by Specialdocs Consultants | Oct 6, 2022 | Healthy Aging, Patient News, Wellness
Senior Moments Or Something More?
As Baby Boomers continue the inexorable journey deep into their senior years, preserving cognitive function understandably tops the list of worries. While Alzheimer’s Disease and related dementias are seen in just 5% of people over 65, that number jumps to 30% for people age 85 and over. Questions abound: is forgetting a name a sign of normal aging or an indicator of a more serious memory disorder? Are any nutritional supplements or pharmaceutical treatments available that are proven to stave off memory loss? Most importantly, what steps can be taken to modify individual risk?
To better understand how to identify and manage dementia and Alzheimer’s disease, we asked one of the country’s leading experts, R. Sean Morrison, MD, for his informed perspective on this growing concern for seniors, their families and caregivers. A practicing geriatrician, palliative medicine physician and health researcher for almost three decades, Dr. Morrison has earned numerous awards and recognition for his work, and currently serves as the Chair of the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai and as Director of the Hertzberg Palliative Care Institute.
Is memory loss an inevitable, natural sign of aging?
Dr. Morrison: The good news is that not all cognitive functions decline with age. The ability to maintain attention, language comprehension, usage, and vocabulary does not decrease. Knowledge learned years ago like how to ride a bike, or brush your teeth, also stays intact. Additionally, when you learn something new and can remember it, you won’t forget it any more rapidly than when you were younger.
The not so good news is that it will take greater effort to learn those new things; more attention, repetition and use of memory-enhancing strategies will be needed. The ability to multitask is also diminished, as processing information takes longer and reaction times are slower. People may experience poorer performance when working under time pressure, and find it more difficult to manipulate information in the brain, such as calculating a tip in a restaurant or figuring out a route to travel from one place to another.
How do you distinguish between a “senior moment” lapse in memory and a sign of Alzheimer’s disease?
Dr. Morrison: So many people experience that temporary inability to remember a name. But if you are able to recall things with a cue or can pick it out from a list of possibilities, that’s evidence of a problem with retrieval but not with storage. You can be reassured that it doesn’t indicate Alzheimer’s disease but a “senior moment” because the information has been successfully stored in your memory.
Is routine screening for dementia recommended in older adults?
Dr. Morrison: The U.S. Preventive Services Task Force does not recommend for or against routine screening, saying no interventions are proven to have a significant effect in people with earlier detected cognitive impairment. However, it is required as part of Medicare’s yearly assessments, and most primary care physicians consider dementia screenings an essential part of their annual wellness exam.
What types of screening tests do you recommend?
Dr. Morrison: At least a dozen tests are available, each with their own benefits and drawbacks. I recommend the following for their ease of use and proven sensitivity and specificity in diagnosing cognitive impairment:
- Mini-Cog is a quick, three-minute evaluation. Patients are asked to repeat three words, draw a clock with hands at a specific time, and then recall the initial three words.
- Memory Impairment Screen assesses free and cued word recall. Patients are read four unrelated words from four categories (e.g. Red Cross, saucer, checkers, telegram) and after a few minutes of diversion, asked to recall the words in 20 seconds, either with no prompting or cued by category.
- Animal Fluency Test. Patients are asked to name as many animals as possible in a 60-second period.
Are there any risk factors for dementia and Alzheimer’s disease that can be controlled by patients?
Dr. Morrison: Quite a few risk factors are modifiable with lifestyle changes and non-pharmaceutical treatments. These include:
- Address hearing and visual impairments, with eyeglasses, hearing aids and other assistance
- Prevent and manage hypertension and diabetes
- Maintain a healthy weight
- Stop smoking
- Seek treatment for depression
- Prioritize regular exercise and physical activity
- Avoid social isolation
- Explore cognitive training
The best advice I can give to people in their 50s to 70s looking to prevent or delay progression of dementia and Alzheimer’s disease: exercise, exercise, exercise and rigorously control your blood pressure.
How are the symptoms frequently experienced by people with dementia – sleep disturbance, mood disorders, agitation – best addressed?
