Age Related Health Changes and 12 Things We Can Do

Pronounced health changes are more obvious in advanced ages of 85 and older but there is also a great variability among all individuals depending on the impact of genetics, lifestyle factors, response to illness and even stress.  It is always a pleasure to see an active, vibrant, high functioning person in their 90's enjoying quality of life in their community; they serve as a positive role model for us all, giving us hope to join the growing number of healthy centurions in our current population.  Sadly, others in their 50's and even younger succumb to a lesser ability to function and must manage a poor quality of life often in a medical institution.  Normal aging brings causes the following normal changes:

Cardiovascular system: Arteries and heart valves become thicker and less pliable; diminished peripheral pulses and circulation. A decline in body temperature is noted as the baseline oral temperature in older adults is 97.4F versus 98.6F in younger adults.  There is a higher risk for fluctuations in Blood Pressure, arrhythmias, or syncope.

Pulmonary system: Respiratory muscle strength becomes weaker, mucus membranes drier and cough reflexes begin to diminish.  Our bodies are less tolerant for exercise, higher risk for aspiration, night time breathing issues and ability to fight upper respiratory infections.

Genitourinary system: Overall a decrease in creatinine clearance due to changes in kidney mass, blood flow and drug clearance.  Decreased bladder muscle tone, capacity and hormones cause higher urine residuals post voiding and increased night time urination.  There is a higher risk for adverse drug reactions, renal injury, dehydration, hypo/hypernatremia, hyperkalemia, volume overload causing heart failure, urinary urgency or incontinence, urinary tract infections and even potential for falls.  For men, a higher risk of enlarged prostate.

Integumentery system: Loss of collagen causes thinner, drier skin with less elasticity which is more prone to sunburn, cuts, tears and abrasion.  Overexposure to the sun earlier in life can cause skin melanoma later in life.

Musculoskeletal systems: Muscle mass and strength decline throughout the whole body.  Lean body mass is replaced with fat and redistributed.  Bone loss especially in women causes osteoporosis; tendons and ligaments become tighter, less flexible.  Intervertebral discs shrink and degenerate, cartilage erosion and changes in posture  may occur with a reduction in height or posture.  These changes not only limit our joint flexibility and range of motion but also increase our risk of falls, unsteady gait, bone fracture, joint inflammation and arthritis.

Oral-Gastrointestinal systems: Even the oral muscles of mastication become weaker along with dental changes cause difficulty chewing or receiving adequate nutrition.  Our perception of taste and thirst becomes impaired.  There is decreased motility throughout the gastrointestinal system causing slower stomach emptying, impaired defecation and malabsorption of nutrients.  The liver has a decreased ability to metabolize medications.  This places us at higher risk for adverse drug reactions, constipation, GERD, or NSAID-induced ulcers.

Nervous system and Cognition: Aging causes a decline in the number of neurons, support cells, synapses and neurotransmitter chemicals produced.  This contributes to overall muscle weakness, decline in reflexes, slowed motor skills and potentially impaired balance and coordination.
Temperature sensitivity is diminished and there may be a blunted or absent fever response.  Cognitive processing is slowed and some decline is common but not universal.  There is a lesser need for sleep time but a higher risk for sleep disorders, delirium and neurological diseases.

Immune system:  Dysfunction of the immune system will increase the susceptibility to infection while increasing the risk of chronic inflammatory diseases.  There may even be a reduced efficacy of vaccinations. 

WHAT CAN WE DO?

1. Get annual wellness dental and medical check-ups to monitor age related changes, obtain early intervention/prevention which will minimize risk factors that could be corrected. Obtain annual preventative testing for early detection of disease: i.e.. Mamography, lab tests.
2. Consider lifestyle changes that will promote healthy successful aging. ie stop smoking, minimize alcohol intake, reduce stress.
3. Keep immunizations current.
4. Emphasize weight bearing exercise, strength and overall fitness: walking, weight training are the best, while swimming, cycling and aerobics are good too.
5. Emphasize stretching all joints and maintaining an erect posture: Yoga is great!
6. Exercise your brain cells with memory and analytical games: Puzzles, Crosswords, Word finding, mathematics, reading and other intellectual stimulation.
7. Eat a well balanced, high fiber diet along with vitamin supplements.  Monitor and maintain a healthy weight.  Women should supplement their diet with 12-1500mg Calcium and 1000 Vitamin D daily.  Check with your doctor regarding recommended vitamin supplements specific to your needs.
8. Stay well hydrated with water.  Minimize soda, caffeine, alcohol consumption.
9. Remove household trip hazards such as area carpets, long cords and keep a safe pathway from bed to bathroom especially for night time toileting; consider night lights along this path.
10. Practice good sleep hygiene. 
11. Monitor skin for changes that may require medical attention, use daily body lotion.
12. Know and examine your body from head to toe; question if changes seem to be normal or abnormal.  Question if suggested medications are right for you.  Keep a record of your personal health history and current medications readily available for doctor visits or in case of any emergency.

