A housing crisis for seniors

According to this informative article that appeared in the New York times, we are into a housing crisis for seniors. This should not be a suprise to any of us who have or will confront the challenge of finding quality, affordable housing for our elderly parents when they need it.

Read it here:  https://nyti.ms/2jBSNHu

 

 

How can we look after our aging brains?

How can we look after our aging brains? If you're interested, the following article from the January 4th issues of the Los Angeles Times is a must read. 

The aging brain is a shrinking brain, and a shrinking brain is, generally speaking, a brain whose performance and reaction time are declining: That is a harsh reality of growing older.

But new research shows that brain shrinkage is less pronounced in older folks whose diets hew closely to the traditional diet of Mediterranean peoples — including lots of fruits, vegetables, legumes, nuts and olive oil, little red meat and poultry, and regular, moderate consumption of fish and red wine.

In a group of 562 Scots in their 70s, those whose consumption patterns more closely followed the Mediterranean diet experienced, on average, half the brain shrinkage that was normal for the group as a whole over a three-year period.

To glean how diet might influence brain aging, researchers tapped into a large group of Scottish people who were all born in 1936 and had many measures of health status and lifestyle tracked from an early age.

Around the time they reached age 70, 843 members of the “Lothian Birth Cohort” filled out a dietary frequency form that gave researchers a broad look at what foods they ate, which they avoided, and how often they consumed them. At about age 73 and again around age 76, their brains were scanned to gauge the volume of the overall organ and a few of its key components.

The researchers used the food-frequency surveys to divide the group into two — those who at least approximated a Mediterranean-style diet and those who came nowhere close. Even though many in the Med-diet group were far from perfect in their adherence, the average brain-volume loss differed significantly between the two groups.

Findings on the impact of Mediterranean diet on healthy aging have been pretty strong — this is generally a good way to eat. Studies large and small have established that following a Mediterranean diet is effective at driving down heart attack, stroke and premature death risks, and improving the health conditions — including hypertension, worrisome cholesterol levels and metabolic problems — that raise those risks.

But researchers are less sure of the particulars of how the diet promotes better health.

In recent years, studies have sought to tease out not only how great the benefits are, but how they work: whether healthier brain-aging is a function of better vascular health or preserved brain volume, and whether the diet’s advantages lie in its dearth of red meat, the positive effects of the fatty acids in fish or olive oil, or the combined benefits of its plant-based foods.

Researchers also must demonstrate that, in their measurements of dietary intake and health, they’re not actually capturing well-understood relationships between intelligence, education and long-term health: People with certain cognitive strengths do better and stay longer in school and earn more; yes, the better educated and paid may consume healthier diets, but they are generally healthier anyway, so maybe the healthier diet is incidental.

The newest study, published Wednesday in the journal Neurology, helps untangle many of those mysteries. But it also leaves many questions unanswered.

Contrary to some research findings on the Mediterranean diet, the findings suggest that reduced brain shrinkage is not specifically linked to low intake of meat and high intake of fish. Maybe, the authors suggest (and many researchers believe this), the magic in the Mediterranean diet is all those plant-based foods, acting collectively to improve subjects’ cognitive health.

The study also finds that subjects across the spectrum of intellect and educational attainment reaped the benefits of the Mediterranean diet in reducing brain shrinkage (or, alternatively, suffered the effects of diets that departed sharply from that diet’s emphasis on plants, fish and polyunsaturated fats). That suggests the researchers are not wrongly crediting subjects’ dietary choices for advantages that may actually stem from higher intelligence and educational attainment.

Finally, the researchers wrote, the study’s design helps establish that the brain-shrinkage rates seen are likely to be the result of dietary patterns, and not just an association. That’s because the subjects’ dietary patterns were measured first, about the time that participants reached 70 years old. Their brain volumes were then measured by imaging scans three and six years later.

Assuming that people did not dramatically change their dietary patterns — a shift that is considered unlikely for folks in their 70s — researchers believe that the dietary habits that Scots reported as they entered older age played some role in the brain changes they detected further down the road.

Left unexplored here is whether a midlife shift toward the Mediterranean diet could have the same effects, or whether the group differences in brain volume are the rewards or penalties for a lifetime of dietary choices.

There’s good evidence that, when it comes to making better dietary choices, earlier is better. In a 2013 study of more than 10,000 women, researchers found that those who followed a Mediterranean-style diet in their 50s and 60s were about 40% more likely to live past the age of 70 without chronic illness and without physical or mental problems than were those with less-healthy diets. 

