Archive for the 'Elderly' Category
March 17th, 2010 by Nina Thompson, ARNP
A 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
March 16th, 2010 by Nina Thompson, ARNP
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
March 1st, 2010 by Nina Thompson, ARNP
Listen 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
February 22nd, 2010 by Nina Thompson, ARNP
The 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
November 21st, 2009 by Nina Thompson, ARNP
Brand 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
March 25th, 2009 by Nina Thompson, ARNP
Low 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 Source.com)
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
January 9th, 2009 by Nina Thompson, ARNP
Osteonecrosis 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
January 6th, 2009 by Nina Thompson, ARNP
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, www.BAMI.us
via Archives of Dermatology, May 2008
via FDA, “Shingles Vaccine”, 2008
December 5th, 2008 by Nina Thompson, ARNP
Alzheimer’s patients who also have obstructive sleep apnea may experience improved mental function from treatment with continuous positive airway pressure (CPAP), according to a recent study from University of California San Diego.
Previous studies have suggested that more severe dementia is associated with more severe obstructive sleep apnea. And in fact, Alzheimer’s patients have a high incidence of obstructive sleep apnea. Previous studies have found that approximately 70% to 80% of Alzheimer’s patients experience at least five episodes of apnea or hypopnea per hour and 40% to 50% have 20 or more episodes per hour.
Sleep apnea occurs when a person’s breathing repeatedly stops and starts for short periods of time during sleep. This abnormal breathing pattern only occurs during sleep, therefore, the person with the disorder may be the last to know he or she has a problem.
Obstructive sleep apnea (OSA), is usually associated with loud snoring (though not everyone who snores has this disorder). Risk factors for obstructive sleep apnea include being male, overweight, and over the age of forty. This condition occurs two to three times more often in older adults and is twice as common in men as in women. However, sleep apnea can affect anyone at any age, even children.
If you think you might have sleep apnea, ask your health care provider for help.
Read more about Obstructive Sleep Apnea from Bay Area Medical Information
via Ancoli-Israel S, et al “Cognitive effects of treating obstructive sleep apnea in Alzheimer’s disease: a randomized controlled study” J Am Geriatr Soc. 2008; 56: 2076-2081.
via MedPage Today, December 4, 2008
December 1st, 2008 by Nina Thompson, ARNP
Screening for mild cognitive impairment can be accomplished in less than five minutes with a three-word memory test and a clock-drawing task, according to Emory researchers. This new test, called the Mini-Cog, is reasonably accurate and allows quick screening by health care professionals. It appears to be a valuable aid for early identification of patients who might be at risk for later development of a serious dementia, such as Alzheimer’s Disease.
The Mini-Cog, combined with a simple functional activities questionnaire, accurately diagnosed 83% of patients with mild cognitive impairment, in this recent Emory study. Current screening for mild cognitive impairment is often logistically difficult because it typically requires 40 to 60 minutes of formal neuropsychological testing and it only achieves 80% accuracy or higher.
Dementia is defined by the American Psychiatric Association as an acquired syndrome of decline in memory and at least one other cognitive domain such as language, visuo-spatial, or executive function sufficient to interfere with social or occupational functioning in an alert person. It’s very important to keep in mind that the word dementia describes a general syndrome and many different diseases can cause dementia. Alzheimer’s disease and cerebrovascular ischemia (vascular dementia) are the 2 most common causes. Some potentially reversible conditions, such as hypothyroidism or vitamin B-12 deficiency, are also some of the many different causes of dementia.
The Mini-Cog test results should only be used in conjunction with other testing in forming a diagnosis by a health care professionals, and should not be used in isolation of diagnostic tests for Alzheimer’s disease.
If a family member starts showing signs of memory loss or other symptoms of mental decline, never assume that nothing can be done. See your health care provider for evaluation and help.
“Memory Loss Screening Tool for Caregivers/Family” from Bay Area Medical Information
“The Mini-Cog” from Bay Area Medical Information