scott Sheridan, who studies the effects of heat and climate on health at Kent State University, researched how people over 65 view heat warnings. In his 2006 study of more than 900 people, he found about 70 percent knew about advice to drink plenty of water on very hot days, avoid outdoor activities and stay inside with air conditioning. But only about half said they followed the advice.

"People well into their 70s would say old people should watch out but not them," he said. "People just didn't want to be thought of in that same category."

Dr. David Zich, an emergency medicine specialist at Northwestern Memorial Hospital, said he has colleagues in medicine that age who shun being thought of as "elderly." But those heat warnings apply to them, too.

As Dr. William Dale, geriatrics chief at the University of Chicago Medical Center explains it, "Any older adult has less reserve and is more likely to become dehydrated than others, just because their overall body water goes down with age no matter how healthy you are."

The amount of water in the body declines with aging, from about 80 percent in young adulthood to about 55 to 60 percent for people in their 80s, Dale said.

Temperature sensors in the brain become less sensitive as people age, so the body doesn't get the same signals to drink water in hot weather, and older people often don't feel thirsty even when they need to replenish, Dale said.

They also may not feel the typical symptoms of dehydration, such as headache or dizziness. Some complain of just feeling "bad" and think they're getting sick, he said.

Conditions were ripe for those types of complaints Tuesday as a dense dome of hot air remained parked over much of the nation's midsection, raising temperatures into the mid- to upper-90s from the Texas Gulf Coast to the Rockies and the northern Plains. Tropical-level humidity raised the heat index in many places to nearly 120 degrees.

In South Dakota, up to 1,500 head of cattle died across the state from the heat. And in eastern Iowa, the scorching sun caused a portion of Interstate 380 to buckle. The weather also sent dozens of people to hospitals, canceled outdoor sporting events and caused sporadic power outages.

In such conditions, dehydration can lead to heat exhaustion and potentially deadly heat stroke. During a heat wave, that can happen in a matter of hours in older people if they over-exert themselves, don't drink enough water or are frail and don't get out of uncooled homes, said Dr. Chris Carpenter, an emergency medicine physician at Washington University School of Medicine in St. Louis.

Heat exhaustion can cause muscle cramps, low blood pressure, rapid pulse and nausea. It can be treated at home, by drinking water, getting into an air-conditioned room or sitting in front of a fan and misting the body with cool water.

But affected people should be monitored for mental changes and to make sure their temperature does not rise above 102 because the condition can quickly lead to heat stroke. A medical emergency, heat stroke involves temperatures of 104 or higher and can cause seizures, loss of consciousness and death.

Medicines many older people take also may make them more vulnerable to the heat. These include diuretics for high blood pressure, which increase urination � and make it more important to drink plenty of water, Dale said.

Some types of drugs can interfere with sweating and raise body temperature, including some medicines for insomnia, nausea, prostate conditions, Parkinson's disease and even Benadryl. Many list "dry mouth" as a side effect � a tip-off to drink more water, Zich said.

There aren't specific guidelines on how much water older people should drink in a heat wave.

Dale said he generally tells his older patients to drink a quart of water throughout the day, and to drink even if they don't feel thirsty.

Doctors also advise older patients to avoid alcohol and coffee during extreme heat because they can cause the body to lose fluid and contribute to dehydration.

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Online:

Centers for Disease Control and Prevention: http://emergency.cdc.gov/disasters/extremeheat/elderlyheat.asp

American Geriatrics Society: http://www.healthinaging.org/public_education/hot_weather_tips.php

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AP Medical Writer Lindsey Tanner can be reached at http://www.twitter.com/LindseyTanner.

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Gov't advisers: Cover birth control for free (AP)

WASHINGTON � Millions of women may soon gain free access to a broad menu of birth control methods, thanks to a recommendation issued Tuesday by health experts advising the government.

An Institute of Medicine panel recommended that the government require health insurance companies to cover birth control for women as a preventive service, without copayments. Contraception � along with such care as diabetes tests during pregnancy and screening for the virus that causes cervical cancer � was one of eight recommended preventive services for women.

President Barack Obama's health care law already requires most health plans to provide standard preventive care for people of both sexes at no additional charge to patients. The women's health recommendations were considered so sensitive that the nonpartisan institute was asked to examine the issue and report back. IOM advises the government on complex issues related to medical science and health care policy.