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WHAT IS SUNDOWNING AND WHAT CAN BE DONE?

Anyone with acute or chronic confusion may become more confused, restless, agitated and anxious in the late afternoon and especially after dark when the sun goes down or seasonally when there are fewer hours of sunlight.  This may happen whether the person is living at home ore in a facility.  The sundowning behavior can worsen following a move or change in routine.  Individuals with sundowning behavior become more demanding, upset, suspicious, disoriented and see, hear, believe things that aren't real or pace/wander.

Those with Alzheimer's Disease act as if their biological clocks are "reset."  These individuals may stay up all night alert and full of energy despite all interventions to encourage them to sleep in bed; then, they will continually doze on/off during the day.  The reasons for these changes in the sleep-wake cycle in Alzheimer's Disease is not known.

The reason for sundowning behavior is also not known. One theory is that there are fewer environmental clues at night when daylight and eyesight is diminished.  Some scientists believe it may be related to the biological clock in the brain which regulate the amount of hormones and other chemicals important for brain function.  If the biological clock is not properly functioning, the brain itself may not be able to properly function as well.

What can be done for those with abnormalities to the sleep-wake cycle?  It can be a very frustrating problem to deal with, but the following suggestions may be worth a try:

1) ACCOMODATE TO THEM.  Granted, this may be the most difficult and costly approach.  Accommodating to the person's new routine must include keeping them in a locked/secured environment and awake night staff for full supervision as well as ongoing stimulation during their awake periods. They could rest and snooze throughout the day to insure they are adequately rested.

2) MEDICATIONS.  It may be appropriate for the doctor to review all medications to consider discontinuing any non-essential medications which may have an effect on sleep.  Other medications that may reduce anxiety, relax muscles or induce sleep may be considered.

3) ASSESS PAIN.  Pain keeps people from sleeping, or may wake them up from sleep.  With some forms of dementia, communicating or expressing one's pain may be impaired.  Those with complex medical problems in addition to dementia may also be affected by musculoskeletal or other source of pain.  In some cases, a trial of a relatively benign pain medication such as Tylenol may be justified.  If sleep problems are in part due to arthritic pain, aspirin or Tylenol may decrease musculoskeletal pain so that the person can sleep more comfortably.

4) ADDRESS NIGHT TIME TOILETING.  Many older persons awaken many times a night to urinate and then are unable to return back to sleep.  Identify if there might be a urinary infection, provide a bedside urinal or commode to minimize walking through the house activity.  With less physical activity involved to manage night time urination, individuals may fall back to sleep more easily.

5) UTILIZE NIGHT LIGHTS.  Elderly individuals may also have low vision which is exacerbated at night.  A small night light helps to orient and minimize agitation if the individual wakes up and becomes frightened by strange surroundings.  Night lights can also be placed to mark the pathway to the bathroom.

6) KEEP A STANDARD, DAILY ROUTINE.  While caregivers may change from day to day, it is helpful to keep a standard daily routine for any individual with dementia.  A standard daily program for wake-up time, meals, medications, toileting and bedtime routines should be followed by all caregivers to provide consistency.  The daily routine should also include physical activity and other mentally stimulating activities which will help to reset the awake-sleep cycle as well as maintain optimal function. A consistent program reduces anxiety so that an individual will also learn to anticipate what will happen next rather than begin to worry or become anxious wondering when they will eat, get their meds, toilet or go to bed.  Make a written program which is followed by all caregivers 7 days/week.

Stroke Recovery: Alternative Treatments: Acupuncture

Stroke is the second most common cause of death (after coronary heart disease) and the leading cause of adult disability in the US today.  Approximately 700,000 strokes occur each year in the US leaving 500,000 survivors with residual disability.  Forty percent of those survivors have moderate impairment and functional limitations related to motor function and basic mobility, while 15-30% are severely disabled.  Physical therapists and other professionals focus recovery on relearning normal patterns of movement or facilitating a rebalance of muscle tone.  In an attempt to further improve outcomes of stroke rehabilitation alternative treatments such as acupuncture or electroacupuncture (EA) are being evaluated for their efficacy in improving functional recovery after stroke.  Acupuncture/EA has been used in eastern medicine for thousands of years to enhance stroke recovery.  It has only been in the last decade that studies of brain function with computed tomography (CT) scan and magnetic resonance imaging (MRI) has substantially expanded our understanding of neuronal recovery and their modulation by various rehabilitation interventions.

