Assessment of utilization of rehabilitation services among stroke survivors

Instead of useless research like this why don't you research the effectiveness of the stroke rehab patients are given? Then you can correct the problems within the medical system, instead of blaming the patients.

Assessment of utilization of rehabilitation services among stroke survivors

Chandel Mahak¹, Shashi¹, Yashomati¹, Hemlata¹, Nagi Manisha¹, Ghai Sandhya¹, Khurana Dheeraj², Manju Dhandapani¹, SS Dhandapani^3
1 National Institute of Nursing Education, PGIMER, Chandigarh, India
² Department of Neurology, PGIMER, Chandigarh, India
³ Department of Neurosurgery, PGIMER, Chandigarh, India

Date of Web Publication

29-Aug-2018

Correspondence Address:
Manju Dhandapani
National Institute of Nursing Education, PGIMER, Chandigarh
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jnrp.jnrp_25_18

  Abstract

Background: Rehabilitation is probably one of the most important phases of recovery for many stroke survivors. The current study was conducted with the objective to assess the utilization of rehabilitation services and factors affecting nonutilization of rehabilitation services among the stroke survivors.  

Materials and Methods: The current study was carried out in the Neuro Outpatient Department of a tertiary care hospital in India. It was a descriptive study. Consecutive 55 stroke survivors who had met the inclusion and exclusion criteria were recruited in this study. Self-structured rehabilitation tool was used to collect the data. 

Results: Data were analyzed using the descriptive and inferential statistics. Majority of the patients comprised 70.9% of males and 29.1% of females. Among participants, 70.90% were aware about rehabilitation, 67% were utilizing rehabilitation services, whereas 33% were not utilizing rehabilitation services. In the current study, certain reasons were found behind not utilizing rehabilitation services. There were 83.3% of participants who had lack of awareness about rehabilitation services and 61.1% of participants who had no availability of rehabilitation services. Only 45.5% of rural inhabitants were utilizing rehabilitation services as compared to 81.2% of urban inhabitants and 83.23% of suburban inhabitants.  

Conclusion: Rehabilitation is of utmost importance. Hemiparesis, difficulty in performing activity of daily living, difficulty in performing social activities, and difficulty in reasoning were the most common problems faced by people suffering stroke after discharge from the hospital. There was lack of awareness and utilization of rehabilitation services by patients among Indian stroke population. Hence, health workers have an immense role in educating, motivating, and ensuring that rehabilitation services in rural inhabitants.

With Stroke Comes Higher Dementia Risk: Study

If most stroke survivors don't develop dementia, where the fuck is the research pointing out the distinction? I need to know how much effort I have to put in in preventing dementia. I bet I drained my cognitive reserve just surviving my stroke.

With Stroke Comes Higher Dementia Risk: Study

FRIDAY, Aug. 31, 2018 (HealthDay News) -- People who've had a stroke face up to twice the normal risk of dementia, a new review suggests.
In what they say is the largest analysis of its kind, British researchers examined 48 studies that included 3.2 million people worldwide.
"We found that a history of stroke increases dementia risk by around 70 percent, and recent strokes more than doubled the risk," said researcher Ilianna Lourida, from the University of Exeter Medical School.
"Given how common both stroke and dementia are, this strong link is an important finding," Lourida added in a university news release. "Improvements in stroke prevention and post-stroke care may therefore play a key role in dementia prevention."
The association between stroke and increased dementia risk remained even after other dementia risk factors such as blood pressure, diabetes and heart disease were taken into account, the researchers said.
Though the study did not prove that strokes cause dementia, this is the strongest evidence to date of a link between the two, according to the researchers.
Researcher David Llewellyn, also from the University of Exeter, said, "Around a third of dementia cases are thought to be potentially preventable, though this estimate does not take into account the risk associated with stroke.
"Our findings indicate that this figure could be even higher, and reinforce the importance of protecting the blood supply to the brain when attempting to reduce the global burden of dementia," he said.
More study is needed to find out if factors such as ethnicity and education influence dementia risk following stroke, the study authors added. In the latest review, there was some suggestion that the risk might be higher for men.
The investigators also noted that most stroke survivors do not develop dementia, so further research is needed to determine whether differences in post-stroke care and lifestyle can reduce the risk of dementia.
About 15 million people worldwide have a stroke each year, according to the World Health Organization. About 50 million people worldwide have dementia, and that's expected to almost double every 20 years, reaching 131 million by 2050.
The findings were published Aug. 31 in Alzheimer's & Dementia: The Journal of the Alzheimer's Association.
More information
The U.S. National Institute of Neurological Disorders and Stroke has more on dementia.

SOURCE: University of Exeter, news release, Aug. 31, 2018

-- Robert Preidt

Last Updated: Aug 31, 2018

Copyright © 2018 HealthDay. All rights reserved.

How Failure Holds the Key to a Meaningful, Successful Life

You need to read and take this Tiny Buddha post to heart. In your stroke recovery you are going to fail millions of times. I have failed in getting my walking correct 4,594,974 steps in the past 4 years, yet I persist. I'm sure I will never walk correctly again because my spasticity will never be cured. I blame that lack of spasticity cure directly at Dr. William M. Landaus' feet because of this totally misguided crapola of his.

Spasticity After Stroke: Why Bother? Aug. 2004 

Good stroke leadership from survivors and a strategy could have gotten around  his blockade. Comeuppance would be too good for him.  