A half century after the introduction of the birth control pill, the IOM recommendations may help to usher in another revolution. Medical experts say easier access could start a shift to more reliable forms of long-acting birth control, such as implants or IUDs, which are gaining acceptance in other economically developed countries.

First, expect a fight over social mores. Catholic bishops and some other religious and social conservatives say pregnancy is a healthy condition and the government should not require insurance coverage of drugs and other methods that prevent it.

However, short of repealing provisions of the health care law, it's unclear what opponents can do to block the recommendations. The final decision, by Health and Human Services Secretary Kathleen Sebelius, is expected to be issued quickly.

"We are one step closer to saying goodbye to an era when simply being a woman was treated as a pre-existing condition," said Sen. Barbara Mikulski, D-Md., who sponsored the women's health amendment. "We are saying hello to an era where decisions about preventive care and screenings are made by a woman and her doctor."

Birth control use is virtually universal in the United States, according to government statistics. Generic versions of the pill are available for as little as $9 a month at big drug store chains.

Yet about half of all pregnancies are unplanned. Many occur among women using some form of contraception, and forgetting to use it is a major reason. Experts say a shift to longer acting forms of birth control would help.

Birth control is about more than sheer prevention of pregnancy � it can help make a woman's next pregnancy healthier by spacing births far enough apart, generally 18 months to two years. Research links closely spaced births to a risk of such problems as prematurity, low birthweight, even autism.

Other preventive services recommended by the IOM panel include: HIV screening; support for breast- feeding mothers, including the cost of renting pumps; counseling about sexually transmitted infections; screening for domestic violence and at least one "well-woman" preventive care visit annually.

Although the services will be free of any additional charge to patients, somebody has to pay the cost. It's likely to be spread among other people with health insurance, resulting in slightly higher premiums.

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Study: Healthy living can help prevent Alzheimer's (AP)

PARIS � Taking care of your body just might save your mind. Millions of cases of Alzheimer's disease worldwide could be prevented by curbing risk factors such as high blood pressure, smoking, obesity and lack of exercise, new research suggests.

The study offers more than the usual pep talk about healthy living. Seven conditions or behaviors account for up to half of the 35 million cases of Alzheimer's around the world, it found. With no cure or treatment to reverse the mind-robbing disease, preventing new cases is crucial.

The study was presented Tuesday at the Alzheimer's Association International Conference in France, where sessions on prevention have been drawing standing-room-only crowds for several days.

"Prevention is a particularly attractive option given the state of therapy. That's why there's so much interest in it," said William Thies, the association's chief scientific officer.

The study was led by Deborah Barnes, associate professor of psychiatry at the University of California, San Francisco. Results also were published online by the British journal Lancet Neurology. The researchers have grants from the Alzheimer's Association and the U.S. National Institutes on Aging.

The study used a mathematical model to estimate the impact of top modifiable risk factors for Alzheimer's disease: smoking, depression, low education, diabetes, too little exercise, and obesity and high blood pressure in mid-life.

How much of an impact each one has on total Alzheimer's cases depends on how common it is and how strongly it affects dementia risk. Researchers calculated the impact globally and just for the United States.

Worldwide, the biggest impact on Alzheimer's cases is low education, because illiteracy is so common, they found. Low education can be a sign of many factors that harm minds, such as poor nutrition. But it also is harmful by itself, because there is less opportunity to develop "brain power" that can carry you into old age.

"Education, even at a young age, starts to build your neural networks," so being deprived of it means less brain development, Barnes explained.

Smoking had the second biggest impact on cases worldwide, followed by too little exercise.

In the United States, however, inactivity is the leading problem because a third of the population is sedentary, Barnes said.

Depression made the next biggest impact on Alzheimer's cases in the U.S., followed by smoking and high blood pressure in mid-life. Untreated or inadequately treated depression has long been known to raise the risk of developing Alzheimer's disease.

Reducing these seven risk factors by 25 percent could mean 3 million fewer cases of Alzheimer's worldwide, including half a million in the U.S., researchers estimated. Reducing risk factors by 10 percent would translate to 1.1 million fewer cases.

"It gives us a little bit of hope about things we could do now about the epidemic that is coming our way," Barnes said.

Alzheimer's cases are expected to triple by 2050, to around 106 million worldwide.

"We can do something about this," said Dr. Ronald Petersen, a Mayo Clinic dementia specialist who had no role in the study. A common misconception is that you're "dealt a deck of cards at birth," he said, but "people need not just sit back and watch this unfold."