Dr. Morrison: There are a number of non-pharmaceutical interventions that have proven effective. Use adaptive clothing and assistive devices to help eliminate distress around bathing and dressing. Create a reassuring familiar structure to the day with a regular routine and activities. Optimize the sleep environment with a comfortable temperature, the right amount of light, a warm milky drink and a bath or shower before bed; avoid stimulating medications, drinks containing caffeine and alcohol, and exercise too close to bedtime. Pharmaceutical treatments can also be considered, including antidepressants to improve cognition and ameliorate agitation and aggression, and melatonin and melatonin antagonists to help with sleep disorders. Of note: medications such as benzodiazepines (BZD), non-BZD hypnotics, mood stabilizers and antipsychotics are no longer routinely recommended as side effects can outweigh possible benefits.
Are there any benefits to nutritional supplements or appetite stimulants?
Dr. Morrison: Nutritional supplements can help with weight gain in patients with anorexia or cachexia (‘wasting’ syndrome) but have no meaningful impact on survival. And while appetite stimulants such as cannabinoids and steroids are often given to help patients with dementia, there is no consistent data regarding their safety and efficacy.
What medications are available to treat or stop the progression of dementia?
Dr. Morrison: Until last year, only four medications were approved for treatment of dementia and Alzheimer’s disease, showing only a minimal to modest improvement in cognition. In 2021 a fifth drug was launched – aducanumab – a monoclonal antibody designed to reduce amyloid protein in the brain. Its fast-track approval was quite controversial as the clinical benefits of the drug were not proven during trials, which were stopped early as a result, and some severe side effects were observed. Interestingly, some researchers are now rethinking the idea that targeting amyloid protein plaques will eliminate Alzheimer’s disease, and instead exploring Alzheimer’s as a disease of inflammation. This could be the next fascinating line of research.
How a Memory is Made
Memory begins to form by giving attention to the information received through your senses. Anything that interferes with your ability to pay attention, such as hearing impairment, will affect the formation of a sensory memory. Successful integration of sensory memories into your working memory enables you to temporarily store, organize and manipulate information. These memories are then encoded into long-term memory and finally put into permanent storage.
by Specialdocs Consultants | Jul 8, 2022 | Healthy Aging, Patient News, Staying Active
Try Pickleball, the Country’s Fastest-Growing Sport
Tired of the same ‘ole routine every summer but find yourself in a pickle and looking for a new summer activity? Well, according to American Council on Exercise (ACE), you might want to consider pickleball.
As everyone from your next-door neighbor to ACE will attest, pickleball is extraordinarily popular. Its rapid rise to ubiquity can be attributed to a number of factors, ranging from easily learned rules and minimal equipment needs to intergenerational appeal and abundant opportunities for socializing.
This blend of badminton, tennis and table tennis can be adjusted to suit the intensity and competitiveness of the players, making it simple enough for beginners but fast-paced enough for more fit or skilled participants.
All of which is to say that if you haven’t yet considered picking up a pickleball paddle and the light, whiffle-like plastic ball, summer 2022 might be the perfect time to do so.
“Pickleball doesn’t require the skill of tennis, so it is easily adapted by most, and provides all the benefits of movement, including calorie burning and enhanced functional capabilities,” says Dr. Cedric Bryant, ACE president and chief science officer.
Already a favorite sport in retirement communities, pickleball has swelled to include more than 4.8 million players in the U.S. – almost double the number from five years ago – earning it the title of fastest-growing sport in 2021 and 2022. According to the Sports and Fitness Industry Association, the spike has been fueled by people ages 54 and younger looking for a friendly yet competitive and lively sport.
“People who play are generally having so much fun they don’t realize how much exercise they’re actually getting,” says Laura Gainor, spokesperson for the USA Pickleball Association.
At 44 x 20 feet, the pickleball court is one quarter the size of a tennis court, so it’s easier to keep the ball in play and achieve a brisk workout. According to ACE, pickleball may provide just what many middle-aged and senior adults are seeking – a safe and effective workout that yields long-term benefits and encourages lifelong participation.