The latest here:

How Failure Holds the Key to a Meaningful, Successful Life

How Failure Holds the Key to a Meaningful, Successful Life

By Joel Almeida

“Perfectionism doesn’t believe in practice shots.” ~Julia Cameron
Within each of us lurks a perfectionist. And perfectionists set themselves up for a lot of pain in life.
How so? I’ll come to that.
First let me describe how our first child took her first step. She was less than ten months old. A very bright girl, who wanted nothing less than my approval at all times.
On one occasion, a few months previous to that, she was crawling on the carpet and picked up some small thing. As she started to put it in her mouth, I called out loudly “No!”
That was the first time she experienced any negative or critical words from me. Otherwise, I had been steadily adoring. What was her response?
She fell flat on the floor and remained perfectly still. It was as if she had been laid flat by a sledgehammer blow.
That’s how much she had come to rely on my approval.
So, what happened when one day she could finally stand up? I decided, as a very proud parent, to teach her how to walk right away.
Now, walking is easy for someone who’s already confident with standing up. It’s more challenging for someone who’s just learned how to stay on their feet unsupported. I was too young and foolish and overeager to think through all that.
In my excitement, I stood by her and urged, “You can walk. Just do this. Look at me. Just lift a foot like this and put it forward.”
In retrospect, I was too hasty and cruel. I’ve grown to recognize that everything happens in its own good time.
Anyhow, I was young and foolish then. So, allow me to tell you the rest of the story.
Our baby looked very doubtful. I demonstrated a step once again. She remained hesitant.
After some more cajoling from me, she decided to do something.
She took the oddest first step you can imagine.
Did she lift one foot as I kept urging? No.
She simply hopped forward, keeping both feet on the ground. Like a baby kangaroo. That was only minutes after she had first stood up without support.
Of course, not long after that she was walking very confidently, and then running, and has gone on to do amazing things with her life.
Imagine if we were all so afraid of failure that we always kept both feet on the ground for safety. How much would that interfere with a full and meaningful life? How would that affect our ability to do whatever we considered to be good and important?
We can see this quite clearly in babies. In order to be able to lift their head, they need to accept that they’ll sometimes flop.
In order to learn how to crawl, they need to accept that they’ll sometimes fall flat on their face.
In order to learn how to stand, they need to accept that they’ll sometimes fall in a heap.
In order to learn how to walk, they need to accept that they’ll sometimes tumble.
In order to learn how to cycle, they need to accept that they’ll sometimes fall off and get bruised.
In order to learn how to swim, they need to accept that they’ll sometimes need rescuing.
In order to learn how to read and write, they need to accept that they’ll get many things hilariously wrong.
In order to learn to love wholeheartedly, they need to accept that some people will betray their trust.
Whenever they want to do something that’s good and important in their lives, they need to accept the possibility of failure.
It’s easy to acknowledge such facts, but it’s more difficult to live by them.
Why is it that we often struggle with failure? Why do we so often consider it as a full stop rather than a necessary comma in our life story? Why does it seem more like a trap than a springboard?
It may have something to do with our need for approval.
Our daughter didn’t want to hear the word “No!” from her beloved parent. It crushed her the first time she encountered it from me.
Only after I picked her up and comforted her did she loosen up and smile again. She was learning that she could get things wrong and still remain completely lovable to me.
People can be good to us. They can build us up. They can teach us that it’s okay to fall and fail, because we’ll still be completely lovable.
However, we’re all human beings. We don’t always do what we set out to do. We don’t stick to doing what we know to be good and important.
As a result, we often wound others and are too often wounded by them.
That tends to suck us into the rat race. Not content with being intrinsically and unshakably lovable, we tend to look for reassurance. And too often we seek it by trying to be one up on others.
We sometimes pounce on the mistakes or flaws of others because it allows us to feel superior despite our own mistakes or shortcomings. We sometimes become overly reliant on praise because we’re terrified that criticism confirms how worthless we are under the surface. 
All this tends to make life a bit like walking on thin ice. Even when it looks as if we’re winning, we’re on edge because we fear that the ice might give way at any moment. I know, because I've struggled with these things myself.
Imagine a different way of living. A calm and courageous way of reaching for whatever we consider to be good and important in our lives, with full acceptance of whatever failures come our way.
Paradoxically, the perfectionist is more likely to fail because they’re too afraid to bring out the best in themselves. They’re so hungry for approval, and so afraid of failure, that they often don’t do what they know to be good and important.
They keep the safety wheels on their bicycles even though it slows them down. That’s because they’re convinced that failure will confirm their worthlessness.
Imagine a different way. Imagine having a deep, unshakable anchor within yourself. An anchor of self-acceptance. No storms in life can then blow you out of the safe harbor of being intrinsically lovable.
The baby who’s uncertain of being lovable might be too afraid to attempt anything worthwhile. It’s the same with us adults.
Our perfectionism goes hand in hand with fear of failure. It’s like a prison. However, we have the key, or we can find it.
This may be the most important lesson life has taught me, and I’m going to share it.
You can get the key to calm, courageous living by letting others know that they are unshakably lovable despite their failures and mistakes and flaws.
When you give this gift to others, you begin to believe it yourself. Not as a sterile principle. But as a reality that you feel deep in your being.
Once you have this key, perfectionism loses its stranglehold over you. You recognize that you are intrinsically worthy and lovable, just like every other human being.
Life becomes really good and inviting, failure can no longer terrorize, and you get more good and important things done.
Once you’re prepared to fall flat on your face, life starts to sparkle.

A perfused human blood–brain barrier on-a-chip for high-throughput assessment of barrier function and antibody transport

With the various brains on a chip our researchers can figure out what intervention needs to pass thru the blood brain barrier to accelerate neuroplasticity and neurogenesis. Five steps to solve this. This is so fucking simple, getting it right might take a while but the concept is simple.

