Minimize emotional pain among the elderly and aging

 

One always hopes that as medical practitioners, we will be able to focus our attention on the medical issues faced by seniors and help families cope with the fears, disappointments and tragedies that are faced by loved ones in the midst of what are often life-altering illnesses. In short, as physicians, we want to minimize emotional pain among the elderly and aging.

Throughout our initial medical training, and most often during post-graduate training programs, the primary focus in general is: what is the “best of medicine” and what does “evidence-based medicine” tell us about treatment decisions and their ultimate impact on health, well-being and, often, the likelihood of death? 

This is particularly the case in the care of the older adult – whether in geriatric medicine or eldercare.

What is often surprising and baffling, especially to younger physicians, is the situation where the core of what appears to be the challenge in care provision is negatively tinged by what might be called family “strife.” 

At times, however, a more appropriate term would be venomous, hateful actions—actions that ultimately will be destructive to the family fabric. This should not be 
surprising to anyone who has even a modest understanding and familiarity with the world of literature—whether limited to English works, or more broadly including European or other literature.

Those medical trainees who have worked with me have in all likelihood heard me either seriously or humorously say, “If I were king, all first degrees would be in English literature.” Or when there is a complex family dynamic playing out, I might say, “It’s King Lear—if you have not read it ever or lately, read it or read it again—it’s all there.”

Sometimes I feel like that great American comic Jimmy Durante, who was quoted as saying, “I have a million of them, a million of them,” referring to his often delectable jokes. According to an online biographical history, it has been said that “I’ve got a million of ’em” is what Durante (1893-1980) often said after telling a corny joke. Durante was credited with “I’ve got a million of ’em” in a 1929 newspaper story.

I say this when referring to complex family situations in which what appears to be the worst in human interactions seems to be playing out. Often the issue is related to money (or property), and if one is in a position to hear the story from all the parties, it often becomes clear that, for whatever reason, the pot has come to a boil at this juncture of life.

This is usually because the flame heating the water that’s not boiling has been on for what appears to have been many years. Most of us know of such stories, hopefully not in our own families, but it is unlikely that there is a family who is not familiar with a “Lear-like” scenario in someone close to them. 

Greed, jealousy, hurtful memories, mean-spirited personalities, events that occurred—sometimes decades earlier— that were never resolved or that left indelible scars are often the reasons cited for the enmity I have had the good fortune to observe that, on some occasions, especially when a parent, in particular, is dying, though it could be another relative, there is the possibility of repairing long held animosities and bringing long-estranged family members back together. 

It does not always succeed, but I have witnessed the monumental efforts of health-care staff—especially those in social work, nursing and medicine, although any and all of the health-care staff can be key—in bridging the emotional moat that often separates family members. It may not always work, but I believe it is always worth the effort.

Living with the result of lifelong family strife is often disabling, and the scars that occur and that are left can have long-lasting negative effects on people’s lives and their own abilities to have meaningful and binding relationships with their siblings and offspring.

We can delay onset of dementia

Here is a very thoughtful piece by the ever-helpful ANDRÉ PICARD in a recent Globe & Mail column. He notes from a study that in fact, we can delay the onset of dementia by taking some proactive steps for ourselves and our aging loved ones.

 

There are few things that aging baby boomers fear more than dementia, a condition that robs one of memory – and too often dignity – and leaves you dying little by little, piece by piece.
The numbers are frightful: An estimated 564,000 Canadians are currently living with dementia, and that figure is expected to rise to 937,000 within 15 years.


Globally, it is estimated that almost 50 million people are afflicted with dementia and that is forecast to rise to 131 million by 2050.


The data are grim – even without mentioning the impact on caregivers, the health system and the economy. Yet, there are little glimmers of hope – in particular, research showing that dementia is preventable, at least in part.


A study published in medical journal The Lancet shows one in three cases could be prevented or delayed if people took better care of their brains.


