Spinal Fluid Test predicts Alzheimer's Disease

Researchers report that a spinal fluid test can be 100 percent accurate in identifying patients with significant memory loss who are on their way to developing Alzheimer’s disease.  Although there has been increasing

evidence of the value of this and other tests in finding signs of Alzheimer’s, the study, which will appear Tuesday in the Archives of Neurology, shows how accurate they can be. The new result is one of a number of remarkable recent findings about Alzheimer’s. 

 

After decades when nothing much seemed to be happening, when this progressive brain disease seemed untreatable and when its diagnosis could be confirmed only at autopsy, the field has suddenly woken up.
Alzheimer’s, medical experts now agree, starts a decade or more before people have symptoms. And by the time there are symptoms, it may be too late to save the brain. So the hope is to find good ways to identify people who are getting the disease, and use those people as subjects in studies to see how long it takes for symptoms to occur and in studies of drugs that may slow or stop the disease.

Researchers are finding simple and accurate ways to detect Alzheimer’s long before there are definite symptoms. In addition to spinal fluid tests they also have new PET scans of the brain that show the telltale amyloid plaques that are a unique feature of the disease. And they are testing hundreds of new drugs that, they hope, might change the course of the relentless brain cell death that robs people of their memories and abilities to think and reason. “This is what everyone is looking for, the bull’s-eye of perfect predictive accuracy,” Dr. Steven DeKosky, dean of the University of Virginia medical school, who is not connected to the new research, said about the spinal tap study.

Dr. John Morris, a professor of neurology at Washington University, said the new study “establishes that there is a signature of Alzheimer’s and that it means something. It is very powerful.” A lot of work lies ahead, researchers say — making sure the tests are reliable if they are used in doctors’ offices, making sure the research findings hold up in real-life situations, getting doctors and patients comfortable with the notion of spinal taps, the method used to get spinal fluid. But they see a bright future.

Although the latest PET scans for Alzheimer’s are not commercially available, the spinal fluid tests are.
So the new results also give rise to a difficult question: Should doctors offer, or patients accept, commercially available spinal tap tests to find a disease that is yet untreatable? In the research studies, patients are often not told they may have the disease, but in practice in the real world, many may be told.
Some medical experts say it should be up to doctors and their patients. Others say doctors should refrain from using the spinal fluid test in their practices. They note that it is not reliable enough — results can vary by lab — and has been studied only in research settings where patients are carefully selected to have no other conditions, like strokes or depression, that could affect their memories. “This is literally on the cutting edge of where the field is,” Dr. DeKosky said. “The field is moving fast. You can get a test that is approved by the F.D.A., and cutting edge doctors will use it.”

But, Dr. John Trojanowski, a University of Pennsylvania researcher and senior author of the paper, said that given that people can get the test now, “How early do we want to label people?” Some, like Dr. John Growdon, a neurology professor at Massachusetts General Hospital who wrote an editorial accompanying the paper, said that decision was up to doctors and their patients.  Sometimes patients with severe memory loss do not have the disease. Doctors might want to use the test in cases where they want to be sure of the diagnosis. And they might want to offer the test to people with milder symptoms who want to know whether they are developing the devastating brain disease.

One drawback is that spinal fluid is obtained with a spinal tap, and that procedure, with its reputation for pain and headaches, makes most doctors and many patients nervous. The procedure involves putting a needle in the spinal space and withdrawing a small amount of fluid.  Dr. Growdon and others say spinal taps are safe and not particularly painful for most people. But, he said, there needs to be an education campaign to make people feel more comfortable about having them. He suggested that, because most family doctors and internists are not experienced with the test, there could be special spinal tap centers where they could send patients.

The new study included more than 300 patients in their 70s, 114 with normal memories, 200 with memory problems and 102 with Alzheimer’s disease. Their spinal fluid was analyzed for amyloid beta, a protein fragment that forms plaques in the brain, and for tau, a protein that accumulates in dead and dying nerve cells in the brain. To avoid bias, the researchers analyzing the data did not know anything about the clinical status of the subjects. Also, the subjects were not told what the tests showed.  Nearly every person with Alzheimer’s had the characteristic spinal fluid protein levels. Nearly three quarters of people with mild cognitive impairment, a memory impediment that can precede Alzheimer’s, had Alzheimer’s-like spinal fluid proteins. And every one of those patients with the proteins developed Alzheimer’s within five years. And about a third of people with normal memories had spinal fluid indicating Alzheimer’s. Researchers suspect that those people will develop memory problems.