• Brain on a chip (6)
• brain organoid (1)

1.  Describe the problem exactly. 
2.  Write an RFP to researchers to solve that problem.
3.  Fund them with foundation grants.
4.  Write stroke rehab protocols based on the research.
5.  Get the Nobel prize in medicine  

A perfused human blood–brain barrier on-a-chip for high-throughput assessment of barrier function and antibody transport

Brain Function Tied to Heart Health Early and Late in Life

In my youth and now I have optimal cardio scores. But that probably means nothing since having a stroke probably overrides those good things. I want to know NOW exactly what I need to do to prevent dementia. But I'm screwed since there is NO protocol for that and no one seems to be even looking for that protocol. With some decent stroke leadership that could be solved. 

Brain Function Tied to Heart Health Early and Late in Life

Both young and old people showed better brain health with optimal cardiovascular scores

• by Judy George, Contributing Writer, MedPage Today August 21, 2018

Action Points

• Cardiovascular health at young and old ages were associated with better brain function, according to two reports: the first, a longitudinal study of older adults in France; the second, an observational assessment of young adults in England.
• Note that prior analyses have examined links between cognitive outcomes and cardiovascular risk factors mostly in middle age, not earlier or later in life, and earlier investigations also focused more often on the deleterious associations of cardiovascular risk factors with cognitive outcomes rather than the advantageous associations of optimal risk factor status.

Cardiovascular health at young and old ages showed ties to better brain function, according to two reports.
Optimal scores on an American Heart Association (AHA) seven-item checklist(now Essential 8) were linked to a lower risk of dementia, a longitudinal study of nearly 7,000 older adults in France found.
And an observational assessment of 125 young adults in Oxford, England, demonstrated that better cardiovascular metrics were associated with higher cerebral vessel density and caliber, higher cerebral blood flow, and fewer white matter hyperintensities.
Previous analyses have examined links between cognitive outcomes and cardiovascular risk factors mostly in middle age, not earlier or later in the life span, noted Jeffrey L. Saver, MD, of the University of California Los Angeles, and Mary Cushman, MD, MSc, of the University of Vermont in Burlington.
Earlier investigations also "more often focused on the deleterious associations of moderate or severe cardiovascular risk factors with cognitive outcomes rather than the advantageous associations of attaining optimal status for each cardiovascular health factor; i.e., ideal cardiovascular health," they wrote in an editorial accompanying the two studies in JAMA.
Older Adults
Among older adults in France, additional improvements in cardiovascular health score were associated with lower risks for dementia and lower rates of cognitive decline, reported Cecilia Samieri, PhD, of the Université de Bordeaux, and co-authors.
"Each additional favorable health factor or behavior was associated with a 10% lower risk to develop dementia in the following decade," Samieri told MedPage Today.
In the Three-City Study, 6,626 people ages 65 or older from Bordeaux, Dijon, and Montpellier who did not have a history of cardiovascular diseases or dementia at baseline underwent in-person neuropsychological testing from 1999 to 2016 and systematic detection of incident dementia until July 2016.
The researchers assessed participants' adherence to the AHA Life's Simple 7 metrics at baseline. Each item was scored as 0 (poor), 1 (intermediate), or 2 (optimal):

• Nonsmoker for more than 12 months
• Body mass index <25
• Regular physical activity
• Eating fish twice a week or more, and fruits and vegetables daily
• Untreated total cholesterol <200 mg/dL
• Untreated fasting glucose <100 mg/dL
• Untreated blood pressure <120/80 mm Hg

Participants had a mean age of 74 at baseline and 63% were women. At baseline, 36.5% of participants had 0 to 2 metrics at optimal levels, and 6.5% had 5 to 7 optimal metrics.
For participants with 0 to 2 optimal metrics, the incidence rate of dementia per 100 person-years over an average follow-up period of 8.5 years was 1.56. For individuals with 3 to 4 optimal metrics, it was 1.23; for those with 5 to 7 optimal metrics, it was 0.83.
In multivariable models, the risk of dementia decreased linearly with both increasing number of metrics at the recommended optimal level (HR 0.90 per each additional metric) and increasing global cardiovascular health score (HR 0.92 per 1-point increase).
The researchers used composite scores of global cognition and memory to determine cognitive decline. In standard units, with values indicating distance from population means (0 equal to the mean, and +1 equal to 1 SD above the mean), the estimated change in cognitive score for each additional metric at the optimal level was 0.031 standard units at inclusion, 0.068 at year 6, and 0.072 at year 12.
Young Adults
Optimal cardiovascular health in 125 young adults in England was associated with more robust cerebral perfusion and fewer subclinical lesions in brain white matter, reported Paul Leeson, PhD, of the University of Oxford, and colleagues.
Examining eight modifiable cardiovascular risk factors, the researchers assigned a value of 1 for each item at the recommended level:

• Body mass index <25
• Highest tertile of cardiovascular fitness and/or physical activity
• Alcohol consumption <8 drinks/week
• Nonsmoker for more than 6 months
• Blood pressure on awake ambulatory monitoring <130/80 mm Hg
• Non-hypertensive diastolic response to exercise (peak diastolic blood pressure <90 mm Hg)
• Total cholesterol <200 mg/dL
• Fasting glucose <100 mg/dL

