Archive for the 'Elderly' Category

New Recommendations for Ovarian Cancer Prevention

Two womenAccording to new recommendations from the Society of Gynecologic Oncologists, women with a strong family history of ovarian cancer or BRCA mutations should have prophylactic bilateral salpingo-oophorectomy after completing childbearing, to reduce the risk of ovarian cancer .

A bilateral salpingo-oophorectomy is a surgical procedure that removes both sets of fallopian tubes and ovaries. 

Read about Ovarian Cancer

Source: “Individualize Decisions about Prophylactic Oophorectomy“, MedPage Today, September 26, 2010

More Information about Prophylactic Oophorectomy from the Mayo Clinic

Volunteer Activities May Help Mental Decline

Two men playing chessSenior citizens can preserve their memory and cognitive abilities longer if they keep their minds and bodies active, according to a number of experts and researchers. 

A recent study from Johns Hopkins Bloomberg School of Public Health found that volunteer activities appears to delay or reverse declining brain function in older people. Although this study was small, it adds to a growing body of literature suggesting that mentally stimulating lifestyles may help maintain or improve cognitive function in aging people.

Another study has found that people who were free of Alzheimer’s disease in later life were more likely to have engaged in mentally stimulating leisure activities when they were younger. These activities included playing chess, reading books, playing a musical instrument, or learning a foreign language.

An active social schedule also appears to be key to healthy mental stimulation.   A 2008 study from Harvard found that elderly people in the U.S. who have an active social life have a slower rate of memory decline.

SOURCE: “Volunteering Keeps Older Minds Sharp”, MedPage Today, December 18, 2009

SOURCE:  Carlson M, et al “Evidence for neurocognitive plasticity in at-risk older adults: The Experience Corps Program” J Gerontol A Biol Sci Med Sci 2009: 64; 1275–82. 


A Simple Way to Make a Major Difference in your Health

Vitamin D supplementsA recent study from the Intermountain Medical Center Heart Institute in Murray, Utah has found that people who increase their vitamin D blood levels to 43 or higher may lower their risk of diabetes, heart attack, heart failure, high blood pressure and heart disease.

Heralded as “One of the Top 10 Medical Breakthroughs of 2007″, Vitamin D continues to surface in new research as a critical nutrient in maintaining good health and preventing disease, yet almost half of the world’s population has lower than optimal levels of vitamin D.  

It is well known that hip fractures and muscle weakness, in people over 50, are linked with a deficiency in Vitamin D.  Many recent studies have also found that low Vitamin D levels are associated with a number of serious, chronic diseases, such as diabetes, gum disease, multiple sclerosis and other autoimmune diseases, peripheral neuropathy, osteoporosis, cancer, stroke, mental decline, depression, high blood pressure and heart disease.

A Vitamin D deficiency can be treated with a simple daily supplement and a blood test can measure the circulating Vitamin D levels in your blood.  A level of 30 nanograms per milliliter of vitamin D is considered normal, although this may vary from lab to lab.

Many doctors are routinely drawing blood levels of Vitamin D to to make sure patients are getting enough vitamin D to optimize good bone health and prevent chronic disease. Ask your doctor about this.

Important Note: Vitamin D is a fat soluble vitamin, thus toxicity can occur from high intakes of vitamin D. Overdosage can occur from large amounts of supplements or cod liver oil, but it is unlikely to result from sun exposure or diet. Parents should consult with their pediatrician before giving any child vitamin D supplements. Excess vitamin D can reach toxic levels and be harmful.

  Source: “Boosting Vitamin D Can Do a Heart Good”, HealthDay News, March 15, 2010 


Is Early Alzheimers a Reason to Stop Driving?

Getting lost can easily lead to a car accident

Driving skills may still be intact in early Alzheimer’s, but the risk of getting lost on familiar streets, may be greater than one would think, according to researchers from the School of Occupational Therapy at Pacific University, Oregon. Memory and navigation skills become impaired in early Alzheimer’s while poor judgment and reasoning frequently compound the problem.

In this recent study of 207 drivers with Alzheimer’s who went missing while driving, 32 died and 35 were found injured, while 70 were still not found by the time the data was analyzed.   Most had set off on routine and familiar trips to the post office, the local store or a relative’s house. Once lost, some had driven for almost two days and covered more than 1,700 miles.   One New Jersey couple in the study, both with dementia, got lost on a trip to the store and drove around until they ran out of gas. The husband went for help but was unable to direct authorities to his car. His wife was found dead several days later.