The prevailing hypothesis about Alzheimer’s says that amyloid and tau accumulation are necessary for the disease and that stopping the proteins could stop the disease. But it is not yet known what happens when these proteins accumulate in the brains of people with normal memories. They might be a risk factor like high cholesterol levels. Many people with high cholesterol levels never have heart attacks. Or it might mean that Alzheimer’s has already started and if the person lives long enough he or she will with absolute certainty get symptoms like memory loss.

Many, like Dr. DeKosky, believe that when PET scans for amyloid become available, they will be used instead of spinal taps, in part because doctors and patients are more comfortable with brain scans.
And when — researchers optimistically are saying “when” these days — drugs are shown to slow or prevent the disease, the thought is that people will start having brain scans or spinal taps for Alzheimer’s as routinely as they might have colonoscopies or mammograms today.  For now, Dr. DeKosky said, the days when Alzheimer’s could be confirmed only at autopsy are almost over. And the time when Alzheimer’s could be detected only after most of the brain damage was done seem to be ending, too.
“The new biomarkers in CSF have made the difference,” Dr. DeKosky said, referring to cerebral spinal fluid. “This confirms their accuracy in a very big way.”

Excerpt from NY Times article

Let Villa Care Homes assist you with your family member who may have Alzheimer's.  We have trained staff capable to handle complex medical conditions, including dementia and Alzheimer's.  We are located in Antioch, Martinez and Alamo, California.       www.VillaCareHomes.com

STROKE WARNING SIGNS

A stroke occurs when the flow of blood to a part of the brain is cut off. This can be due to something (usually a blood clot) blocking the flow of blood to the brain (ischemic stroke). It can also be caused by a burst blood vessel bleeding into the brain (hemorrhagic stroke). About 80% of strokes are ischemic and 20% are hemorrhagic. Without a blood supply, the brain cells in the affected area start to die.
The effects of a stroke depend on which part of the brain is affected and how severe the damage is. A stroke may affect your ability to move, your ability to speak and understand speech, your memory and problem-solving abilities, your emotions, and your senses of touch, hearing, sight, smell, and taste. In some cases, a stroke can be fatal.
It's important to recognize the warning signs of stroke, because quick treatment can reduce the risk of brain injury and death. A stroke usually comes on suddenly, over a few minutes or hours. The warning signs of stroke include:

• sudden weakness, numbness, or tingling of the face, arm, or leg (often on only one side of the body)
• sudden confusion, trouble speaking, or trouble understanding speech
• sudden vision loss (often in one eye only) or double vision
• sudden trouble walking, dizziness, loss of balance or coordination, or falls
• sudden severe headache (often described as "the worst headache of my life") with no known cause

If you notice these symptoms, call 911 (or your emergency medical number if you do not have 911 service) immediately. Stroke is a medical emergency.

Elderly are Easy Targets of Financial Scams

Senior Safety is an important issue, including financial safety.  More than ever, the elderly have become targets of financial fraud, and surprisingly the scammers are of retirement age themselves! “One out of five Americans over the age of 65 has been the victim of a financial scam, according to the Washington-based Investor Protection Trust, a nonprofit that promotes shareholder education. That means more than 7.3 million seniors have been taken advantage of financially through inappropriate investments, high fees, or fraud, which insurer MetLife says comes at a cost of more than $2.6 billion a year. “Older people are being targeted because, as 1930s robber Willie Sutton said when asked why he robs banks, ‘that’s where the money is,’” says Kathleen Quinn, executive director of the National Adult Protective Services Assn. in Springfield, Ill.”
“Many of today’s scammers have a particularly good understanding of their victims–because the fraudsters themselves are of retirement age, if not exactly retired. More elderly con artists than ever seem to be preying on retirees, perhaps because senior citizens put more confidence in someone their age, says Denise Voigt Crawford, president of the North American Securities Administrators Assn. “It’s astounding that you can’t even trust older people anymore,” Crawford says.” (Bloomberg Business Week-Scams:  A Sucker Retires Every Minute, July 15 2010)

The primary way that seniors are taken advantage of is by purchasing financial products that are inappropriate, unsuitable and at times down right fraudulent.   Seniors, including veterans, who are isolated are likely to become targets, and their retirement assets are at great risk.  If you are the caretaker of an aging senior, please take the time to make sure that their retirement savings are secure, and that any changes are truly in their best interest.  If you are have an aging parent living alone, or are a long distance caregiver, reach out for professional care giving help to insure the overall safety of your aging family member.  For help with an aging loved one in the California San Francisco Bay Area, visit VillaCareHomes.com