A small research study recently conducted by the organization among people ages 40 to 85 showed that playing four 15-minute pickleball matches three days each week meets exercise intensity guidelines for improving and maintaining cardiorespiratory fitness. Study authors reported the positive impact on cardiometabolic risk factors, with participants experiencing favorable changes in cholesterol levels, systolic and diastolic blood pressure, and peak oxygen uptake after six weeks.
The smaller court also benefits older people or those who have problems with their joints, because less running is needed, resulting in less wear and tear on the joints. One cautionary note: Experts advise learning proper technique to prevent falls. As always, be sure to check with your healthcare provider before beginning any new physical activity.
“Take a few lessons to get started, and you’ll quickly ramp up,” assures Gainor. “After three to five games, you’ll have a very good understanding of how to play, and will become addicted to it shortly after!”
Take It Outside: Keep Moving This Summer
There’s no one-sport-fits-all approach, so if pickleball doesn’t appeal, find your inspiration in one of these activities, spanning the spectrum from low exertion to highly energetic:
- Stroll through farmers’ markets or art fairs
- Go produce picking at a local orchard
- Forest bathe – immerse yourself in nature at a forest preserve
- Gardening – remember to bend from your knees and waist rather than your back
- Swim – use a variety of strokes to limber up your whole body
- Disc golf – a low-impact way to challenge your coordination
- Yard yoga – take your mat and routine outdoors
- Hike, jog, run or cycle on an outdoor trail
- Kayaking – for a vigorous upper body workout
- Stand-up paddleboarding or Boga – challenging, board-based water workouts
Sources: American Council on Exercise, American Heart Association, USA Pickleball Association
by Ivan | Nov 26, 2019 | Healthy Aging, Patient News, Wellness
Life’s Happiness Continuum
Is there a predetermined peak age for happiness, before which our normal outlook is gloomy and melancholy and after which we slump back into these non-euphoric ways? When Are the Best Years of Our Lives?
Studies Show Two Stages of Life Happiness
Like trying to define why some people are born to be joyful and others to play the role of curmudgeon, this issue has long intrigued psychological and social science researchers. While no singular conclusion has been reached, there are a number of compelling hypotheses…and you may be pleasantly surprised to learn that a number of studies suggest a U-shaped happiness curve with peaks for young and old, giving us not one but two stages of life to savor. Mid-life can be stressful, full of the challenges and demands of raising a family and sustaining a career, but according to some experts, there is indeed a light at the end of the tunnel.
The Economist’s international survey of happiness gathered data from America’s General Social Survey, Eurobarometer and Gallup finding an upward trajectory of happiness until age 30, a downward trend into midlife, with the lowest point reached at age 46, and up to higher levels again after the 50’s. Jonathan Rauch, a senior fellow at the Brookings Institution and author of the 2018 book, The Happiness Curve, says although its effects vary between individuals, there appears to be a subtle but insistent tug that makes happiness more difficult to achieve in midlife and then reverses direction when we least expect it.
Other research supports this finding, including a University of Chicago retrospective study of 28,000 Americans over a 32-year period which showed older age groups were consistently the happiest. Interestingly, Dr. Dilip Jeste, director of the UC San Diego Center for Healthy Aging, describes it not as a curve, but more of a linear improvement in mental health that occurs even as physical and cognitive function declines.
Might Happiness in Women Peak Between the Ages of 50-70?
In particular, today’s women may find some of their sweetest times between ages 50 and 70, according to an in-depth lifestyle study spanning three decades conducted by the TrendSight Group. The take-away for younger generations: “Aging isn’t a dirty word, with it can come incredible confidence, strength and freedom,” says study author Marti Barletta. Even better, a full 59% of women ages 50 to 70 felt their greatest achievements were still ahead of them.
Happiness may Increase with Age
Experts theorize a number of reasons that happiness may increase with age, including increased wisdom or psychological intelligence in handling challenges, fewer aspirations and expectations of self, greater appreciation for life, living in the moment with less worry about the future, greater ability to regulate emotions and less worry about pleasing everyone all the time. Stanford psychologist Laura Carstensen’s Socioemotional Selectivity Theory, which is grounded in the unique human ability to monitor time, suggests that relative to younger people, older adults focus more on positive than negative information and prioritize emotionally meaningful activities – notably, deepening close relationships – over those related to individual achievement and exploration.
