Exercise is good for us: boomers and our aging parents

This is worth a couple of minutes of your time to read: http://cbc.sh/0ctW9JL.

It's a good CBC News story about the benefits for the eldery to exercise. It's an easy read, but the message is important for all of us pressing into their late fifties and over.

Flu shots important for aging parents, yourself


            “I never get the “flu”. I often hear that from patients, colleagues and friends. After awhile the public seems to ignore news about the “flu”. When reports first came out of Mexico about the “swine flu” in 2012 (more accurately called H1N1) and the number of cases mounted and the World Health Organization issued reports about the potential for a world-wide outbreak (pandemic), the media issued reports every day which caused a great deal of concern in the US and Canada.

            However, as it became clear that for most people who contracted H1N1 infections, the cases were mild, there seemed to be a sense of boredom on the part of the public about the risks entailed in this “flu” outbreak. The excessive media focus on the outbreak may have done an inadvertent disservice to public health officials who were trying to prepare the public for the upcoming “flu” season. The fact is, it’s important to get a flu shot each year to ward off illness for aging parents and yourself and family.

Personal History of “Asian Flu”

            As a teenager growing up in Brooklyn I contracted the Asian “flu”. I recall how terribly ill I was, being bed bound for a week with high fevers and excruciating muscle pains. The Asian influenza outbreak of 1957-1958 was followed years later by the Hong Kong outbreak of 1968-69. In both outbreaks it is estimated that hundreds of thousands if not more people succumbed to the illness directly or indirectly due to underlying chronic illnesses worsened by the infection. This was especially the case in the senior population.

            One problem with the public’s recognition of the potential seriousness of such outbreaks is that we have tended to use the term “flu” for a disease which rightfully should be called influenza. The term “flu” is used almost dismissively for almost any type of viral infections, many of which are minor in nature and have nothing to do with influenza. Sometimes health care professionals will describe non-specific illnesses with fever and respiratory symptoms as the “flu”. Since these illnesses are usually not serious, the whole idea about the potential catastrophic nature of true influenza is lost. Telling people to get the “flu shot” even when used by public health officials may be perpetuating the false sense of security about influenza being relatively innocuous.

            People who refuse the vaccine often justify their decision with, “I never get ‘the flu’ or last year I got the ‘needle’ and got ‘the flu’ anyway so what good did it do?” Then there is always the story about someone they knew or heard about who got the ‘flu shot’ and got sick or died or was paralyzed or some other perceived and often unsubstantiated disaster. Most of these stories are erroneous and part of the well-known tendency to propagate myth as if it is fact, especially when it is self- serving.

What to do?

            The first and most important point for you, your parents and health care professionals to understand is that characterizing influenza as “the flu”, especially when it is preceded by the phrase “it’s just” is very misleading. Influenza can be a very serious and potentially lethal disease. The influenza outbreak of 1918 following the First World War killed more people than that terrible war itself. According to the website of the CDC (Centers for Disease Control and Prevention in the US): For everyone, getting vaccinated each year provides the best protection against influenza throughout flu season. It’s important to get a flu vaccine every year, even if you got vaccinated the season before and the viruses in the vaccine have not changed for the current season.

Historical Perspective Should Inform Us

            The development of influenza vaccine during the Second World War and its improvements subsequently has been one of the great advances in medicine. We have been very fortunate in the United States and Canada in that the vaccine is readily available to the population and in some jurisdictions it is available without cost to everyone. Manufactures are trying to include a fourth strain of influenza into the 2013-2014 vaccine repertoire so that we can decrease its risk on our population. So remember, “it’s not the ‘flu’ – it’s influenza’- get the ‘shot’ and encourage everyone in your family, especially aging parents to do the same.

Giving thanksgiving with our aging parents

Thanksgiving is upon us. It’s a great time to remember that those aging parents who now need some of our support for years selflessly supported us.

The Thanksgiving tables are turning for Boomers and many others with older parents who aren’t as able to look after all their needs as they once could. Now, it’s our turn to help out, whether they’re experiencing some degree of Alzheimer’s, Parkinson’s, or any cognitive or physical challenges.

Remember Thanksgivings from years ago, the sense of family, that amazing meal, the wonderful tastes, the sense of total contentment after a mega-meal?

Well, if you do, help make this Thanksgiving just as memorable for your older loved ones. Let them know they’re important, and give thanks together for being able to be together. Thanksgiving with our aging parents is special ever time we can share it.

New study rates elderly well-being high in Canada

A new study rates elderly well-being high in Canada. Just released by the United Nations, the study ranks the well-being of the elderly as being fifth best overall of the 91 nations studied.