Based on a review of scientific literature and mathematical modelling, a panel of 24 global experts identified nine factors that increase the risk of dementia and how much those risks could be lowered if they were addressed:
Mid-life hearing loss: 9 per cent;
Failing to complete secondary (high-school and above) education: 8 per cent;
Smoking: 6 per cent;
Failing to seek early treatment for depression: 4 per cent; Physical inactivity: 3 per cent; Social isolation: 2 per cent; High blood pressure: 2 per cent; Obesity: 1 per cent;
Type 2 diabetes: 1 per cent. All told, the potential risk reduction adds up to 36 per cent – but, of course, health problems are easier to avoid in theory than in practice.


Still, some important lessons can be drawn from this list of modifiable risk factors. While things such as smoking and inactivity are commonly seen as lifestyle choices, they are largely symptoms of poor socioeconomic conditions.


That’s a reminder that, as Dr. Martin Prince of the Institute of Psychiatry, Psychology and Neuroscience at King’s College London writes in The Lancet: “Dementia selectively affects the old and frail, women and the socioeconomically and educationally disadvantaged.”
The research also drives home another key point: The brain changes at the root of dementia occur years before the onset of symptoms.


Dr. Antoine Hakim, emeritus professor of neurology at the University of Ottawa, stresses this point in his new book, Save Your Mind: Seven Rules To Avoid Dementia. While the script for dementia is written early, perhaps as early as our teenage years, he writes, the risk of dementia is modifiable – up to and including when symptoms of cognitive decline begin – because of the plasticity of the brain.


Dementia is caused by the death of brain cells. But Dr. Hakim notes that most cases are not Alzheimer’s – characterized by tangles and plaques in the brain – but caused by vascular problems such as high blood pressure and stroke. In other words, what’s good for the heart is good for the brain (and vice versa).


Of his seven golden rules for brain health and reducing dementia risk, Dr. Hakim’s No. 1 recommendation is to “save for a rainy day,” to grow the brain’s capacity and resiliency by exercising it like a muscle.


We can’t prevent dementia from killing people, but we can delay its onset. A one-year delay would translate into nine million fewer cases by 2050; a five-year delay would halve the prevalence of dementia globally in that same time period.


Want to stave off dementia? Read. Write. Play music. Be physically active. Be socially engaged. Eat healthy food. Maintain a healthy weight. Sleep well. Don’t sit mindlessly in front of the TV. Those simple counsels are the best tools we have in a world in which there are no drugs or treatments that prevent dementia.


There are 100 billion neurons, trillions of contact points known as synapses and 600 kilometres of blood vessels in the brain, and “everything we do – and don’t do – affects the health of these cells and their connections,” Dr. Hakim writes.


Dementia is not a natural consequence of aging. Risk depends, in part, on genetics, and on the lifestyle “choices” we make. (And we have to be careful with that word because major factors such as poverty and education are rarely a choice.)


As The Lancet notes, “dementia is the greatest global challenge for health and social care in the 21st century.” But it is not a runaway train. We have the ability prevent – or more realistically, delay – the disease. And keeping dementia at bay, even temporarily, can change a lot of lives.


We can save a lot of minds by using our heads.

Three lifestyle changes to help ward off dementia

Here is a recent excellent article that appeared on Global News online, written by carmen.chai@globalnews.ca

If you’re worried about keeping your brain healthy and staving off dementia, new research is pointing to three lifestyle changes you can make.

Keep your brain sharp with cognitive training, manage your blood pressure levels and always make time for exercise, American scientists say. While studies are still confirming their effectiveness, the study suggests they offer a “modest” effect in keeping dementia away.


“There is good cause for hope that in the next several years much more will be known about how to prevent cognitive decline and dementia, as more clinical trial results become available and more evidence emerges,” Dr. Alan Leshner, CEO emeritus at the American Association for the Advancement of Science, said in a statement.

Leshner is also chair of the committee that pulled together the report.

“Even though clinical trials have not conclusively supported the three interventions discussed in our report, the evidence is strong enough to suggest the public should at least have access to these results to help inform their decisions about how they can invest their time and resources to maintain brain health with aging,” he said.

In 2010, another review committee decided there was “insufficient evidence” to make recommendations about how to keep your brain healthy and away from disease. Since then, research has come a long way, though.


“The evidence is getting stronger that there are things we can do to potentially lower our risk of developing Alzheimer’s disease or another form of dementia. Previously, before this evidence came to light, people … said it’s luck of the draw if they’ll get this disease and there was a real sense of helplessness and lack and control,” Mary Schulz, director of education at the Alzheimer Society of Canada, said.

