MONDAY, Sept. 29 (HealthDay News) -- Elderly Americans who live in low-income ZIP codes are more likely to die after surgery than those who live in higher-income ZIP codes, according to new research.

The study analyzed death rates among more than one million older adults who had one of six common high-risk heart or cancer surgeries between 1999 and 2003.

The risk of death was between 17 percent and 39 percent higher for patients in low-income ZIP codes, mainly because the quality of care is lower at hospitals in lower socioeconomic areas, the study authors said.

In fact, all patients (regardless of income) who had surgery at hospitals in the poorest areas were more likely to die, while all patients who had surgery at hospitals in the richest areas were less likely to die.

"It may be that hospitals that treat patients of lower socioeconomic status have lower quality of care due to fewer resources, such as technologically advanced equipment or specialists," lead author Dr. Nancy Birkmeyer, an associate professor of surgery at the University of Michigan, said in a Center for the Advancement of Health news release.

The study was published in the September issue of the journal Medical Care.

"While some prior studies have demonstrated socioeconomic disparities in the outcomes of individual procedures, ours is the first to show that the relationship is consistent across a wide range of surgical procedures," Birkmeyer said.

While the study can improve understanding of patterns of care, it doesn't offer concrete answers for elderly patients who need surgery, said Dr. Harlan Krumholz, a professor of medicine, epidemiology and public health at Yale University.

"The study can only really raise questions about inequalities in outcomes, because the authors have limitations in their ability to know the socioeconomic status of any particular patient and the condition of the patient when they had the surgery," Krumholz said in the news release. "Nevertheless, it is time for us to look closely at whether people are getting the same care and outcomes regardless of their financial circumstances."

More information

The U.S. National Institute on Aging has more about seniors and surgery.

THURSDAY, Sept. 25 (HealthDay News) -- In 2009, 97 percent of Medicare beneficiaries will have access to a drug plan with premiums that are the same as this year's or even lower, Medicare officials announced Thursday.

The various Medicare prescription drug plans in the agency's "Part D" program cover about 90 percent of all Medicare beneficiaries, Kerry Weems, the acting administrator of the U.S. Centers for Medicare & Medicaid Services (CMS), said during a late morning press teleconference Thursday.

Overall, 25.4 million Americans are currently enrolled in some type of Medicare Part D prescription drug coverage. Open enrollment in the 2009 Part D plans begins Nov. 15 and ends Dec. 31.

There was more good news, according to Weems. "Part D continues to come in under budget and has consistently high satisfaction rates, and with it, millions of Americans are living better lives," he said, noting that, "Medicare's Part D prescription drug plan will enter its fourth year when open enrollment begins in November."

From year to year, Medicare prescription drug providers do change their plans, Weems said, so it's important that enrollees check up on their plan to see if anything has been altered.

"Some beneficiaries will see significant changes in their plans. These could be changes in premiums or changes in coverage," Weems said. "We are encouraging all beneficiaries to review how their plans are changing and what other options are available to determine which plan best meets their needs," he said.

For instance, the monthly premium for the most popular Medicare Part D plan, the AARP Medicare Rx Preferred Plan, will rise 15 percent, from $32 to $37. The next most popular plans are offered by Humana Inc., and the premium for the standard Humana plan will go up 60 percent, from about $25 to $40. The premium for the enhanced Humana plan will go up from about $23 to $38, the Associated Press reported.

Medicare beneficiaries across the United States will be able to access at least one prescription drug plan with premiums of less than $20 a month, except for people living in Alaska, where the one prescription drug plan has a premium of $23 a month, Weems said.

People who qualify for the full Medicare subsidy will have no premiums or deductibles on these plans. The average monthly premium for the basic Medicare drug benefit in 2009 is expected to be about $28, Weems said.

Medicare beneficiaries will also continue to have access to drug plans with a wide range of options, including plans with no deductibles. In addition, plans that cover the gap for generic drugs are available in all states.

All Medicare beneficiaries will have access to Medicare Advantage plans, Weems noted. These plans cover all Medicare services, including prescription drugs. Many of these plans have prescription drug coverage that will enable more than 93 percent of those enrolled in the plan to get their drugs with no premiums and no deductibles, Weems said.

He added that the marketing of prescription drug plans in 2009 is covered by new regulations intended to protect Medicare beneficiaries from "deceptive or high-pressure marketing tactics by insurance companies and their agents."

Paul Precht, director of Policy and Communications at the Medicare Rights Center, said people should shop around for the best prescription drug plan and not just continue on with the plan they have.

"The first thing consumers should look for is the premium," Precht said. "But the more important and the more difficult challenge is to figure out if there are changes in the coverage," he said.

Consumers should also look to see if there are drugs that were covered in 2008 that won't be covered in 2009, Precht said. "You need to find out if there are drugs that are covered without restriction this year that will now be subject to prior authorization or step therapy [using the most cost-effective drug first]," he said.

People considering switching to Medicare Advantage should first find out if their current doctor and hospital are part of the plan and what the plan covers and doesn't. In addition, they should also find out which drugs are covered and which are not, Precht said.

More information

For more on Medicare Part D, visit the U.S. Centers for Medicare and Medicaid Services.

FRIDAY, Sept. 26 (HealthDay News) -- Cognitive and social activity in midlife may significantly reduce men's risk of dementia, says a U.S. study that followed 147 male twin pairs for 28 years.

Among the twins, higher cognitive activity scores predicted a 26 percent reduction in risk for developing dementia first. Twins who developed dementia first had significantly lower total cognitive activity scores than twins who didn't develop dementia.

The study found that reduced dementia risk was most strongly associated with participation in intermediate novel activities including home and family activities, visiting with friends and relatives, club activities (such as attending parties and playing card games), and home hobbies.

"These activities might be indicative of an enriched environment, which has been shown in animal models to enhance the creation of new brain cells and promote brain repair," noted study author Michelle C. Carlson, an associate professor in the department of mental health and the Center on Aging and Health at the Johns Hopkins Bloomberg School of Public Health, and colleagues.

Two other categories of cognitive activities -- novel and passive receptive -- also reduced dementia risk but not to the same degree as intermediate novel activities. Novel activities include reading, studying for courses, and extra work (overtime or other employment), while receptive activities include watching television, listening to radio, going to movies, or seeing theater, art and music shows.

The study was published in the September issue of Alzheimer's & Dementia.

"This fascinating study provides some of the first relatively strong evidence that cognitive activity, including social interaction, reduces dementia risk," William Thies, vice president of medical and scientific relations at the Alzheimer's Association, said in an association news release. "The results extend earlier twin study data that showed the beneficial impact of similar activities on Alzheimer's and dementia risk in women."

A growing body of evidence suggests a link between low social activity and increased risk for Alzheimer's disease, and that mid- and late-life social activity is associated with better mental and physical health.

"Overall, these findings suggest that engaging in activities that incorporate both cognitive and social activity might confer protection against Alzheimer's and dementia, particularly among those at elevated genetic risk for the disease," Carlson said. "These results can help inform future preventive interventions, especially because they point to a range of activities that individuals are likely to maintain, because they are rewarding, entertaining and engaging."

Carlson and her colleagues wrote that their findings "have immediate implications for a generation of male baby boomers approaching retirement. Approximately one third of many individuals' lives will be spent after retirement. The expansion of the human life span makes it imperative to identify lifestyle opportunities that increase health and 'add life to years.'"

More information

The U.S. National Institutes of Health has more about Alzheimer's Disease prevention.