Giving up the car keys is  often a monumental loss for elderly folks who are considered unsafe to drive. Especially for men, it’s a milestone that represents a loss of independence, freedom and control.  Families are frequently put in the difficult position of identifying the problem and enforcing the restrictions. So what is a family to do?  Here are some helpful tips and resources: 

  • This is an important time to seek the help of the elderly person’s doctor.  Have a confidential meeting or phone conversation ahead of their visit so the doctor has a clear understanding of the circumstances.  People often will listen more to their doctor and less to their spouses and children about driving ability.
  • There are many excellent resources for family members available through the Area Agency on Aging.  Call their Senior Information Line at 800-645-2810 for a copy of booklets, brochures, or DVD’s about safe driving with aging.
  • The Alzheimer’s Association offers a web-based program called “Comfort Zone” that families of Alzheimer’s patients can use if the person can still drive safely in familiar places. The driver agrees to limit driving to a “comfort zone,” and a global positioning system (GPS) monitors driving. If the driver leaves the area, the family is notified in real time.

 Read more about “Comfort Zone

Source: Linda Hunt, Ph.D., associate professor, Pacific University, Oregon; Elizabeth Gould, M.S.W., director, quality care programs, Alzheimer’s Association, Chicago; March 2010, American Journal of Occupational Health

Source: “Driving With Early Alzheimer’s May Be Ill-Advised”, HealthDay, March 12, 2010

Pleasant Music is Good for the Mind and Body

PianoListen to music you like for 15 to 20 minutes a day — and consider it a healthful a practice like regular exercise and a healthy diet, says Dr. Michael Miller from the Center for Preventive Cardiology, in an article by Health Day.

Involve your child in music on a daily basis, says the Nemours Foundation.  

A growing body of research is pointing to the healthful benefits of listening to pleasant music.  It has been found to help with such things as pain, stress, depression, intelligence, memory, and sleep to name a few.

One recent study found that soothing music was associated with a  reduction in heart rate, respiratory rate, and blood pressure in patients with coronary heart disease. And another study found that music, like laughter, may benefit heart health. 

Music therapy is being used successfully with stroke patients. Finnish researchers recently found that listening to music for a few hours a day was associated with a stroke patient’s early recovery.

“Listening to music offers many benefits to children, research indicates. Musically inclined kids appear better at math and reading, have shown better focus, improved self-esteem and seem to play better with other children,” report experts in a recent article by Health Day. 

Much more research needs to be done, but the healthful benefits of music are surfacing in almost every area of our lives. 

Source: “Health Tip: Introduce Your Child to Music”, Health Day, March 1, 2010
Source: “Tune Up Your Health”, Health Day, January 29, 2010
Source: Michael Miller, M.D., professor, medicine, and director, Center for Preventive Cardiology, University of Maryland Medical Center, Baltimore
Source: Aniruddh Patel, Ph.D., Esther J. Burnham senior fellow, Neurosciences Institute, San Diego
Source: Robert Zatorre, Ph.D., Montreal Neurological Institute, and professor, department of neurology and neurosurgery, McGill University, Montreal
Source: Bradt J, et al “Music for stress and anxiety reduction in coronary heart disease patients” Cochrane Database of Syst Rev 2009; DOI: 10.1002/14651858.CD006577.pub2

Breast Cancer Drop Linked to Decreased Use of HRT

2 womenThe decline in breast cancer rates among women over age 50 is linked to less use of hormone replacement therapy (HRT), according to Harvard Researchers. In their study of more than 350,000 women, the decline was most significant for cases of estrogen receptor-positive cancer and among affluent, white women who were most likely to have used HRT.

Source: American Journal of Public Health, February 2010

Generics Versus Brand Names

The FDA allows a variance of 20% when it comes to generic medicationsBrand named drugs are becoming more and more expensive these days and many people just can’t afford them.  Often insurance companies won’t pay for a brand name if a generic equivalent is available, so more than ever people are faced with the question–are the generics equally effective and safe?

Both the FDA and generic drugmakers say that the generics are clinically identical to the brand named medications, but is this always the case?

Generic drugs have to meet the requirements of the FDA which requires ”90% confidence intervals for maximal concentration and the area under the concentration-time curve must be no less than 80% and no more than 125% of the means for the branded drug”, according to MedPage Today.  In other words, yes there can be some variation. 

This variation may or may not be a problem.  It can be serious if the disease requires very specific blood levels of the drug, however, such as in a seizure disorder.  

Carbamazepine (Tegretol) is a drug used to treat seizure disorders.  The levels of the drug need to be predictable, reliable and effective, otherwise a seizure may occur.  In a recent study at John Hopkins University, generic versions varied markedly in FDA-sanctioned bioequivalence studies.  So in the case of carbamazepine, this variability could have significant clinical consequences for patients who switch from the branded product or from one generic version to another.