Antipsychotic medications are warranted, but being relied upon far too often in seniors with dementia

Antipsychotic medications are warranted, but are being relied upon far too often in seniors with dementia.

Here is a recent Globe and Mail article exploring this important issue: Read this on The Globe and Mail

Nursing home drama: wrong treatment

This is an email from a long time friend on the west coast. 

Her point is simple and poignent… a nursing home drama: wrong treatment.

Her challenge: how to help her failing fahter.

It's not pretty, and so many of us experience the same trauma. 

Please read on.

On Thursday, dad's geriatric psychiatrist contacted me to discuss his treatment. The facility is saying he is being aggressive, so they are looking at his meds to adjust. Less than a half hour later the doctor called me back asking if the facility had contacted me because they are indicating they will send him to emergency where he will essentially be sedated. The doctor doesn't agree with this and has him on the waiting list to get into the geriatric floor at the hospital. 

Dad is physically fine, he gets around and is busy. He tends to get into other people's rooms and moves everything around and tries to fix things. His eyesight is really bad, so he feels for things. One care aide at the home is calling this aggressive behaviour. He has had a couple of incidents, but they were because he was alone and could have been redirected, no one was hurt or even close to being hurt. Dad jokingly does a one two jab action, then laughs. It is a jest, not aggressive whatsoever. His main care aides say he is the least aggressive person, but busy and gets into things. The facility have told us we have to be there from the time he wakes until he goes to sleep or they will send him to emergency here he will be sedated and returned to the facility or he may not have anywhere to go. 

The home has a lack of staff and often there is often no LPN on his floor. If they are on breaks there is no one there. This is a dementia unit for high needs patients. They will move in temporary replacement staff that do not have dementia training, nor read the patients charts and make comments such as why are we even feeding these people.

They have lost his shoes, his dentures, his glasses, they don't shave him and I have to ask for him to be changed. They are supposed to contact us when incidents occur and they haven't.

It is appalling. I am putting in a formal complaint to the health authority, licensing board, and ministry. The disease is hard enough on its own without having to deal with the system. Not sure why I am sharing, except that I know you went through the disease part. This is not the norm as far as care, is it? I am working with the doctor and hopefully we can get him into a place that has adequate care. 

Maybe you need a follow up book on how to ensure your parent is being cared for?

Clearly, her father needs the right kind of care. 

He seems to need regular attention and care. And a way to vent his interets and energy.  It seems he's not violent or dangerous. But ongoing stimulation may be needed.

Bottom line: the system needs stronger checks and balances. It needs to be able to effectively understand and manage the needs to those who are suffering from various stages of dementia. 

 

Free course about understanding dementia

We tripped across this multi-week free course offered online by the University of Tasmania in Australia. We did not sign up, but we did poke around and it looks interesting, engaging, and helpful. 

It's worth checkng out. 

Go here: https://mooc.utas.edu.au/?utm_source=Facebook&utm_medium=Landing%20Page&utm_campaign=UDMOOC

Medications and the elderly: some good advice

Here is an excellent recent article in the Globe & Mail about medications and the elderly. Well worth the read and some reflection. 

THE QUESTION
My mother is in her 70s and suffers from a lot of health problems. I am very worried that she has been given too many different medications that are too strong for her. What should I do?


