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.

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

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

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

Will steroid injections for knee issues really help?

Posted on May 2017 by

There has been much debate how to deal with 'bad' knees.

And more and more aging boomers and their elderly paretns have knee issues of some kind.

But will steroid injections for knee issues really help?

Here is a current CTV News report that makes one wonder.

Read it here: http://www.ctvnews.ca/health/study-questions-steroid-injections-for-knee-arthritis-1.3424724

Why bother buying time and looks when you’re aging?

Posted on May 2017 by

Most all of us who are aging are busy buying time and looks.

Just saw a piece on BBC UK online that said seniors can buy five extra years with enough and the right kind of exercise.

Yesterday, saw an article that claimed various seaweeds help us stay healthier and live longer.

Continue reading “Why bother buying time and looks when you’re aging?”

Falling down: Accept your fate and roll with it

Falling down: Accept your fate and roll with it is a very timely and helpful piece that appeared in
The Globe and Mail Metro (Ontario Edition) on January 26, written by KATE MURPHY
KATHY OSBORN of the New York Times. It's a good 'heads up' for aging boomers and our elderly parents and other loved ones.


Rare is the individual who hasn’t tripped over a pet or uneven pavement, tumbled off a bike, slipped on ice or maybe wiped out skiing or skating.


Some get injured while others go unhurt – often claiming it’s because they knew how to fall.

Continue reading “Falling down: Accept your fate and roll with it”

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.