In this analysis, the mean age was 25; 49% were women, and participants had an average of 6.0 modifiable cardiovascular risk factors at recommended levels.
Cardiovascular factors were correlated with cerebrovascular morphology and white matter hyperintensities in multivariable models. For each additional risk factor at the recommended level, vessel density was greater by 0.3 vessels/cm³, vessel caliber was greater by 8 μm, and white matter hyperintensity lesions were fewer by 1.6 lesions.
The researchers also examined cerebral blood flow in 52 participants using vessel-encoded arterial spin labeling. Cerebral blood flow varied with vessel density and was 2.5 mL/100 g/min higher for each healthier risk factor.
Both this study and the Three-City Study of older adults in France were observational, so they indicate association, not causation, Saver and Cushman noted. And in both studies, unmeasured and residual confounding may exist.
But with these caveats, these studies convey an immediate message to clinicians, policymakers, and patients, they said: "Available evidence indicates that to achieve a lifetime of robust brain health free of dementia, it is never too early or too late to strive for attainment of ideal cardiovascular health."
In the Three-City Study, even subtle changes decreased dementia risk, Samieri pointed out.
"From a pragmatic and public health perspective, promoting change in cardiovascular health from poor to intermediate levels may be more achievable and have a greater population-level effect than the more challenging change from poor to optimal levels," she said.
"These results offer new insights on the way to formulate recommendations for dementia prevention which may be implemented at both collective and individual levels."

The Three-City Study was conducted under a partnership agreement between INSERM, the ISPED of the University of Bordeaux, and Sanofi-Aventis. One researcher reported receipt of a grant from Roche. No other disclosures were reported.
The Oxford study was funded by a British Heart Foundation (BHF) project grant, the Oxford BHF Centre for Research Excellence, and National Institute for Health Research, Oxford Biomedical Research Centre. Researchers reported relationships with Siemens Healthcare, Michael J. Fox Foundation, Deutsche Parkinson Gesellschaft, and Prothena Biosciences.
The editorialists reported no industry relationships.

• Reviewed by Henry A. Solomon, MD, FACP, FACC Clinical Associate Professor, Weill Cornell Medical College and Dorothy Caputo, MA, BSN, RN, Nurse Planner

• Primary Source

  JAMA

  Source Reference: Samieri C, et al "Association of cardiovascular health level in older age with cognitive decline and incident dementia" JAMA 2018; 320(7): 657-664.

• Secondary Source

  JAMA

  Source Reference: Saver J, Cushman M "Striving for ideal cardiovascular and brain health: It is never too early or too late" JAMA 2018; 320(7): 645-647.

• Additional Source

  JAMA

  Source Reference: Williamson W, et al "Association of cardiovascular risk factors With MRI indices of cerebrovascular structure and function and white matter hyperintensities in young adults" JAMA 2018; 320(7): 665-673.

Modulation of Cerebellar Cortical Plasticity Using Low-Intensity Focused Ultrasound for Poststroke Sensorimotor Function Recovery

My conclusion is that this is useless.

1. You'd have to find a hospital that has ultrasound
2. You'd have to convince a doctor it works.
3. It talks of motor evoked potentials NOT actual movement.
4. Followup is needed.
5. Significantly decreased edema  is not an objective measurement.
6. Could be, NOT does this.

http://journals.sagepub.com/doi/abs/10.1177/1545968318790022

Show all authors

Hongchae Baek, MSc, Ki Joo Pahk, PhD, Min-Ju Kim, ...

First Published August 29, 2018 Research Article

https://doi.org/10.1177/1545968318790022

Article information

Abstract

Background: Stroke affects widespread brain regions through interhemispheric connections by influencing bilateral motor activity. Several noninvasive brain stimulation techniques have proved their capacity to compensate the functional loss by manipulating the neural activity of alternative pathways. Over the past few decades, brain stimulation therapies have been tailored within the theoretical framework of modulation of cortical excitability to enhance adaptive plasticity after stroke.  
Objective: However, considering the vast difference between animal and human cerebral cortical structures, it is important to approach specific neuronal target starting from the higher order brain structure for human translation. The present study focuses on stimulating the lateral cerebellar nucleus (LCN), which sends major cerebellar output to extensive cortical regions.  
Methods: In this study, in vivo stroke mouse LCN was exposed to low-intensity focused ultrasound (LIFU). After the LIFU exposure, animals underwent 4 weeks of rehabilitative training.
Results: During the cerebellar LIFU session, motor-evoked potentials (MEPs) were generated in both forelimbs accompanying excitatory sonication parameter. LCN stimulation group on day 1 after stroke significantly enhanced sensorimotor recovery compared with the group without stimulation. The recovery has maintained for a 4-week period in 2 behavior tests. Furthermore, we observed a significantly decreased level of brain edema and tissue swelling in the affected hemisphere 3 days after the stroke.  
. This study provides the first evidence showing that LIFU-induced cerebellar modulation Conclusions: Could be an important strategy for poststroke recovery. A longer follow-up study is, however, necessary in order to fully confirm the effects of LIFU on poststroke recovery.

Is Gadolinium From MRIs Entering the Brain?

You'll have to ask your doctor if gadolinium was used in your scans and what problems that might cause. Then what solution are they proposing.

A discussion on the safety of gadolinium-based contrast agents

Is Gadolinium From MRIs Entering the Brain?

The Top Countries Where You Can Retire on $150K

Maybe when I'm 80 and tired of all the traveling and fun I might have to settle in these places for a year at a time.  It would be way too boring and expensive to fully retire in the US.  I've already visited Malta, Spain, France, Ecuador, Italy and soon Portugal. In only six years, ever since moving to Michigan and getting divorced.

