FRIDAY, Dec. 19 (HealthDay News) -- A common form of dementia often mistaken for Alzheimer's can be prevented with good health habits, a new report says.

Vascular cognitive impairment (VCI), the second most common cause of dementia, occurs in up to 4 percent of Americans over age 65 and up to 20 percent of those with some form of dementia. Brain damage from multiple small strokes, which can occur from narrowing or blocked arteries in the brain, are often the cause of VCI.

An overview of the disease, published in the December issue of Mayo Clinic Women's HealthSource, notes that people can greatly reduce their risk of developing the disease by lowering their blood pressure, quitting smoking, and keeping diabetes and cholesterol levels under control.

VCI shares Alzheimer's symptoms such as confusion, agitation, language and memory problems, and unsteady gait and falls. However, the first symptom of VCI usually is the declining ability to organize thoughts or actions. In Alzheimer's, memory problems are usually the first sign of the condition.

More information

The U.S. National Institute of Neurological Disorders and Stroke has more about dementia.

THURSDAY, Dec. 18 (HealthDay News) -- The Centers for Medicare and Medicaid Services unveiled an updated Web site Thursday intended to make choosing a nursing home easier for elderly Americans and their families.

The updated Nursing Home Compare site uses a five-star rating system, similar to that used for hotels and motels, to rank institutions nationwide.

"The old site had a lot of information, but the information wasn't necessarily terribly usable by the average consumer. You knew if the facility was above or below the state average, but you didn't know what that meant," said Charles Phillips, a professor of health policy and management at Texas A&M Health Science Center School of Rural Public Health, in College Station. "What you have with the five-star system is a very well-thought-out way of summarizing all of that information that was available on the earlier site with new information. … This allows you to do a much more direct comparison in a user-friendly way."

Roughly 10 percent of the facilities have five stars and roughly 20 percent have one star, said Phillips, who served on the advisory panel that developed the rating system.

Geriatric experts, however, were concerned the site might not reflect patients' and families' true concerns.

"My reaction [to the site] is I have never been asked any of these questions because people assume good medical care, maybe incorrectly," said Debra Greenberg, a senior social worker in the division of geriatrics instruction at Montefiore Medical Center and Albert Einstein College of Medicine in New York City. "There are other quality-of-life issues they are very concerned about -- the atmosphere, cleanliness, ratio of nursing professionals, the ability to go visit. None of that is reflected in what gives this a five-star rating."

Dr. Laurie Jacobs, director of the Resnick Gerontology Center, also at Montefiore Medical Center and Albert Einstein College of Medicine, said that "the positive about this is they are finally bringing to the public a rating of medical care that had been a mystery before, based on surveys, but it's limited to that and has none of the other information that families also desperately want when they want to decide on a facility."

Meanwhile, the National Citizens' Coalition for Nursing Home Reform issued a statement saying it is "fully aware of the shortcomings of the rating system," but it would still support it as an important educational tool.

But the American Association of Homes and Services for the Aging was more critical of the new effort.

"The five-star rating system is a great idea prematurely implemented. We support a consumer-friendly nursing home rating system based on reliable quality information that the public can understand. But what is being launched tomorrow is poorly planned, prematurely implemented and ham-handedly rolled out," Larry Minnix, president and CEO of the association, said in a statement.

The importance of comprehensive, up-to-date information on the nation's 16,000 nursing homes is indisputable.

U.S. Census figures project that the number of Americans age 65 or older will double by 2030 and that two-thirds of today's 65-year-olds will require some period of long-term care later in their lives.

According to the Centers for Medicare and Medicaid Services (CMS), more than 1 million Americans enter a nursing home each year.

The decision to enter a nursing home -- or to place a family member in a nursing home -- can be gut-wrenching.

"This is one of the hardest decisions that families ever make," Greenberg said.

Rankings on the new site are based on input from three areas: quality measures, nurse staffing levels and health inspection reports.

"You get stars for the overall status of the facility, but you also get information on how many stars they got on staffing and how many on the quality measures," Phillips explained.

Although the Web site formally launched Thursday, CMS is soliciting comments on the site through June and July.

But Nursing Home Compare online should not be the only source families use, experts noted.