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Online:

National Institute on Aging: http://www.nia.nih.gov/Alzheimers

Alzheimer's Association: http://www.alz.org

Lancet: http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(11)70072-2/abstract

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Poll: Obesity hits more boomers than others in US (AP)

WASHINGTON � Baby boomers say their biggest health fear is cancer. Given their waistlines, heart disease and diabetes should be atop that list, too. Boomers are more obese than other generations, a new poll finds, setting them up for unhealthy senior years.

And for all the talk of "60 is the new 50" and active aging, even those who aren't obese need to do more to stay fit, according to the Associated Press-LifeGoesStrong.com poll.

Most baby boomers say they get some aerobic exercise, the kind that revs up your heart rate, at least once a week. But most adults are supposed to get 2 1/2 hours a week of moderate-intensity aerobic activity � things like a brisk walk, a dance class, pushing a lawn mower. Only about a quarter of boomers polled report working up a sweat four or five times a week, what the average person needs to reach that goal.

Worse, 37 percent never do any of the strength training so crucial to fighting the muscle loss that comes with aging.

Walking is their most frequent form of exercise. The good news: Walk enough and the benefits add up.

"I have more energy, and my knees don't hurt anymore," says Maggie Sanders, 61, of Abbeville, S.C. She has lost 15 pounds by walking four miles, three times a week, over the past few months, and eating better.

More boomers need to heed that feel-good benefit. Based on calculation of body mass index from self-reported height and weight, roughly a third of the baby boomers polled are obese, compared with about a quarter of both older and younger responders. Only half of the obese boomers say they are are regularly exercising.

An additional 36 percent of boomers are overweight, though not obese.

The nation has been bracing for a surge in Medicare costs as the 77 million baby boomers, the post-war generation born from 1946 to 1964, begin turning 65. Obesity � with its extra risk of heart disease, diabetes, high blood pressure and arthritis � will further fuel those bills.

"They're going to be expensive if they don't get their act together," says Jeff Levi of the nonprofit Trust for America's Health. He points to a study that found Medicare pays 34 percent more on an obese senior than one who's a healthy weight.

About 60 percent of boomers polled say they're dieting to lose weight, and slightly more are eating more fruits and vegetables or cutting cholesterol and salt.

But it takes physical activity, not just dieting, to shed pounds. That's especially important as people start to age and dieting alone could cost them precious muscle in addition to fat, says Jack Rejeski of Wake Forest University, a specialist in exercise and aging.

Whether you're overweight or just the right size, physical activity can help stave off the mobility problems that too often sneak up on the sedentary as they age. Muscles gradually become flabbier until people can find themselves on the verge of disability and loss of independence, like a canoe that floats peacefully until it gets too near a waterfall to pull back, Rejeski says.

He led a study that found a modest weight loss plus walking 2 1/2 hours a week helped people 60 and older significantly improve their mobility. Even those who didn't walk that much got some benefit. Try walking 10 minutes at a time two or three times a day, he suggests, and don't wait to start.

"I don't think there's any question the earlier you get started, the better," says Rejeski, who at 63 has given up running in favor of walking, and gets in 30 miles a week. "If you allow your mobility to decline, you pay for it in terms of the quality of your own life."

When it comes to diseases, nearly half of boomers polled worry most about cancer. The second-leading killer, cancer does become more common with aging.

"It's the unknown nature, that it can come up without warning," says Harry Forsha, 64, of Clearwater, Fla., and Mill Spring, N.C.

Heart disease is the nation's No. 1 killer, but it's third in line on the boomers' worry list. Memory loss is a bigger concern.

"On a scale of one to 10, seven or eight," is how Barry Harding, 61, of Glen Burnie, Md., puts it. "It's more talked about now, Alzheimer's and dementia."

In fact, more than half of boomers polled say they regularly do mental exercises such as crossword puzzles.

After Harding retires, he plans to take classes to keep mentally active. For now, he's doing the physical exercise that's important for brain health, too. He also takes fish oil, a type of fatty acid that some studies suggest might help prevent mental decline.

Sanders, the South Carolina woman, says it was hard to make fitness a priority in her younger years.

"When you're younger, you just don't see how important it is," says Sanders, whose weight began creeping up when breast cancer in her 40s sapped her energy. Now, "I just know that my lifestyle had to change."