The Top Countries Where You Can Retire on $150K

In 2018, American retirees are collecting average monthly Social Security payments of just $1,404, or a mere $16,848 for the year.
That's hardly enough to afford a decent life in America, particularly when seniors are facing out-of-pocket health care costs of more than $13,000 per year.
But what if you didn’t retire in the U.S.? The fact is that health care, housing and daily expenses cost significantly less in other countries.

We count down our picks for the cheapest — and safest — countries for retiring outside the U.S., the places where even $150,000 or less in retirement savings would be enough to live comfortably.
Our recommendations reflect local daily living costs, changes to visa programs and political developments.

20. Croatia

Gaspar Janos / Shutterstock
Croatia's Istrian Peninsula has been compared to Tuscany.

With more than 1,000 islands to explore off its shores, seaside towns, mountain getaways and a simple, peaceful lifestyle, Croatia will never be a boring retirement destination.
The Balkan nation has cold winters and very hot summers, although its infamous "bura" wind will cool you right off. English is widely spoken in seaside towns, but you'll need to know some basic Croatian to get by in inland villages.
In-the-know expats head to the northern peninsula of Istria, which is "the new Tuscany," according to International Living magazine.
A one-bedroom in the small coastal towns of Pula and Rovinj will rent for around $300 a month, while you could buy an apartment that size for $70,000. Or, for as little as $110,000, you could own a home in the vibrant capital, Zagreb.

How to retire to Croatia

John_Silver / Shutterstock
You'll need to live in Croatia for five years before you can apply for permanent residency.

To gain residency, first you must register for the state health system and pay a year's worth of back payments, which costs about $800 for two people, says International Living. The best hospitals are in Zagreb, Pozega and Slavonski Brod.
To stay longer than 90 days, you’ll need to apply for a temporary residence permit at the local Ministry of Interior office or police station and prove you have adequate financing and that you own property or that your yacht is moored in the marina(!).
After renewing this temporary residence visa for five years, you can apply for permanent residency.

19. Bolivia

Olga Kot Photo / Shutterstock
If you retire to Bolivia, you'll be lured to the famed salt flats.

The landlocked South American nation of Bolivia has been luring expats for years with its lovely weather, unique geographical features and extremely low cost of living.
If exploring mountains, salt flats, charming colonial towns and bustling cities sounds like a good time, then you might just enjoy retiring in Bolivia!
Public health care in Bolivia is still under development, so you’ll find better care in private clinics. Health insurance can help cover the costs.
Expats can lead a comfortable life for around $1,000 a month in affordable Tarija. Many foreign retirees also have happily visited and settled in Santa Cruz and La Paz. Being able to speak Spanish will help you fit in.

How to retire to Bolivia

Bruce Raynor / Shutterstock
Bolivia is a nation that's rich in history and has an abundance of natural wonders.

If you want to retire in Bolivia, you’ll need to enter the country with a "specific purpose visa", which requires you to submit a letter stating your intentions and including proof of your economic situation and a police record check.
But you’ll probably want to check the place out before you make the leap. To visit, you’ll need to get a tourist visa from the Bolivian consulate.
Calculate how much more you need to save each month to reach your retirement nest egg goal.

18. Belize

Matyas Rehak / Shutterstock
Belize is stunning.

Belize has been growing in popularity with international retirees thanks to its Caribbean vibes, beautiful nature preserves and beaches, and affordable, slower pace of life. It's an English-speaking nation; Spanish is the second most widely used language.
Popular expat destinations include Placencia Peninsula, a 19-mile swath of land bordered by white sands and blue waves, and the island of Ambergris Caye. These are among the most expensive areas of Belize, but you can still find rents as low as $700 a month.
You will want to stay away from border towns, isolated regions and Belize City, as criminal activity is much higher in these areas.
In Belize, most hospitals are not well-equipped to deal with serious health concerns. Health care in Mexico, Nicaragua, and Costa Rica is significantly better by comparison, says Expat Exchange.

How to retire to Belize

triocean / Shutterstock
Belize offers plenty of opportunities for field trips with your fellow expats.

If you’re in good health or you just want to move to Belize for a few years, then you can become a resident of the country fairly easily.
After staying in the country for the required 50 weeks, you can apply for residency once you can prove you will be able to transfer $24,000 each year into a Belize bank account. The application costs $1,000.
Note that officials prefer to see your income stream coming from a combination of Social Security, a pension plan and/or a 401(k) or IRA.

17. Vietnam

Richie Chan / Shutterstock
Da Nang is an exciting, bustling city.

Culture-rich Vietnam is quickly becoming a popular retirement destinations for North Americans. And with its French colonial architecture, endless natural pursuits and amazing street food, what’s not to love?
Particularly affordable expat-friendly destinations include the beach town Nha Trang and the bustling city of Da Nang, where around $1,000 can cover your living costs for a month.
There’s a growing expat community in Nha Trang and expanding services catering to Westerners and locals alike. Da Nang is modern, international and welcoming, and its lovely weather will allow you to enjoy the city’s parks, beach and riverfront year-round.
In Vietnam’s cities and tourist centers, English is becoming more commonly spoken, and the government has put more emphasis on English-language learning in schools. But you’ll need some knowledge of Vietnamese to communicate in smaller towns and rural areas.

How to retire to Vietnam

Jochen Netzker / Shutterstock
You can relocate to Vietnam via a renewable one-year visa.

Vietnamese health care is good for basic needs, but the country doesn’t score high for specialized care or surgeries.
Vietnam doesn’t have a retirement visa, but U.S. citizens can get a one-year multiple-entry visa that will have to be renewed. It requires that you leave the country once every 90 days.