"Things like Nursing Home Compare are tools, not the be-all and end-all," Phillips said. "Any individual who faces putting someone in a nursing home should talk to the nursing home ombudsman in the area. They're at the area agency on aging."

"The other thing is, there is absolutely no substitute for physically going to the facility yourself and getting a picture of what that facility is like and whether or not you think your loved one will be comfortable in it," Phillips added.

Data are also available from the United Jewish Federation, which has regional offices, as well as from the U.S. Department of Aging and from Friends and Relatives of Institutionalized Aged, Greenberg added.

More information

Check out the updated nursing home Web site.

MONDAY, Oct. 27 (HealthDay News) - Regardless of declines in either mental or physical health, most senior citizens do not change their outlook on how they want their end-of-life care to be when the time comes, new research suggests.

The study notes, however, that despite observing an overall stability in patient perspective, certain patients do seem to change their mind over time.

"We found that the people who wanted the least [aggressive treatment] were the most likely to continue wanting the least, whereas the people wanting the most were the most likely to change over to wanting less over time," noted study author Dr. Marsha N. Wittink from the department of family medicine and community health at the University of Pennsylvania School of Medicine in Philadelphia.

Wittink and her team published the observations in the Oct. 27 issue of the Archives of Internal Medicine.

Their findings are based on a comparative analysis of two end-of-life treatment preference questionnaires completed by 818 physicians, all of whom graduated from Johns Hopkins University between 1948 and 1964.

At an average age of 69 when the study was launched, all the participants completed an initial survey in 1999, followed by a second survey in 2002.

At both times, the patients were asked to indicate which types of interventions they would want should they experience brain death that rendered them unable to either speak or recognize those around them. Possible interventions included surgery, insertion of a feeding tube, dialysis, and/or cardiopulmonary resuscitation.

Serious changes in the participants' physical and/or mental health over the course of the intervening three years were also monitored.

The research team found that the overall percentage of study participants who fell into each level of treatment preference --"aggressive," "intermediate" or "least aggressive"-- remained pretty constant over the three years, as patients who turned down particular treatments in 1999 continued to be likely to do so in 2002.

Specifically, while 12 percent, 26 percent and 62 percent respectively preferred aggressive, intermediate or least aggressive treatment in 1999, overall preferences had shifted only slightly by 2002: to 14 percent, 26 percent and 60 percent, respectively.

Getting older or experiencing a decline in either mental or physical health did not appear to impact patient preferences, the researchers noted.

However, although the absolute numbers of those choosing one type of treatment approach or another remained more or less constant, individuals didn't necessarily stay in their original category, with some gravitating towards more or less aggressive intervention over time.

For example, among those who had indicated that they wanted "aggressive" treatment in 1999, just 41 percent maintained that preference in 2002.

On the other hand, those who lacked either a living will or a durable power of attorney when they first outlined their preferences in 1999 were twice as likely to want "aggressive" life-sustaining care (as opposed to "least aggressive" care) when they were re-interviewed in 2002.

"This dynamic is important to understand, because even though most people are stable in their preferences -- which is not surprising -- some people are not," said Wittink. "So that means that both doctors and patients need to be thinking and communicating about patient feelings as preferences change."

Dr. Steven Pantilat, director of the palliative program at the University of California, San Francisco, suggested that the findings make intuitive sense.

"Previous research has actually suggested that people do change their minds, and that it's hard to predict whether an individual will end up wanting more or less aggressive treatment down the road," he said. "But even though this finding is a little different than what the prior literature has indicated, I have to say that it's more in line with what I've personally observed. Which reflects the fact that generally people's values and goals don't change that much over time."

"I also think that moving from wanting more treatment to wanting less is typical of many patients," he said. "Because as seriously ill people experience the increasing burden of treatment coupled with what they realistically can expect to get from it, there is often a shift in focus towards gaining comfort and a better quality of life, and away from aggressive life-prolonging intervention."

"Whatever the case, what's important is that patients are upfront at an early stage about their preferences, so they get the care they want," he stressed. "Because preferences about end-of-life are not whims. And if you don't express yourself you may very well get the kind of care you don't want."

More information

For more on end-of-life directives, visit the American Academy of Family Physicians.