Another drug of concern is generic thyroid.   Fortunately a blood test (TSH) can determine if you’re getting the right amount of thyroid medication, but it should only be done two months after taking the medication on a daily basis. Also, the problem might arise if the pharmacy switches generic brands, which they have been known to do.  So if you have a choice, choose the brand name when it comes to thyroid medicine. If you’re forced to take the generic option, let your doctor know and pay attention to the color and appearance of the pill.  If it ever changes, ask the pharmacist.  If the pharmacy does switch generics, let your doctor know so a blood test can be scheduled. 

 As a health care practitioner, I’m concerned about generic alendronate (Fosamax).  While the generic version may contain the correct amount of the drug, you may not be getting the absorption needed for it to be effective.  This is particularly important for medications that have poor GI absorption to begin with. The absorption of the generic may be even worse than the brand name with the end result being little or no benefit when it comes to improving bone density. 

Venlafaxine (Effexor), a popular drug for depression was recently studied by Franck Chenu, PharmD, PhD, of the University of Ottawa.  The researchers found that the side effects of the generic version was three times more common than with the branded version, Effexor. Their findings were reported in the July 2009 issue of the Journal of Clinical Psychiatry.

When it comes to generics it’s always a good idea to talk it over with your doctor before you make the decision of generic versus brand name.  And if you can only afford generic, let your doctor know. 

Source: “AAN: Wide Variability in Generic Versions of Epilepsy Drug”, MedPage Today, May 1, 2009
Source: “Generics versus Brands: Are They Really Equivalent?”, MedPage Today, August 25, 2009

Dizziness Linked with Poor Bone Health

A woman with osteoporosisLow bone mineral density may be associated with a disorder that causes dizziness, according to Korean researchers.  Benign positional vertigo is an inner ear disorder that results in the sudden onset of dizziness, spinning, or vertigo when moving the head.  In this recent study, people with osteopenia had double the risk of benign positional vertigo, and those with osteoporosis had triple the risk of the condition, which was unrelated to head trauma or other known causes.

Osteoporosis is a major public health threat for 44 million Americans and is known as the “silent disease”. It is a silent disease in that it progresses insidiously and painlessly up until the first symptom, which is usually a broken bone.  Unfortunately by then, most of the damage has been done.  Early detection and prevention of osteoporosis is vital. (Image courtesy of Merck

Both men and women over age 50 are at risk. One-half of all women and one-fourth of all men over age 50 will have an osteoporosis-related fracture in their remaining lifetime. This occurs despite the fact that osteoporosis can be prevented and treated.  

Read more about the prevention, detection, and treatment of Osteoporosis

Source: Jeong S-H, et al “Osteopenia and osteoporosis in idiopathic benign positional vertigo” Neurology 2009; 72: 1069-1076.

Source: “Dizziness Linked to Bone Health” MedPage Today, March 23, 2009


Fosamax and Boniva linked to dental complications

Drawing of a toothOsteonecrosis of the jaw, as a complication of dental procedures, has occurred in 4% of patients taking oral alendronate (Fosamax), whereas none of those who didn’t take the drug experienced any complications.

Fosamax, as well as Boniva and Actonel, are oral bisphosphonates.   Fosamax is the most widely prescribed oral bisphosphonate, and in 2006 it was the 21st most prescribed drug overall. 

In an article in MedPage Today, the the researchers are quoted as saying, “…if patients are using bisphosphonates, dentists should consider alternate treatment options for non-necessary extractions and good oral hygiene should be achieved before extractions to minimize microbial load. Also, follow-up should be more vigilant and a chlorhexidine rinse pre- and post-operatively ‘can be effective’ in ensuring socket and wound healing and mucosal coverage of exposed bone…”

These findings are preliminary, but if you’re taking any one of the bisphosphonates, be sure to let your dentist know, especially before any dental procedures.

via MedPage Today, January 2009

Shingles appears to have a hereditary link

If you have a blood relative who has had shingles, you may be a greater risk of developing the disease. 

Shingles is a very painful rash that can last from one to three months.  In May of 2006, the FDA licensed a new vaccine to reduce the risk of shingles in older Americans. Zostavax, a live virus vaccine, is given as a single injection and is recommended for use in people 60 years of age and older.

View photos and read more about Shingles from Bay Area Medical Information,

via Archives of Dermatology, May 2008
via FDA, “Shingles Vaccine”, 2008