16. Ecuador

Ecuadorpostales / Shutterstock
Ecuador's scenery is breathtaking.

For years, Ecuador has come out on top as one of the most popular retirement destinations for expats, and the majority of foreign retirees in the country are Americans.
With its pristine natural surroundings, busy cities, charming historical towns, and low cost of living, there’s something for everyone in Ecuador.
In the capital city, Quito, you’ll spend about $460 a month to rent a one-bedroom apartment in the middle of town.
In the quaint and friendly town of Cuenca, the same thing will cost you about $340 a month, reports living-costs website Numbeo.

How to retire to Ecuador

DFLC Prints / Shutterstock
Ecuador is a popular retirement choice among U.S. seniors.

Visitors can stay for only 90 days, so retirees should consider applying for the pensioner residency visa at an Ecuadorean consulate in the U.S.
The visa requires proof that you will be receiving $800 or more per month from a recognized pension source, says International Living magazine. Once the visa is approved, you’ll have to sign up for public or private health insurance.
Ecuador’s political forecast is looking quite sunny these days. Citizens voted in early 2018 to reinstate presidential term limits, setting the country apart from more troubled nations in the region, such as Venezuela.

15. Ireland

Frank Bach / Shutterstock
County Mayo is affordable and looks like something out of a storybook.

Settle here, and you’ll find the people welcoming, the culture and castles stunning, and the nearby travel options in the U.K. and Europe inspiring. Plus, Ireland can be very affordable.
While housing prices in major cities like Dublin have hit all-time highs, there are still plenty of perfect places for a lower-cost and low-key retirement on the Emerald Isle. In County Mayo, Roscommon or Monaghan, homes sell for under $100,000.
Hospitals in Ireland are generally very well-appointed, and the level of care is highly rated. Since you're not a citizen of the European Union, you will need health insurance to cover your health care costs.

How to retire to Ireland

Sandra Mori / Shutterstock
Ireland can be a breathtakingly beautiful retirement destination.

Unlike some other countries on this list, Ireland does not have a retirement visa option if you are not an EU national. So, you'd need to apply for a “D” visa that would allow you to stay for three months.
Next, you'd need to apply for permission to remain as a "person of independent means" and show clear proof that you have sufficient resources to cover your expenses in Ireland.
That can mean annual income of 50,000 euros (about $58,000) per person, plus savings to cover emergencies and large expenses, such as buying a home or car.

14. Chile

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Chile is known for its majestic mountains and busy cities.

Chile is known for its beautiful beaches, majestic mountains, busy cities and warm and welcoming people.
As one of the most stable countries in South America, Chile offers the chance to enjoy a safe, comfortable, middle-class lifestyle for a fraction of the cost of retiring in the U.S.
For about $1,000 a month, you’d be able to cover housing and basic costs just about anywhere in the country. Spend a little more, and you can eat, hike and travel the land to your heart’s content.

How to retire to Chile

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Chile offers retirees opportunities for travel and hiking.

If you want to enter Chile with the intent to retire there, you’ll need a regular tourist visa and then apply to change it to a retirement or income visa. Those are good for one year.
After your temp visa is approved, you’ll need to stay in Chile for 180 days out of the year to be able to apply for permanent residency.
There is no official minimum income requirement. But the Spencer Global law firm in Chile estimates you’d need at least $1,000 per person for the first one or two years as you complete the visa process and set up your home in Chile.

13. Uruguay

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Uruguay offers a mix old-world charm and modern amenities.

Uruguay is one of the most affluent countries in South America and has a strong democratic government, modern infrastructure, white sand beaches and temperate four-season weather.
The cost of living is higher than in other Latin American nations — yet food, housing and clothing are still far cheaper than in the U.S. In Salto, the second-largest city in Uruguay, you can spend $800 a month and live comfortably.
Uruguay's most popular health care option is called a mutualista. It costs around $100 a month, offers access to a private hospital and clinics, and covers just about any health care need you’ll have.

How to retire to Uruguay

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The living is very easy for American retirees in Uruguay.

Uruguay has several visas that might work for retirees. The first is the rentista visa, which requires proof of monthly income of $1,500 for a single applicant.
There's also a foreign retiree visa that allows a duty-free import of your personal items. But this visa is harder to come by, and you’d need a lawyer to help you apply.
It’s worth noting that while obtaining residency in Uruguay is simple enough, the country generally does not want to give out citizenship to foreigners.

12. France

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Pau is a smaller French city that's surprisingly affordable.

France isn’t the first destination you’d think of for a cheap retirement — but several of its smaller towns are known for their affordable housing.
The city of Pau, which sits near the Spanish border, has mild winters and summers, and a one-bedroom apartment in the center of town goes for around $500 a month. A nice dinner for two costs about $46, reports living-costs website Numbeo.
The lovely Mediterranean university town of Montpellier also is very reasonably priced. Renting a one-bedroom flat will cost between $500 and $750. Both Pau and Montpellier have great health care and hospitals.

How to retire to France

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If you want to spend retirement in France, you'll have to apply for a long-term visa.

France doesn’t have a special visa for retirees, so you’d have to apply for a long-term visa at a French consulate in the U.S., reports International Living magazine.

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The consulate will want to see that you can finance your trip and that you have health insurance that works in France. Social Security statements, bank account information and investments all can help demonstrate your financial situation.
The long-term visa can be renewed yearly, and you’d have to submit current financial information at renewal.

11. Thailand

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Chiang Mai in Thailand provides a good mix of the old and the new.