THE ANSWER
It’s possible that your mother may need all the drugs she is currently taking. But it’s also true that patients sometimes get prescribed drugs and remain on them when they are no longer required.
“Doctors are really good at starting medications, we are not so good at stopping them,” says Dr. Kimberly Wintemute, the primary care co-lead of Choosing Wisely Canada, an organization dedicated to reducing unnecessary medical treatments.
During a hospital stay, for instance, a patient might be given a sleeping pill or a heartburn drug and the prescription keeps getting renewed.
Over time, a patient can end up on a growing list of medications. About twothirds of seniors living in their own homes take five or more drugs, according to data collected by the Canadian Institute for Health Information. One-quarter of seniors are prescribed 10 or more medications.
Each new drug that’s added to the mix increases the risk of adverse side effects and medication interactions.
» The elderly are especially vulnerable to these problems. Not only do they tend to have more chronic conditions than younger people, but the aging process can also change the way the body handles medications.
For instance, the liver and kidneys – which play a key role in processing and excreting drugs – tend to work less efficiently as we age.
In fact, the liver can sometimes become overwhelmed trying to handle several drugs simultaneously. As a result, certain medications don’t get “activated” and essentially won’t work.
“Picture a bus and everyone is trying to get on at the same time – some people are not going to fit and will be left behind,” explains Dr. Cara Tannenbaum, co-director of the Canadian Deprescribing Network, a group that is trying to prevent the inappropriate use of medications.
Furthermore, as we age, we lose muscle mass which is replaced with fat and that can cause problems because some drugs are stored in fat tissue. This means medications can linger longer in the body and thereby exaggerate their effects, Wintemute says.
Another concern is the government approval process for new medications. Drugs are usually tested on relatively young people with just one medical condition – not elderly individuals with multiple ailments. “We don’t always know how a new drug is going to act in very old and very frail people,” says Dr. Debbie Elman, the lead physician for the Academic Family Health Team at Sunnybrook Health Sciences Centre.
Patients may suffer from a host of side effects and drug interactions including confusion, dizziness, fatigue, constipation, diarrhea, incontinence, weight loss, depression, agitation, anxiety as well as sexual dysfunction. It can be difficult to tell if a particular symptom is caused by a medication or if it represents a new medical ailment. A patient might be wrongly diagnosed with dementia or another medical condition even though a drug is really to blame.
So, what can be done to reduce the risks posed by multiple medications?
First and foremost, a patient should get all medications at the same pharmacy, Elman says.
She points out that patients are often treated by several medical specialists – and each one may be prescribing different medications. No single doctor may have a complete picture of what a patient is taking. However, when all prescriptions are picked up at the same drug store, the pharmacist can check for potentially hazardous drug combinations.
The pharmacist can also conduct a review of a patient’s medications and help determine if some may no longer be appropriate.
For a thorough assessment, the pharmacist will need to know if the patient is also taking any non-prescription drugs, herbal remedies or vitamin and mineral supplements. It’s important to keep in mind that so-called “natural” health products may interact with medications and either reduce or intensify their effects.
Tannenbaum says many patients don’t know why they are taking certain medications or what they do.
She suggests that patients, or their family members, should use the website medstopper.com to learn more about their medications. Simply type in the name of a drug and up pops a great deal of useful information, including if a certain medication might be particularly risky for seniors. Another website, deprescribing.org, provides guidance on how to wean off a medication that may be harmful or is no longer needed.
Of course, patients shouldn’t quit taking a drug without consulting their medical specialists or family doctor. But by first talking to a pharmacist and checking out the recommended websites, they can at least have an informed discussion with the physician responsible for their medical care, Tannenbaum says.


Paul Taylor is a patient navigation advisor at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. You can find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

A very helpful guide to medical alert systems for the elderly

Since our very first book together in 2002, we've been big advocates to home safety measures for the elderly. We've both written and talked extensively about 'elder proofing' the home of our aging parents in a timely way. It's like having an insurance policy.

One critical component of home safety is having a reliable monitoring system. 

We have found a very interesting online site that reviews various products. One of its recent reviews was on home monitoring systems. It looks thorough, reliable, and unbiased. We thought you may find it helpful. It's here: http://www.reviews.com/medical-alert-systems/

Alzheimer’s in the family? Should you test yourself?

Here is a very thought-provoking recent article from the Globe & Mail about whether those of us caring for aging parents with dementia should consider getting ourselves tested to see if we have the gene that will more than likely ensure we end up with Alzheimers. It will make you think about this pressing dilemma. 

A blood test can reveal if you carry a hereditary gene, but many people decline to find out.


Marty and Matt Reiswig, two brothers in Denver, knew that Alzheimer’s disease ran in their family, but neither of them understood why. Then a cousin, Gary Reiswig, whom they barely knew, wrote a book about their family, The Thousand Mile Stare.

Continue reading “Alzheimer’s in the family? Should you test yourself?”

Elderly parents may be taking wrong medications

 

This is an interesting and worrysome article about how many aging people are taking the wrong medicines: http://www.ctvnews.ca/health/more-than-400m-a-year-spent-in-canada-on-drugs-that-harm-seniors-study-1.2956741

If you haven't, it might be a good time to ensure your aging parents and loved ones are taking the right meds. Talkk with them; ask their pharmacists to go over what they take. And don't forget over the counter medicines and vitamins.

How technology could help with dementia care

Here is a really interesting recent article on hoe evolving technology could do more to help in the home where demential is an issue and challenge:


A chance conversation was all it took to give Alex Mihailidis’s burgeoning career a new focus.
As a graduate student in 1996, the now 41-year-old met a man whose wife had developed dementia in her early 50s. Her bizarre behaviour, such as taking soiled toilet paper, folding it up and hiding it around the house, had her husband at wit’s end.

Continue reading “How technology could help with dementia care”