The mechanism by which acupuncture increases cerebral blood flow is not fully understood but immunohistochemical analysis in animals suggests an enhanced expression of vascular endothelial growth factor.  Clearly, post stroke outcome is dependent on stroke severity in the acute phase and that patients with intact cortical function have an advantage to better participate with motor recovery.  The location of the lesion site plays a significant role in the responsiveness to any therapeutic intervention as does the type of stroke: ischemic vs. hemorrhagic.    During the functional reorganization of  neural pathways following a stroke, therapeutic techniques rely on the neuroplasticity of the brain to achieve improved motor abilities and functional outcomes

Current evidence for clinical efficacy of acupuncture/EA for stroke recovery is promising but still controversial; it's efficacy as an adjunct to standard post-stroke rehabilitation programs can be demonstrated with accurate treatment intervention using electrical stimulation over acupuncture points, proper selection of patient and functional outcomes measures.  Additionally, acupuncture/EA may be helpful in treating pain, sleep disturbance, anxiety, depression, or other conditions which are common in stroke and often a barrier to recovery.

Honest Communication with Seriously ill Patients

It is not easy to tell patients they are going to die.  Despite the fact that chemotherapy delivered to cancer patients with a poor prognosis is intended only to provide palliation, not a cure, a majority of patients with metastatic cancer have false expectations regarding the curative potential of the treatment.

This raises the question of whether the needed patient-physician conversations about palliative and end-of-life care are even taking place.  Patients who do not know whether a treatment offers any possibility of cure may be compromised in their ability to make informed treatment decisions that are consonant with their preferences.  This misunderstanding could represent an obstacle to optimal end- of-life planning and care.

If patients have unrealistic expectations of a cure from a therapy that is administered with palliative intent, there is a serious miscommunication that needs to be addressed.  Studies have shown that two-thirds of doctors tell patients at the initial visit that they have an incurable disease, but only about a third actually state the prognosis.   It is not easy to tell patients that they are going to die and many physicians choose not to do this.  It might explain why two months before death, many patients with cancer have not heard any of their doctors use the word "Hospice."

Most patients want to know whether or not they can be cured, and physicians can provide them with the information they need in order to plan for their remaining life.  If patients are offered truthful information on what is going to happen to them, they can choose wisely and physicians can help them make these difficult decisions. 

Helping seriously ill patients and their families to become proactive in understanding and seeking the services of palliative medicine and Hospice care is the focus of a new educational campaign from The Joint Commission. "Speak Up: What You Need to Know about Your Serious Illness and Palliative Care," the program offers free downloadable brochures, videos and posters.  Topics addressed in the brochure include how and when to get palliative care, questions palliative care specialists may ask patients, questions for patients to ask their palliative care providers and where to get more information.  www.jointcommission.org/topics/speakup_brochures.aspx

The Villas in Antioch, Martinez and Alamo work together with families, residents, physicians and Hospice or Palliative care agencies to insure there is clear and honest communication with patients living with serious illnesses.  We are proud to assist guiding residents and their families through one of life's most challenging times with clinical expertise and compassion.  Please contact us if we can assist you with placement of a loved one, or just information regarding eldercare services.
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Vitamin D deficiency ages bones

A recent study conducted by American and German scientists found that vitamin D deficiency not only inhibits the formation of new bone but also accelerates aging of existing bone, according to an article in Medical News Today. The study appears in the journal Science Translational Medicine.
Robert Ritchie, leader of the American team from the University of California, Berkeley, said, “The assumption has been that the main problem with vitamin D deficiency is reduced mineralization for the creation of new bone mass, but we’ve shown that low levels of vitamin D also induce premature aging of existing bone.”
Vitamin D helps the body absorb calcium. When a person becomes vitamin D deficient, his or her body takes calcium from the bone to replenish blood calcium levels, which can lead to rickets (in children), osteomalacia, or osteoporosis. According to Björn Busse, leader of the German team and a scientist at the University Medical Center in Hamburg, “Unraveling the complexity of human bone structure may provide some insight into more effective ways to prevent or treat fractures in patients with vitamin D deficiency.”
The study highlights the importance of continually monitoring and maintaining vitamin D levels in patients who are at risk for vitamin D deficiency. The article suggests that vitamin D deficiency is a growing problem in the United States.
It is not too late to start adding vitamin D to your daily regimen. Patients 65 and older stand to benefit from everyday vitamin D supplementation. In 2012, the U.S. Preventive Services Task Force suggested that supplemental vitamin D combined with exercise can reduce the risk of falls in individuals who are at an increased risk. To reap the benefits, it is crucial that patients take a high enough dose as determined by a physician. The American Geriatrics Society recommends that patients with proven vitamin D deficiency take at least 800 IUs a day.

Please visit us at VillaCareHomes.com   We care about the physical, social, mental and emotional needs of our residents.

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