Your retirement checks will definitely go further in tropical Thailand. You can live comfortably anywhere in the country on $1,500 to $2,000 a month, including rent.
The affordable city of Chiang Mai is full of modern amenities, like health clubs, shopping malls and high-quality (yet inexpensive) health care. Beautiful and sun-soaked island haven Koh Samui also offers an economical cost of living.
Even busy Bangkok is affordable and has some of the best private hospitals in the country. Thailand’s political climate is quite stable, and there is an active police presence, especially in big cities and tourist centers.

How to retire to Thailand

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To retiree in Thailand, you need only have savings and annual income totaling about $24,000.

Thailand offers a one-year retirement visa that can be extended.
Expat retirees must have savings and annual income totaling at least 800,000 Thai baht — currently about $24,000. You'd also need to report to the Thai immigration authorities every 90 days.
Want to save more for your retirement? Find out how much more you need to put away each month to reach your goal.

10. Italy

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Matera, in the Basillicata region, looks like a movie set. But it's real!

If you’re among the many people who have fallen in love with Italy’s regional cultures, mouthwatering cuisines and fantastic climate, then you’ll be happy to hear that retiring here is cheaper than you think!
In the southern region of Basilicata, you could buy a home in one of the smaller villages for just $32,000. In the charming historical town of Matera, you can rent a one-bedroom apartment for less than $600 a month.
In the eastern Puglia region, renowned for its sunny beaches and fresh seafood, the cost of living is even lower.

How to retire to Italy

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U.S. retirees who become Italian residents can enroll in the national health care system.

Italy doesn’t have a retirement visa program, so your best bet is to apply for an elective residency visa.
You'd need to provide proof of your yearly income from a pension, 401(k) or other liquid assets. The minimum is currently about $35,000 for one person and between $40,000 and $70,000 for two people.
Plus, you'd need to show proof of a rental agreement and medical insurance. Once you’re a resident of Italy, you qualify for the national health care system, which is ranked second in the world by the World Health Organization and costs about $400 a year per person.

9. Peru

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The biggest health risk for U.S. retirees in Peru is altitude sickness.

Adventure-seekers already know that Peru offers the amazing Machu Picchu, beautiful beaches and fascinating ancient cultures. For retirees, the cost of living is a big draw: A couple can get along very comfortably on $1,500 a month, says International Living.
In popular expat destinations such as Arequipa and Cusco, a one-bedroom apartment rents for about $225 a month, and a nicer three-course meal for two costs between $10 and $12.
Public health care is pretty affordable, too, but expats prefer to have health insurance and use private health clinics. The main health concern for newcomers is altitude sickness in Peru's high elevations.

Retiring to Peru

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Peru offers American retirees lots of photo opportunities.

The country offers an infinitely renewable retirement visa called the rentista visa.
To qualify, you’d have to demonstrate that you have a permanent monthly income of $1,000 for one person, plus $500 per dependent.
Anyone holding the rentista visa is exempt from paying the taxes owed with other Peruvian visas, which is pretty great!

8. Slovenia

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Slovenia is a hidden gem.

Slovenia has been gaining a reputation as a beautiful and affordable retirement destination in eastern Europe. In this hidden gem, you'll find lovely historical villages, a livable four-season climate and a range of outdoor pursuits.
Renting a one-bedroom apartment in the modern capital city of Ljubljana costs about $550 a month, and local food and staples also are reasonably priced.
All residents must pay for compulsory state health insurance, which provides access to very adequate health care. Expats and residents often add on private, local health insurance for additional services.

How to retire to Slovenia

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The word is getting out: Slovenia is a great place for North American retirees.

Slovenia doesn’t have a retirement visa for noncitizens of the European Union citizens, so you'd have to start your retirement plans by applying for a one-year temporary residence permit before you leave the U.S.
The permit must be renewed every year. After five years of living in Slovenia with this visa, you could apply for permanent residency.
To apply for temporary residency, you’d have to show you have an income at least equal to the basic minimal income in Slovenia, which is currently equivalent to about $1,000 per month.

7. Spain

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Valencia is spectacularly affordable.

Europeans have long seen Spain as a warm and sunny retirement haven, and it remains one of the most popular cities on the continent for expats.
With low food costs, natural beauty and practically no winter to speak of, Spain makes a great base for retirees hungry to travel around Europe.
Be aware that housing costs vary hugely across Spain. In major tourist centers like Barcelona, rents are comparable to those in the U.S.. In smaller towns like Valencia, a one-bedroom apartment goes for about $630 a month.

How to retire to Spain

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To spend your retirement in Spain, you'll need to show monthly income of at least $2,500.

To apply for a "retirement visa" in Spain, it's important to nail down proof that you have an income of at least $2,500 per month, or $30,000 per year.
You'd also need to show that you have health insurance that works in Spain.
It might take a few appointments to obtain your foreign visitor number (the NIE, necessary for everything from opening a bank account to installing internet in your home), but after that bureaucratic nonsense, the rest is gravy.

6. Portugal

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Portugal promises sun, sea and history.

Portugal has been winning travelers' hearts, and more people are deciding to move there every year.
The nation offers a lower cost of living than next-door Spain, sun for more than 300 days a year, and all the historical castles and fresh seafood you could want. Plus, it’s fairly stable, politically.
Renting an apartment in a smaller town is your best bet for an affordable retirement. Portuguese public health care has gotten a bit under the weather recently, so private health care is strongly preferred by international residents.

How to retire to Portugal

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Portugal has been gaining popularity as a retirement destination.