The AP-LifeGoesStrong.com poll was conducted from June 3-12 by Knowledge Networks of Menlo Park, Calif., and involved online interviews with 1,416 adults, including 1,078 baby boomers born between 1946 and 1964. The margin of sampling error for results from the full sample is plus or minus 4.4 percentage points; for the boomers, it is plus or minus 3.3 percentage points.

Knowledge Networks used traditional telephone and mail sampling methods to randomly recruit respondents. People selected who had no Internet access were given it free.

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EDITOR'S NOTE � Lauran Neergaard covers health and medical issues for The Associated Press in Washington. AP Writer Stacy A. Anderson, AP Polling Director Trevor Tompson, Deputy Polling Director Jennifer Agiesta and News Survey Specialist Dennis Junius contributed to this report.

Online:

http://health.lifegoesstrong.com/heart-vs-cancer

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Brain injury raises dementia risk, US study finds (AP)

PARIS � A large study in older veterans raises fresh concern about mild brain injuries that hundreds of thousands of troops have suffered from explosions in recent wars. Even concussions seem to raise the risk of developing Alzheimer's disease or other dementia later in life, researchers found.

Closed-head, traumatic brain injuries are a legacy of the Afghanistan and Iraq wars. Body armor is helping troops survive bomb blasts, but the long-term effects of their head injuries are unknown.

Other research found a possibly high rate of mild cognitive impairment, or "pre-Alzheimer's," in some retired pro-football players, who take many hits to the head in their careers.

The studies, reported Monday at the Alzheimer's Association International Conference in France, challenge the current view that only moderate or severe brain injuries predispose people to dementia.

"Even a concussion or a mild brain injury can put you at risk," said Laurie Ryan, a neuropsychiatrist who used to work at Walter Reed Army Medical Center and now oversees Alzheimer's grants at the U.S. National Institute on Aging.

Don't panic � this doesn't mean that every soldier or student athlete who has had a concussion is in danger. Pro-football players and boxers "are almost a different species from us" in terms of the repeated blows they take to the head, said William Thies, the Alzheimer's Association's scientific director.

It does mean you should try to avoid one, by fall-proofing your home and wearing helmets and seat belts, he said. About 1.7 million brain injuries occur each year in the U.S.

Troops also need to prevent any further harm, said Dr. David Cifu, national director of physical medicine and rehabilitation for the Veterans Health Administration.

"What the people who have had a head injury and read this should do is to exercise and eat right and take their medicines and take their aspirin and do meditation to reduce stress � reduce risk factors that are modifiable," he said. The new study is "a great start," but limitations in its methods mean that it can't prove a brain injury-dementia link, he said. More definitive studies are starting now but will take many years to give results.

The veterans study was led by Dr. Kristine Yaffe, a University of California professor and director of the Memory Disorders Clinic at the San Francisco VA Medical Center. The Department of Defense and the National Institutes of Health paid for the work.

"It's by far the largest" study of brain injury and dementia risk, she said. "It's never been looked at in veterans specifically."

Researchers reviewed medical records on 281,540 veterans who got care at Veterans Health Administration hospitals from 1997 to 2000 and had at least one follow-up visit from 2001-2007. All were at least 55 and none had been diagnosed with dementia when the study began. This older group was chosen because dementia grows more common with age, and researchers needed enough cases to compare those with and without brain injuries.

Records showed that 4,902 of the veterans had suffered a traumatic brain injury, or TBI, ranging from concussions to skull fractures. Researchers don't know how long ago the injuries occurred. Many participants were Vietnam War vets and their injuries were during active duty. None were due to strokes � those cases were weeded out.

Over the next seven years, more than 15 percent of those who had suffered a brain injury were diagnosed with dementia versus only 7 percent of the others � a more than doubled risk. Severity of the injury made no difference in the odds of developing dementia.

"It's not just one kind of TBI or super-severe TBI" that poses a danger, Yaffe said.

That worries Ryan Lamke, 26, a medically retired Marine who lives in suburban Washington, D.C. He suffered a traumatic brain injury from multiple blast exposures in 2005 in Iraq. "I'm diagnosed as a moderate (brain injury) but it feels like a mild," said Lamke, who relies on electronic calendars and other gadgets to stay organized. He's a student at Georgetown University and works part-time as a government relations intern for a private firm.

"I have to read for twice as long as my classmates" to accomplish what's needed, he said. "I've not found a doctor so far who can give me a true understanding of what's going to happen 20 or 30 years down the road."