See more in the Globe & Mail story: http://www.theglobeandmail.com/news/world/canada-ranks-fifth-in-well-being-of-elders-study/article14621721/

Taking to bed: an undercover problem


            Staying in bed is not a “normal” aspect of aging, other than for the occasional day or two which may occur as part of an underlying short-term illness. Most people want get out of bed and greet the day as soon as they can. So if an elderly loved one ‘takes to the bed’ and stays there, a full health evaluation and possibly intervention for depression, should be done.

Proper Assessment Is Essential

            The most important aspect of an in-home assessment is discovering any underlying medical problems that could cause someone to ‘take to bed.’ Clearly, any distinctive physical symptoms—such as pain or shortness of breath— that are relieved by staying in bed will need to be addressed.  In the absence of such fairly obvious physical symptoms, major depression ought to be considered.  Older men in particular have a significant risk of late onset depression, a condition that is easily overlooked, especially when the person denies feeling depressed.  Not every depressed person expresses negative or ‘blue’ thoughts, or mentions feelings of hopelessness or helplessness. Fortunately, treatment for depression, which might include medications or other therapies, is usually effective. 

What’s Wrong with Staying In Bed?

            When older people start taking to bed and refuse to get up, it makes perfect sense to them.  “I don’t have the energy or interest to get out of bed,” or “I just feel better being in bed,” are common explanations. But bed rest of more than a day or two very quickly becomes problematic, causing muscle tone and functional ability to deteriorate so that after a short period of being in bed, the person may indeed have difficulty performing everyday activities. Sometimes, physical condition can deteriorate seriously, leading to the need for hospitalization and urgent medical intervention. Family members often have a difficult time persuading their loved ones that staying in bed is bad for them. 

A Return to Meaningful Mornings and Engaging Days

            ‘Remaining in bed’ may not sound serious, but it can be symbolic of an important underlying condition which needs to be addressed and treated quickly and properly by the whole team of those who care for the older person. Sometimes, especially for the person who is living alone, moving to the more engaging and supportive environment of an assisted living facility may be worth considering. Ultimately, the ‘best decision’ is whatever helps the person look forward to getting out of bed and participating in the world around them. 

Elder care living choices: decisions are not easy

    It is a fairly common scenario: the daughter who was the primary care giver of her 84 year old mother was sitting together with her in my office. “I feel a lot better since that visit to the emergency room in the summer when they changed my medications. I have not had any more dizzy spells or falls.”  The daughter concurred and I confirmed from the discharge summary of the finding following a fall that was found to have blood pressure levels that fell when she stood up as well as a slow heartbeat.  It was believed to be the result of a combination of medications for her high blood pressure which were producing an excessive effect, leading to “postural hypotension” (an excessive fall in blood pressure when standing) 

The real issue beyond the medical care

    I was told that since the fall the mother was living in her daughter’s home; the mother’s apartment had suffered water damage during a rainstorm that required repairs. It was not yet certain if she would feel secure enough to return and live on her own, even though that was what she was appeared to prefer. The mother had mild cognitive impairment; but her every day and basic functioning was normal. She was able to care for herself in most ways despite being a bit repetitive. She expressed herself quite clearly and made reasonable sense about what was happening to her.

    The daughter asked quite bluntly after the assessment, “Do you think my mother should move into a retirement home rather than living with me? During the day she is alone in the house but we have checked it all for safety and she has an emergency call system which she knows how to use” I asked the patient and asked her how she felt about living in her daughter’s house. Other than musing that returning to her own home would be her preference she stated that she felt quite comfortable living with her daughter. The house was arranged in such a way that she could do everything she wanted to do and be comfortable on the modified ground floor.

Conflict between siblings

     The daughter continued, “My sister who lives in Toronto and brother (who lives in New York) feel she should in a retirement home for safety reasons. On their urging our mother tried one that seemed very nice and suitable but after three days she called and begged to be taken back to my house. They are now looking at others but my mother insists on staying at my house if she cannot return to her own apartment.”  

How such living decisions should be made

    Making elder care living choices is not easy. I explained to mother and daughter the principles according to ethics and the law, by which such living decisions should be made. The important point was the apparent ability of the mother to participate in such decisions.  I explained to the daughter and patient, “I think you and your siblings need a good discussion with someone who understands the process of personal decisions and how alternative housing arrangements should be made. Arrangements were therefore made for a family meeting with a social worker. The mother seemed very pleased that her wishes were being listened to and respected—that step and process is key to any such discussions. Being the daughter who in this case was the proverbial “It” in the middle of family discord is not easy.