Recent findings from the Harvard Study of Adult Development, one of the world’s longest studies of adult life, begun in 1938, also point to the vital role of relationships in happiness at older ages. According to the research, these ties protect people from life’s discontents, help to delay mental and physical decline, and are better predictors of long and happy lives than social class, IQ or genes. Dr. Robert Waldinger, study director and psychiatrist at Massachusetts General Hospital, acknowledges that the research shows correlation, not necessarily causation. However, after following the subjects (including both Harvard graduates and inner-city residents) for many decades and comparing the state of their health and their relationships early on, he is confident that strong social bonds play a causal role in long-term well-being.
Perhaps 19th century journalist David Grayson had the best advice of all: “The other day a man asked me what I thought was the best time of life. ‘Why,’ I answered without a thought, ‘now.’”
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by Ivan | Sep 4, 2019 | Healthy Aging, Medical Conditions, Patient News
This Too Shall Pass: Treating and Preventing Kidney Stones
More common, frequently less painful and far more preventable than reputed, kidney stones have, entered a new era of highly effective, noninvasive procedures. We bring you up to date on kidney stone treatment & prevention
Q: Why do kidney stones happen?
A: They form when substances such as calcium, oxalate, cystine or uric acid are present at high levels in urine, becoming crystals that gradually increase in size to a stone. According to the Urology Care Foundation, Calcium stones are the most common (80%), with Uric Acid and Struvite / Infection stones making up the other 20%.
Q: How likely am I to experience kidney stones?
A: One in 10 people deal with kidney stones in their lifetime, more frequently men, but in recent years, women are rapidly closing the gap. Genetic factors also play a role: if kidney stones are prevalent among your family members, you are at higher risk of developing them.
Q: Are kidney stones very painful?
A: Over the years, the pain associated with kidney stones has taken on an almost mystical aura, sometimes described as “worse than childbirth.” However, the truth is that not every kidney stone causes intense pain. Some are small enough to pass unnoticed, and many are asymptomatic and only discovered when blood is found in the urine during routine testing. Others are large but can stay in the kidney forever without incident. It is only the stones that become “stuck” on their way out of the body that cause renal colic, or waves of severe pain, which can be promptly treated with pain medication.
Q: Does back pain mean I have kidney stones?
A: This is frequently asked by patients concerned about pain felt in the flank area near the kidney. A careful history will be taken to help determine the location of the pain, but a fairly simple way to distinguish the cause is to change positions. If the pain worsens, it is more likely to be a musculoskeletal type of strain. Kidney stone pain is less likely to be positional.
Q: How do you determine if treatment is needed?
A: A noninvasive, less expensive ultrasound is used for screening, but a spiral computed tomography (CT) scan provides superior imagery used to more accurately pinpoint the stone’s location. If only a partial obstruction is seen and not much pain is involved, time is on your side and we can wait to see if the stone passes naturally. At that point, many patients can rest comfortably at home and may be given antispasmodics (such as Flomax) to relax the ureter, pain medications to manage pain and instructed to drink plenty of water to aid the stone’s passage.
Q: What if it doesn’t pass on its own?
A: It’s reassuring to realize there is no urgency to remove the stone unless the kidney is obstructed or infected or the patient is experiencing intractable pain. And when removal is indicated, urologists (specialists in diseases of the urinary tract) have a number of options available, many of them noninvasive or minimally invasive. Open surgical procedures are a rare event. Instead, an outpatient ureteroscopy can be done, using an endoscope to break up or remove the stone. Even less invasive is lithotripsy, good for small stones, which directs high-energy shock waves toward the stone and breaks it into fragments to more easily pass out of the body. For extremely large or resistant stones, a minimally invasive percutaneous nephrolithotomy is conducted to remove the stone via an endoscope inserted through a small incision in the skin.
Q: What is the best way to prevent kidney stones from forming again?