Osteoporosis Part III: Precautions and Treatment

PREVENTION: Elderly people with osteoporosis should take every precaution to avoid accidental falls.  This disease is responsible for many of the hip, wrist, and spinal fractures that occur in elderly women.  If glasses are necessary for general vision, they should always be worn.  A cane or walker should be used if you do not feel steady on your feet, or if one has been recommended.  Shoes and slippers should have skid-resistant soles.  Additionally, handrails in bathrooms and sturdy banister rails along all stairs inside and outside should be installed for safety.

TREATMENT: Treatment of osteoporosis is geared toward halting, or at least slowing down the progress of the disease.  This may involve increased calcium intake, estrogen replacement therapy (provided there are no contraindications), physical therapy and weight-bearing exercise. 

At least six glasses of milk or equivalent servings of other high-calcium foods such as cheese or yogurt and a small supplement of vitamin D may be prescribed to be taken daily.  Oral calcium supplements may also be prescribed.  For postmenopausal women with osteoporosis, estrogen-replacement therapy has been shown to be the most effective way of slowing down bone loss.  Today, many doctors prescribe a combination of estrogen with a synthetic progesterone to simulate the hormonal environment existing before menopause.  As with any medication, there may be certain side effects from such a regimen; report any you notice to your physician.

Exercise is very important, especially the kind of exercise that allows your body weight to bear down on your skeletal frame.  Those who are bedridden, confined to a wheelchair, or with limited ability to move, physical therapy should be received on a regular basis.  While swimming and bicycling are great cardio-workouts, simple walking or light jogging is better for those with osteoporosis.  Walking is one of the best exercises for those who do not want to take part in active sports or who cannot do so because of their general health.

SUMMARY: Bone loss to some degree is inevitable as we grow older; however, with osteoporosis, the process is much more pronounced.  Bones are weaker and thinner (especially those of the sping), and fractures can occur more easily.  New treatments are being developed that may increase bone formation and thereby reverse osteoporosis.  Meanwhile, however, the object of treatment is to stop or slow down the process of the disease.  Current treatment involves an increased intake of calcium, estrogen replacement therapy, physical therapy and weight bearing exercise.  Preventative therapy for premenopausal women consists of a diet high in calcium and vitamin D and regular exercise.

Osteoporosis Part II

Osteoporosis is sometimes called the "silent disease" because it generally remains undiscovered until a fracture occurs.  One of the earliest and most common signs of osteoporosis is a gradual decrease in height and rounding of the shoulders following menopause as a result of small, spontaneous fractures occurring in the spinal column.  The wrists and hips are also very susceptible to easy fracture.

The change in curvature of the spine may produce a nagging backache.  Severe or sharp back pains are rare, but they should be brought to your doctor's attention immediately, as they may be the result of spontaneous collapse or fracture of one or more of the bones that make up the spinal column.  As the spinal column becomes more compressed, people with osteoporosis become progressively shorter.  10-15 years after menopause a woman may lose 1-3 inches in height; 25-30 years after menopause a woman may lose as much as 6 inches or more if they have severe kyphosis (rounding of the back)

PREVENTION: By paying attention to the amount of calcium you are receiving in your diet, the amount of exercise you do daily, and the amount you smoke or drink, you can help protect yourself from developing osteoporosis. 
     Calcium: To reduce the risk of developing post menopausal osteoporosis, docotor now advise any woman who is 45 or older to increase her clcium intake.  One way of accomplishing this is by increasing your consumption of foods that are naturally high in calcium.  Some of these foods include kale, spinach, turnip greens, raw oysters, sardines and canned salmon.  The greatest source of calcium however is dairy products such as milk and cheese.  If you find it difficult to get enough calcium from your meals alone, your doctor may prescribe calcium supplements and sometimes vitamin D, which helps the body absorb calcium better.
   Exercise: Any kind of physical activity can help slow down the rate of bone loss associated with osteoporosis.  Therefore, it is highly desirable to exercise regularly.  While it may not be possible for you to engage in strenuous physical activities, you can always take daily walks.  Regular exercise, particularly if it stresses weight bearing can be very effective, since it keeps both bone and muscle healthy.
   Cigarettes and alcohol: Although there is no direct link between these two substances and osteoporosis, an unusually high percentage of women who have osteoporosis are cigarette smokers.  Also, some sources believe excessive alcohol intake may increase the risk of developing osteoporosis.