To apply for a residence permit as a retiree, first you’d need to go to a Portuguese consulate in the U.S. and bring a valid passport, proof of income and health insurance, and show you've undergone a criminal background check.
All of this would allow you to apply for permanent residency after you arrive in Portugal.
Income requirements are not specified for either temporary or permanent resident applicants, but you must have sufficient income to sustain you for the length of time you intend to stay in your chosen region in Portugal.

5. Malaysia

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Kuala Lumpur, Malaysia's capital and largest city, is more affordable than U.S. cities.

Ever-popular Malaysia has plenty to offer retirees, from warm weather to affordable food and entertainment and many English-speaking services. Just brace yourself for Malaysia’s monsoon season during the winter months.
Kuala Lumpur offers lower-cost living than in U.S. cities; a one-bedroom apartment rents for $550 a month. If the island lifestyle beckons, check out colorful Penang, where a one-bedroom will cost you just $290 a month.

How to retire to Malaysia

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To retire in Malaysia, you'll need to get a 10-year visa.

The country offers a 10-year visa that is renewable to those who are 50 or older and can prove a monthly income of at least $2,386, or liquid assets of around $83,500, says International Living.
Malaysia is generally quite safe, but petty theft is common in tourist centers, and home break-ins may happen when houses are empty.
The State Department advises Americans to avoid the eastern Sabah region due to violent activity and kidnappings-for-ransom.

4. Malta

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You can rent an apartment in Qawra, Malta, for $450 a month.

Malta is a temperate and cultured country with a lower cost of living than other Mediterranean locales in the EU. The island is rich in history and natural beauty.
Making things easier for North American retirees, English is one of Malta’s official languages. The nation’s health care system is in the top five globally, according to the WHO.
In the northern coastal villages of St. Paul’s Bay, Qawra and Mellieha, rent can cost just $450 per month, and there’s plenty of beach to keep you occupied. And since this is an island, you can drive to a bigger town quite easily.

How to retire to Malta

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Retiring in Malta is relatively easy.

Malta's residency permit programs live up to the country's reputation for being open and peaceful.

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The country offers several visa options for non-EU residents, including infinitely renewable one-year visas for pensioners and self-employed people who wish to live and work in Malta.

3. Panama

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For a big city, Panama City is surprisingly affordable.

Noted for its high quality of life, laissez-faire tax laws and great health care, Panama has been popular with retirees and investors for many years.

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Living here comes with all the glorious sunshine, culture, and natural beauty you could want to fill your retirement years. Spanish is the first language, but English is widely-spoken, especially in big cities.
The capital, Panama City, is surprisingly affordable. A one-bedroom in the city center rents for about $1,000 a month; internet costs about $52 a month; and a nice dinner for two at mid-range restaurant is about $50, says Numbeo.

How to retire to Panama

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Activities in Panama include watching ships go through the Panama Canal.

Panama’s retirement program, called the visa pensionado, is very attractive. You’d need to provide proof of a lifetime retirement income of $1,000 a month from a recognized source in the U.S.
If you’ll be getting less than $1,000 but more than $750, then you can buy a property in Panama for at least $100,000, and your lifetime monthly pension requirement will be reduced to $750.
This visa entitles you to a wide range of discounts on medical care (including dental and vision), travel, utility costs, loans and much more. There is no minimum or maximum age to qualify for the visa.

2. Mexico

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When you live in the Yucatan, you'll want to visit Chichen Itza.

Mexico is another top retirement destination, particularly its Yucatan peninsula. Considered to be the safest area for international retirees, the Yucatan is home to white sand beaches, fantastic wildlife, and the legendary Mayan complex at Chichen Itza.
Plus, you’ll see plenty of familiar businesses, from Starbucks to Petco and Walmart, around town.
A centrally located one-bedroom apartment rents for less than $200 a month in the town of Merida in the Yucatan. Because Mexico is so close to the U.S., many retirees keep their medical insurance from home and pay out of pocket for occasional medical needs.

How to retire to Mexico

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Income retirements to retire in Mexico can be surprisingly low.

It's recommended that potential residents apply for a temporary resident permit, which allows free movement in and out of Mexico for up to four years. After that, you’d need to apply for a permanent resident visa.
Temporary resident applicants need to show they had an income of approximately $1,400 over the past six months (from pensions, investments, etc.) or that they've had savings of about $23,500 over the past year.
Permanent resident applicants need to show proof of at least $2,325 in income over the previous six months, or savings of $93,000 during the preceding year.
Stay tuned for any changes to Mexico's visa requirements as a result of the country's recent election.

1. Costa Rica

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Costa Rica's Southern Zone is gorgeous and convenient.

Our winner for 2018's top affordable retirement spot is Costa Rica, with its famed pura vida lifestyle, safety and stability, and fantastic travel opportunities.
Costa Rica's Pacific coastline, known as the Southern Zone, is very popular with North American expats.
Offering sunny beach living near the region's amazing biodiversity, southern towns like Dominical, Ojochal and Uvita have lots of amenities including restaurants, markets, and public and private medical clinics.

How to retire to Costa Rica

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You can retire to Costa Rica if you can show income of at le

To get and keep residency under the pensionado program for retirees, you’d have to show proof of at least $1,000 in monthly income from a recognized source like Social Security or a state retirement fund.
Note that IRAs and 401(k)s are not recognized here. You’d also have to pay a percentage of your monthly income into the public health care system. Most expats opt for higher-quality private health care, for an additional cost.
Costa Rica is stable thanks to its influx of tourism dollars, and the living is quite safe as long as you show some common sense. If you haven’t been to Costa Rica yet, then isn’t it about time to check it out?

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