A: We can take the time to develop an individualized approach, based on your stone’s composition. First, your stone will be tested and categorized as calcium oxalate (the most common type), calcium phosphate, a mix or a non-calcium type. Also recommended is a 24-hour urine collection to form a clear picture of how the crystals form in your body, as well as blood tests for further analysis. While those who have formed stones before are at higher risk for forming a subsequent one, we know that dietary modifications tailored to stone type and – if needed – drug therapy can substantially reduce that risk. If you form calcium oxalate stones, we’ll work on a plan to avoid foods high in oxalate, such as spinach, beets and rhubarb, and keep sodium consumption at a minimum. Also important to know is that despite its role in the stone’s composition, there is no need to restrict calcium. In fact, increasing your calcium intake with higher-calcium foods such as milk, yogurt and cheese can help lower oxalate levels in the urine. Finally, keep in mind that the single best preventive measure is to simply fill a bottle with water and drink often.
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by Ivan | Apr 2, 2019 | Healthy Aging, Patient News, Staying Active
Ramping Up your Sprint Fitness after a Long, Sedentary Winter
Whether you went into hibernation as the result of a record cold winter season, or took time off from your usual exercise routine because of a busy schedule or illness, spring is an ideal time to get back in action. When done with care, starting or rebooting your fitness regimen this spring will set you up for a vibrant, energetic summer. After being cleared for exercise by our office, consider these issues to ensure you’re not sidelined by injury, fatigue or boredom and get the most out of your spring fitness efforts
Aerobic or strengthening exercise?
Both. According to the 2018 Physical Activity Guidelines for Americans, any amount is helpful but the recommendations to help prevent chronic diseases is 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity, aerobic activity is recommended each week, and muscle-strengthening activities (free weights or resistance bands) two or more days a week. It would be ideal for older adults to add balance training to the mix. If it’s challenging to find long periods of time to exercise, note that three 10-minute bouts or one 30-minute bout will deliver equal improvements in fitness.
Stretch before or after exercise?
Before, after or both can all work well, if done properly. Do not attempt long stretches beforehand when your muscles are cold and you’re likely to pull a tendon, cautions Christine Butz, Doctor of Physical Therapy at Athletico. Instead, take 10 minutes to pedal on a stationary bike, march in place or walk around. Post exercise is the time for long, 30-second stretches that help you slowly increase muscle length (see below for examples). Most importantly, don’t push through pain, says Butz. “If you experience sharp, persistent pain, or have difficulty moving through a full range of motion, stop and see a physician to determine if it’s a strain, tear or fracture.”
Steady state or interval training?
Once the bastion of elite athletes, interval training can be used at any level, according to Mayo Clinic. Simply alternate short bursts (approximately 30 seconds) of intense activity with longer intervals (three to four minutes) of less intense activity. For instance, if your exercise is walking, try incorporating a brief surge of jogging into your regular walks or alternate leisurely strolling with periods of brisker walking. As your cardiovascular fitness improves, you’ll be able to exercise longer or with more intensity during your spring fitness routine.
What are the best activities to try?
Tap into one of these fitness trends to reinvigorate your workouts:
- Starting with Jazzercise in the 1980s, and rising again in the 2000s with Zumba, both of which remain popular, numerous dance-centric classes are offered at health clubs and park districts – Broadway show routines, tap dancing, belly dancing, Irish dancing, square dancing, line dancing and ballet-inspired barre workouts. Interesting note: a number of studies are in progress exploring the possible benefits of dance in enhancing cognitive function and reducing stress.
- Indoor cycling classes such as SoulCycle, Flywheel and CYC provide a fast-paced, high-energy environment. If you prefer to stay outdoors, but feel a bit unsteady on a 10-speed racer, check out the proliferation of classic cruiser bikes featuring wide, comfortable seats and upright handlebars.
- Yoga and Pilates. Both are low-impact workouts that focus on using bodyweight resistance. Yoga builds strength, balance (ideal for preventing falls) and harmony in mind and body, with breathing exercises, meditation and postures (asana or poses) that stretch and flex various muscle groups. Pilates is excellent for improving core strength and recovering after injury.