OSTEOPOROSIS

Osteoporosis is a disease marked by thinning of the bones, making them brittle and more vulnerable to spontaneous fractures.  The disease affects some twenty million people in the United States.  After the age of forty-five, it is nine times more common in women than men.  Older persons are more susceptible than middle-aged people, and whites/Orientals more than blacks.  Fair-haired, fair-skinned people are particularly vulnerable.  Osteoporosis tends to run in families; a person who has a close relative with the disease is likely to develop it later in life.  Osteoporosis is irreversible after a certain stage.  However, with treatment, its progression can be halted or at least slowed down.  You may already have osteoporosis or be at risk of getting it; in either case, there is a lot you can learn and do about the disease.

Bone Changes: Bone is living tissue that is constantly being broken down and rebuilt in very complex ways, even in adults.  Bones require calcium, vitamin D, and phosphorus; the availability and use of these substances by the skeleton is regulated by hormones and physical stress on the ends of the bones is necessasary to help them form and grow.  The contribution made by calcium in association with vitamin D seems to be the most important factor in this process.  The absorption of calcium into bone in women is ultimately dependent upon the hormone estrogen.  Some degree of bone loss is an inevitable consequence of aging.  In people with osteoporosis however, the rate of bone loss considerably exceeds that of bone formation.

Causes: Exactly what causes the increased bone loss due to osteoporosis is unknown.  However, there appears to be many contributing factors, including hormonal imbalances, which affect the absorption of calcium and phosphorus, and the decrease in estrogen production in menopausal women.  Almost one in four postmenopausal women has osteoporosis: the disease also develops early in women who have had a premature menopause due to surgical removal of the ovaries.  Women with small bones appear to be particularly susceptible to this disease.  Other factors relating to an individual's life-style may have an effect on the development of osteoporosis.  Prolonged bed rest, immobilization and inactivity promote bone loss in young people and to an even greater extent, in the elderly.  Inadequate nutrition, including a diet lacking in calcium, vitamin D, and protein, is also thought to contribute to the onset of the disease.

Memorial Day Trivia

The Villa Care Homes wishes to honor and acknowledge veterans from every corner of the country who gave their all to preserve the freedoms we now enjoy.  Sharing a bit of history and trivia about the day makes it all that more special:
Memorial Day, which falls on the last Monday of May, commemorates the men and women who died while serving in the American military. Originally known as Decoration Day, it originated in the years following the Civil War and became an official federal holiday in 1971. Many Americans observe Memorial Day by visiting cemeteries or memorials, holding family gatherings and participating in parades. Unofficially, at least, it marks the beginning of summer.
Memorial Day was originally known as Decoration Day because it was a time set aside to honor the nation's Civil War dead by decorating their graves. It was first widely observed on May 30, 1868, to commemorate the sacrifices of Civil War soldiers, by proclamation of General John A. Logan of the Grand Army of the Republic, an organization of former sailors and soldiers. On May 5, 1868, Logan declared in General Order No. 11 that:
The 30th of May, 1868, is designated for the purpose of strewing with flowers, or otherwise decorating the graves of comrades who died in defense of their country during the late rebellion, and whose bodies now lie in almost every city, village, and hamlet churchyard in the land. In this observance no form of ceremony is prescribed, but posts and comrades will in their own way arrange such fitting services and testimonials of respect as circumstances may permit.
During the first celebration of Decoration Day, General James Garfield made a speech at Arlington National Cemetery, after which 5,000 participants helped to decorate the graves of the more than 20,000 Union and Confederate soldiers buried in the cemetery.
This 1868 celebration was inspired by local observances of the day in several towns throughout America that had taken place in the three years since the Civil War. In fact, several Northern and Southern cities claim to be the birthplace of Memorial Day, including Columbus, Miss.; Macon, Ga.; Richmond, Va.; Boalsburg, Pa.; and Carbondale, Ill.
In 1966, the federal government, under the direction of President Lyndon Johnson, declared Waterloo, N.Y., the official birthplace of Memorial Day. They chose Waterloo—which had first celebrated the day on May 5, 1866—because the town had made Memorial Day an annual, community-wide event during which businesses closed and residents decorated the graves of soldiers with flowers and flags.
By the late 1800s, many communities across the country had begun to celebrate Memorial Day and, after World War I, observances also began to honor those who had died in all of America's wars. In 1971, Congress declared Memorial Day a national holiday to be celebrated the last Monday in May. (Veterans Day, a day set aside to honor all veterans, living and dead, is celebrated each year on November 11.)
Today, Memorial Day is celebrated at Arlington National Cemetery with a ceremony in which a small American flag is placed on each grave. Also, it is customary for the president or vice-president to give a speech honoring the contributions of the dead and lay a wreath at the Tomb of the Unknown Soldier. About 5,000 people attend the ceremony annually.
Several Southern states continue to set aside a special day for honoring the Confederate dead, which is usually called Confederate Memorial Day.
source: history.com