“There are no guarantees that if you follow these [lifestyle habits] to a letter that you won’t develop a form of dementia but we’re learning that they have some protective measures,” she told Global News.

Now, the scientists are pointing to three measures people can take:

Cognitive training

This includes problem solving, memory and speed of processing. It’s supposed to delay or slow age-related cognitive decline. Right now, research suggests that cognitive training can improve performance on a task, at least in the short term.

Learn a new language, take up chess or even take piano lessons. Stimulating your brain helps to reinvigorate it, Schulz said.

“It’s something new and it wakes up your brain, giving it a jolt and startling it. You’re also teaching it to adapt, and be flexible as you have messages fired around in your brain in a way it doesn’t normally,” she explained.

Managing blood pressure

Avoiding high blood pressure is key, especially in your middle years, between 35 to 65 years old, the scientists say.

It prevents stroke and heart disease, and in turn, prevents Alzheimer’s-type dementia.

Keep in mind, last year, Heart & Stroke doctors warned that there’s an “increasingly powerful” relationship between stroke and dementia.

“Stroke and dementia need to be studied together because in some ways they are one and the same,” Dr. Andrew Demchuk, director of the Calgary Stroke program and spokesman for the foundation, said.

“Stroke causes brain cells to die and this can precipitate dementia or worsen pre-existing dementia. There are different causes of dementia, and research now shows that stroke is a major contributor,” Demchuk said.

Stroke happens when blood stops flowing to parts of the brain, causing cells to die. Having a stroke more than doubles your risk of developing dementia later on in life.

Out of every 100 stroke patients without a past history of dementia, 16 are likely to develop dementia after their first or subsequent stroke.

Exercise

Physical activity comes with handfuls of benefits, including stroke prevention – they all benefit brain health.

The review pointed to a number of randomized controlled trials that found exercise being effective in keeping away cognitive decline.

You don’t need to run marathons to keep dementia at bay, but doing some form of physical activity goes a long way in keeping your brain young.

Exercise gets your heart rate up, which increases blood flow to the brain, nourishing cells with nutrients and oxygen. It also encourages the development of new cells, all factors in reducing your risk of stroke, Schulz said.

Gym memberships aren’t necessary — walk to the grocery store instead of driving, take the stairs instead of the escalator and get off of the bus two stops ahead on your way home.

Your brain is just like your heart. They’re both muscles that need to be given a workout to stay healthy.

 

Are we ignoring immunization needs of the elderly?

Are we ignoring the immunization needs of the elderly? The recent New York Times opinion piece by Louise Aronson, a professor of geriatrics at the University of California, San Francisco, offers an interesting proposition. about the needs of those in their 70s and up. Read it by clicking here:

https://www.nytimes.com/2017/08/11/opinion/sunday/vaccinations-elderly.html?action=click&pgtype=Homepage&clickSource=story-heading&module=opinion-c-col-left-region®ion=opinion-c-col-left-region&WT.nav=opinion-c-col-left-region&_r=0

Elderly financial abuse

ELderly financil abuse keeps getting a bigger issue.

As an elder, or more often as the child of an enderly parent or relative, please take a vary careful look at anything that's offered, foisted, pressed on you… 

We're seeing more and more scames being launched onto the elderly.

Please take a careful double look… examine, consider, and don't buy in right away!

See this site for more…

http://www.ctvnews.ca/5things/how-to-thwart-growing-threat-of-elderly-financial-abuse-1.3460984

Keep elderly on the move

Japan automakers look to robots to keep elderly on the move

TOKYO (Reuters) – Japanese automakers are looking beyond the industry trend to develop self-driving cars and turning their attention to robots to help keep the country's rapidly graying society on the move.

Toyota Motor Corp said it saw the possibility of becoming a mass producer of robots to help the elderly in a country whose population is ageing faster than the rest of the world as the birthrate decreases.

The country's changing demographics place its automakers in a unique situation. Along with the issues usually associated with falling populations such as labor shortages and pension squeezes, Japan also faces dwindling domestic demand for cars.