- Water classes are another low-impact option to build core muscles and help improve flexibility, stability and balance. Choices include traditional aqua aerobics as well as aqua ballet, aqua yoga and aqua tai chi.
- Functional Training classes are designed to improve balance, coordination, agility, speed and strength, such as BOSU (both sides utilized) ball workouts.
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by Specialdocs Consultants, LLC | Nov 20, 2017 | Healthy Aging, Patient News
As almost 10,000 Baby Boomers officially become senior citizens each day, the focus on preventing and treating age-related ailments becomes distinctly more urgent. HealthWise presents an ongoing look at research that provides valuable insights to help today’s seniors – and the generations set to follow – create a vibrant next chapter. We began with strategies to keep the aging brain healthy, and continue in this issue with a look at how your senses, specifically taste and smell, are affected by the aging process. Look for the latest on safeguarding your sight and sound in future editions.
A Taste of the Future
Savoring the sweetness of a rich chocolate, breathing in the scent of a fresh burger on the grill…taste and smell trigger the delights of eating by matching odorous molecules in the air with memories stored in your brain.
Taste buds have helped humans since the beginning of time identify foods as sweet, salty, sour, bitter or savory, and provide a warning not to ingest toxic substances. Forever intertwined with smell, food molecules travel through the rear of the nasal cavity to olfactory receptors in the roof of the nose – that is why if you hold your nose and put chocolate in your mouth, you will not taste the chocolate.
An effortless process for most, recognizing tastes and odors is actually cognitively demanding, and for older people, can be extremely challenging, as these capabilities greatly diminish as we age. Although new neurons continue to form in the olfactory region of the brain into adulthood, by age 50, the sense of smell starts to deteriorate rapidly as the number of sensor cells that detect aroma decrease…by age 80, smell detection is reduced by almost 50 percent. There is also a weakening of the nerves that carry the signals to the brain, and in the olfactory bulb, which processes them. In addition, the sense of smell may be diminished by reduced production of mucous, thinning of the nose lining and hormonal changes.
At the same time, the tongue’s taste buds are on the wane, dwindling from a high of 10,000 to just 5,000 in older adults. Dry mouth, caused by a reduced flow of saliva that is commonly seen in the elderly, or from medications such as antihistamines or antidepressants, also cause a loss of taste perception.
Why this matters: The ability to detect odors from spoiled foods, gas leaks and smoke is critical to safety. Taste issues means food becomes less appealing, and unhealthy amounts of sugar or salt may be added to food to make it more palatable, or less food is eaten, potentially leading to nutrition problems.
Preserve, protect and adapt
While there may not yet be a way to completely halt the decline, experts recommend a number of strategies to sharpen your senses of smell and taste and keep them working longer and better:*
Take brisk walks daily…exercise heightens the smell sense.
- Conduct your own sniff therapy by inhaling the scent of items such as peppermint and cinnamon first thing in the morning, sparking different receptors in the nose to work.
- Quit smoking…tobacco smoking impairs the ability to identify odors and diminishes the sense of taste.
- Reduce your risk of head injury by wearing protective helmets during sports and seat belts when riding in the car…trauma to the head can damage olfactory nerves.
- Treat nasal or sinus infections promptly, a primary cause of smell problems. The same advice holds for treating nasal polyps, small, non-cancerous growths in the nose or sinuses
that can block the ability of odors to reach olfactory sensory cells.
- Consider a change in medications that may be affecting your sense of smell, such as anti-allergy medicines.
- Choose foods that are naturally stronger flavored, such as mustard, pickles, radishes and peppers; add herbs and spices instead of salt. Use sun-dried tomatoes, vinegars, concentrate fruit sauces, extracts of almond, vanilla, citrus juice and peels to enhance tastes. Eat a variety of foods and textures, and change it up at every bite to keep your taste buds firing.
- Get an annual flu shot to help you avoid respiratory and ear infections that can interfere with taste.
- Practice good oral hygiene…take care of gum disease, inflammation or infections in the mouth, which can cause taste problems.
Finally, buy safety products, such as a gas detector that sounds an alarm you can hear.
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