Heart Patients Vulnerable to Depression

Heart patients are particularly vulnerable to depression and should be screened, and if necessary treated, to improve their recovery, U.S. researchers discovered.

"Depression and heart disease seem to be very much intertwined," Judith H. Lichtman of Yale University of School of Public Health said in a statement.  "you can't treat the heart in isolation from the patient's mental health."

The statement that screening heart patients for depression is part of a scientific advisory issued by the American Heart Association and co-authored by Lichtman.

The American Psychiatric Association has endorsed the statement and recommends:

• Routine and frequent screening for depression in patients with chronic heart disease in a variety of settings, including the hospital, physician's office and cardiac rehabilitation centers.
• Help for patients with positive screening results by a professional qualified to diagnose and manage treatment for depression.
• Careful monitoring of patients to ensure adherence to their treatment plan.

While there is no evidence that screening for depression leads to improved outcomes for people with cardiovascular complications, the advisory does state that depression is linked with increased morbidity and mortality, lower rates of cardiac rehabilitation and poorer quality of life, Lichtman said.

Source:www.thirdage.com

Hospice Care

For many, the word "hospice" is difficult to hear.  It conjures up feelings of hopelessness and abandonment....but the realities are so much more promising.  Hospice often opens the door for more meaningful choices when curative treatments are no longer effective; families can obtain the support and services they need with confidence to address end-of-life issues in the home, care facility, skilled nursing or hospital settings.

 Hospice care involves addressing all the physical, emotional and spiritual needs of the resident and their families, then coordinating that with the medical team for a collaborative plan of care.  Hospice staff are accustomed to having difficult conversations about medical treatment decisions and can personalize the approach for each individual. 

Having Hospice care available to residents may improve the quality of care for residents by positively influencing nursing home clinical practices.  Residents enrolled in Hospice are:

• Less likely to be hospitalized
• More likely to be assessed for pain and receive pain treatment
• Less likely to be physically restrained
• Less likely to have parenteral or IV feeding
• Less likely to have feeding tubes in place
• Less likely to have medications administered by IV or intramuscular injection
• More likely to have completed an advance directive.  

As a result, nursing staff become more aware of end-of-life issues and their attitudes toward hospice change.  They come to realize that hospice care does not cause patients to die sooner; in fact many residents live longer and more comfortably because of the multidisciplinary services provided by the entire team of hospice professionals.

Senior Citizen Longevity & Statistics

We are Living a Decade Longer Than Our Parents’ Generation Due to Healthy Aging

Good news is that after age 110, chance of death does not increase. Bad news is that it holds steady at 50% per year.  People today are living substantially longer than their parents’ generation, not because aging has been slowed or reversed, but because they are staying healthier. A demographer writes on the longevity phenomenon in the March 25 edition of Nature and wonders how we can keep in going.  People in developed nations are living in good health as much as a decade longer than their parents did. "We're living longer because people are reaching old age in better health," said demographer James Vaupel, author of a review article appearing in the March 25 edition of Nature. “But once it starts, the process of aging itself - including dementia and heart disease - is still happening at pretty much the same rate. "Deterioration, instead of being stretched out, is being postponed."

	Study Finds We Are Winning the War on Cancer as Death Rates Decline Steadily Since 1990 For those under age 75, drop in cancer death rate between 1970-2006 resulted in about 2.0 million years of potential life gained March 9, 2010 Senior Citizens May Be Significantly Shortening Lives by Too Much Time Watching TV New study focused on television watching but suggests any prolonged sedentary behavior, such as sitting at a desk or in front of a computer, may pose a health risk, too Jan. 11, 2010 Physical Activity Has Anti-Aging Effect on Cardiovascular System: German Study Utah scientist reports on emerging importance of telomeres in aging, cancer and maybe immortality; seniors with short telomeres most likely to die –  see below story Dec. 1, 2009 Read more Longevity & Statistics on Senior Citizens

    The better health in older age stems from public health efforts to improve living conditions and prevent disease, and from improved medical interventions, said Vaupel, who heads Duke University's Center on the Demography of Aging and holds academic appointments at the Max Planck Institute for Demographic Research in Rostock, Germany, and the institute of Public Health at the University of Southern Demark.