Troops will need close monitoring in the years ahead and treatment for post-traumatic stress, depression and other conditions that can lead to cognitive problems, experts said.

"While we don't want people frightened to think they're going to be permanently impaired, a mild traumatic brain injury does not necessarily mean" no long-term problems, said Dr. Gregory O'Shanick, a psychiatrist and chairman of the board of the advocacy group Brain Injury Association of America.

The other study is follow-up work on nearly 4,000 retired National Football League players surveyed in 2001. New surveys were sent in 2008 to 905 of them who were over 50. Of those who responded, 513 had spouses who could complete the part assessing the players' memory.

"We were surprised that 35 percent of them appeared to have significant cognitive problems," said lead researcher Dr. Christopher Randolph of Loyola University Medical Center in Chicago.

Researchers sent 41 of them to the Center for the Study of Retired Athletes at the University of North Carolina in Chapel Hill. Tests showed they had mild cognitive impairment that resembled a comparison group of much older patients from the general population.

The results are preliminary, and suggest the players have higher rates of impairment than would be expected for their age, but they also have more dementia risk factors, such as obesity, high blood pressure and diabetes, Randolph said.

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Online:

National Institute on Aging: http://www.nia.nih.gov/Alzheimers

Alzheimer's Association: http://www.alz.org

Center for the Study of Traumatic Brain Encephalopathy: http://www.bu.edu/cste

CDC: http://www.cdc.gov/concussion/HeadsUp/youth.html

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Marilynn Marchione can be followed at http://twitter.com/MMarchioneAP

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Are grandparents safer drivers than mom and dad? (AP)

CHICAGO � Kids may be safest in cars when grandma or grandpa are driving instead of mom or dad, according to study results that even made the researchers do a double-take.

"We were surprised to discover that the injury rate was considerably lower in crashes where grandparents were the drivers," said Dr. Fred Henretig, an emergency medicine specialist at Children's Hospital of Philadelphia and the study's lead author.

Previous evidence indicates that car crashes are more common in older drivers, mostly those beyond age 65. The study looked at injuries rather than who had more crashes, and found that children's risk for injury was 50 percent lower when riding with grandparents than with parents.

The results are from an analysis of State Farm insurance claims for 2003-07 car crashes in 15 states, and interviews with the drivers. The data involved nearly 12,000 children up to age 15.

Henretig, 64, said the study was prompted by his own experiences when his first grandchild was born three years ago.

"I found myself being very nervous on the occasions that we drove our granddaughter around and really wondered if anyone had ever looked at this before," he said.

Reasons for the unexpected findings are uncertain, but the researchers have a theory.

"Perhaps grandparents are made more nervous about the task of driving with the `precious cargo' of their grandchildren and establish more cautious driving habits" to compensate for any age-related challenges, they wrote.

The study was released online Monday in the journal Pediatrics.

Northwestern University Professor Joseph Schofer, a transportation expert not involved in the research, noted that the average age of grandparents studied was 58.

"Grandparents today are not that old" and don't fit the image of an impaired older driver, he said. "None of us should represent grandparents as kind of hobbling to the car on a walker."

Grandparents did flub one safety measure. Nearly all the kids were in car seats or seat belts, but grandparents were slightly less likely to follow recommended practices, which include rear-facing backseat car seats for infants and no front-seats. But that didn't seem to affect injury rates.

Only about 10 percent of kids in the study were driven by grandparents, but they suffered proportionately fewer injuries.

Overall, 1.05 percent of kids were injured when riding with parents, versus 0.70 percent of those riding with grandparents, or a 33 percent lower risk. The difference was even more pronounced � 50 percent � when the researchers took into account other things that could influence injury rates, including not using car seats, and older-model cars.

Kids suffered similar types of injuries regardless of who was driving, including concussions, other head injuries and broken bones.

The study does not include data on deaths, but Henretig said there were very few. It also lacked information on the types of car trips involved; for example, driving in busy city traffic might increase chances for crashes with injuries.

Schofer, the Northwestern professor, said other unstudied circumstances could have played a role. For example, grandparents could be less distracted and less frazzled than busy parents dropping their kids off at school while rushing to get to work or to do errands. Driving trips might be "quality time" for older drivers and their grandchildren, Schofer said.

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Online:

Pediatrics: http://www.pediatrics.org

American Academy of Pediatrics car seat recommendations: http://bit.ly/rqmKhT

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