Toyota, the world's second largest automaker, made its first foray into commercializing rehabilitation robots on Wednesday, launching a rental service for its walk assist system, which helps patients to learn how to walk again after suffering strokes and other conditions.

Toyota's system follows the release by Honda Motor Co of its own walking assist "robotic legs" in 2015, which was based on technology developed for its ASIMO dancing robot.

"If there's a way that we can enable more elderly people to stay mobile after they can no longer drive, we have to look beyond just cars and evolve into a maker of robots," Toshiyuki Isobe, chief officer of Toyota's Frontier Research Center, told Reuters in an interview on Wednesday.

Speaking to reporters, he added that mass producing robots would be a natural step for the company which evolved from a loom maker in 1905 into an automaker whose mission is to "make practical products which serve a purpose".

"Be it robots or cars, if there's a need for mass produced robots, we should do it with gusto," Isobe said.

GROWING OLD

Japan is graying faster than the rest of the world, with the number of people aged 65 or older accounting for 26.7 percent of the population in 2015, dwarfing the global average of about 8.5 percent. 

As a result, demand for care services for elderly people has boomed and a shrinking working population means that fewer able-bodied adults are available to look after them.

Globally, sales of robots for elderly and handicap assistance will total about 37,500 units in 2016-2019, and are expected to increase substantially within the next 20 years, according to the International Federation of Robotics. 

At the same time, car sales in Japan have fallen 8.5 percent between 2013-2016, as older drivers stop buying cars while car ownership becomes less of a priority among younger drivers.

Like most major automakers, Toyota is still competing fiercely to develop self-driving cars, committing $1 billion to a robotics and A.I. research center.

Isobe conceded that it took Toyota longer to develop robots than cars, as it stretched the company further beyond its comfort zone. As a result, Toyota's new walking assist system took more than 10 year to bring to market.

"The biggest challenges have been in determining the needs of the robot market, which is relatively new, and to ensure that our products are safe," Isobe said.

Still, industry experts said that automakers were well placed to compete with medical technology companies including Switzerland's Hocoma and robot manufacturers such as ReWalk Robotics of the United States, both of which have developed robotic walking assist systems.

"Cars operate using engines and other components which enable mobility and control," said Nagayoshi Nakano, research vice president at Gartner Research's IoT Center of Excellence.

"On top of that, many of them have been partnering with the likes of Google and other companies looking at applying artificial intelligence, which will put them in a strong position to compete in robot services for the elderly."

 

Looks like dementia, but it’s not!

There is a disorder that's been identified that looks like dementia, but it's not! Apparently, it presents a number of similar symtoms and so can be disdiagnosed as some variation of dementia. However, in this case, it can be treated if identified correctly

To read more about this form CTV, look here: www.ctvnews.ca/health/little-known-disorder-looks-just-like-dementia-but-can-be-reversed-1.3373866

Care costs for aging parents higher

 

A recent CIBC study reported by CTV news reveals that the care costs for aging parents are ever higher and higher.

It notes that there are the direct costs of caring for aging parents, and then the indirect costs, like lost worktime.

Read the story here: www.ctvnews.ca/business/caring-for-aging-parents-costs-canadians-33b-a-year-survey-1.3402778

A last wish: to die at home

Have you heard this from an aging parent? "It's a last wish: to die at home".

I've heard that from hundreds of families.

And it's not an unrealistic wish.

There is a certain comfort and dignity to being able to die in one's own bed, in one's own home. Clearly this is not an option for a parent whose been institutionalized in a hospital or nursing home. Howevever, it seems that dying at home with the appropriate care for someone who is sliding toward the end can be accommodated. 

Hospic-like arrangements can be provided in the home, and ideally as much of the broader family would be engaged in the process.

This also can allow time to share memories, and if possible photos.

It's worth exporing if the circumstances are right.

Ultra sound for Alzheimer’s?

There is some interesting evolving research that might show some promise in treating Alzheimer's disease.

Is it possible: ultra sound for Alzheimer's?

Read this recent CTV News story of what is being done in Canada here: www.ctvnews.ca/health/alzheimer-s-patients-treated-with-ultrasound-to-open-the-blood-brain-barrier-1.3394807