   Over the past 170 years, in the countries with the highest life expectancies, the average life span has grown at a rate of 2.5 years per decade, or about 6 hours per day.  The chance of death goes up with age up until the most advanced ages. The good news is that after age 110, the chance of death does not increase any more. The bad news is that it holds steady at 50% per year at that point, Vaupel said. "It is possible, if we continue to make progress in reducing mortality, that most children born since the year 2000 will live to see their 100th birthday -- in the 22nd century," Vaupel said. If gains in life expectancy continue to be made at the same pace as over the past two centuries, more than half of the children alive today in the developed world may see 100 candles on their birthday cake.

This leads to an interesting set of policy questions, said Vaupel.

  ●  What will these dramatically longer lifespans mean for social services, health care and the economy?

  ●  Can the aging process be slowed down or delayed still further? And why do women continue to outlive men – outnumbering them 6 to 1 at age 100?

It also may be time to rethink how we structure our lives, Vaupel said. "If young people realize they might live past 100 and be in good shape to 90 or 95, it might make more sense to mix education, work and child-rearing across more years of life instead of devoting the first two decades exclusively to education, the next three or four decades to career and parenting, and the last four solely to leisure."

   One way to change life trajectories would be to allow younger people to work fewer hours, in exchange for staying in the workforce to a later age. "The 20th century was a century of the redistribution of wealth; the 21st century will probably be a century of the redistribution of work," Vaupel said.

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AARP Online Tax Assistance

The AARP Tax-Aide Program is a volunteer-run, free tax-preparation and assistance service offered to low- and middle-income taxpayers with special attention to those age 60 and older. Volunteers are trained and IRS-certified to understand individual federal-tax issues. They provide tax assistance as a public service and cannot guarantee the accuracy of the information provided.  http//:www.AARP.org

Three Tax Traps for Grandparents:

Between a sputtering economy and the approaching holiday season, the elderly have plenty of opportunities to dote on their grandchildren. There are, however, some pitfalls to philanthropy. Here are some of the main culprits, and ways to avoid them, courtesy of the New York Times: Cash gifts — The annual exclusion for gift tax exemptions this year is $13,000, unchanged from last year. If grandchildren are minors, their gifts may go into custodial accounts until they come of age, but your clients should resist the temptation to name themselves as custodians; if they do, the funds could be considered part of their estates.
College savings — Your clients can contribute as much as $65,000 at a time to a 529 plan, as long as they file a gift-tax return that treats the lump-sum as a gift spread over five years, the Times writes. If the donor dies within that time, the portion of the gift that reflects undistributed funds would be included in his or her estate.

Family loans — As heartless as it sounds, if your clients lend money to family members, they must charge the applicable federal interest rate to avoid being taxed themselves. The rates change each month — for November, it’s 3.92 percent for a long-term loan.

Between a sputtering economy and the approaching holiday season, your clients have plenty of opportunities to dote on their grandchildren. There are, however, some pitfalls to philanthropy. Here are some of the main culprits, and ways to avoid them, courtesy of the New York Times: Cash gifts — The annual exclusion for gift tax exemptions this year is $13,000, unchanged from last year. If grandchildren are minors, their gifts may go into custodial accounts until they come of age, but your clients should resist the temptation to name themselves as custodians; if they do, the funds could be considered part of their estates.
College savings — Your clients can contribute as much as $65,000 at a time to a 529 plan, as long as they file a gift-tax return that treats the lump-sum as a gift spread over five years, the Times writes. If the donor dies within that time, the portion of the gift that reflects undistributed funds would be included in his or her estate.
Family loans — As heartless as it sounds, if they lend money to family members, they must charge the applicable federal interest rate to avoid being taxed themselves. The rates change each month — for November, it’s 3.92 percent for a long-term loan.

Vacancy Updates

We have a new vacancy at Villa Speranza in Antioch: a large semiprivate suite with attached bathroom.  This opening is for a female which may be ambulatory or non-ambulatory.  There is also an opening at Villa Vietri in Alamo for a standard room which may be private or semiprivate for a male or female.  Please feel free to contact me for a tour or visit my website for more details regarding our program: www.VillaCarehomes.com