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Hypothyroidism Warning Signs and Treatment

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Background

Hypothyroidism results from lack of sufficient thyroid hormone being produced by the thyroid gland. Older adults may have subclinical hypothyroidism, in which the TSH (thyroid-stimulating hormone) is elevated and the T4 (thyroxine or thyroid hormone) is normal; 4.3–9.5% of the general population has this problem (Woolever & Beutler, 2007). In this condition, the body is trying to stimulate production of more thyroid hormone. Some older adults with this condition will progress to have primary or overt hypothyroidism. This is when the TSH is elevated and T4 is decreased. Hashimoto’s disease is the most common cause and represents 90% of all patients with hypothyroidism (American Association of Clinical Endocrinologists [AACE], 2005; Woolever & Beutler, 2007), though certain pituitary disorders, medications, and other hormonal imbalances may be causal factors.

Warning Signs

Older adults may present an atypical picture, but the most common presenting complaints are fatigue and weakness.

Diagnosis

Diagnosis should include a thorough history and physical. Bradycardia and heart failure are often associated factors. Lab tests should include thyroid and thyroid antibody levels (common to Hashimoto’s), and lipids, because hyperlipidemia is also associated with this disorder.

Treatment

Treatment centers on returning the thyroid ¬hormone level to normal. This is done through oral thyroid replacement medication, usually L-thyroxine. In older adults with coexisting cardiovascular disease, starting with the usual doses may exacerbate angina and worsen the underlying heart disease, so it is important to start low and go slow. Titration should be done cautiously, with close monitoring of the older adult’s response to the medication. The does should be adjusted on 6- week intervals until normal levels of thyroid hormone are achieved. Once the TSH is within normal limits, then checking the TSH should be done every 6 to 12 months to monitor effectiveness and blood levels, because hyperthyroidism is a side effect of this therapy and can have serious implications on the older person’s health.

Patients need to learn the importance of taking thyroid medication at the same time each day without missing doses. Sometimes older adults have other problems associated with hypothyroidism, such as bowel dysfunction and depression. Any signs of complicating factors should be reported to the physician, and doctors’ appointments for monitoring should be religiously kept. Strategies for managing fatigue and weakness should also be addressed, because some lifestyle modifications may need to be made as treatment is initiated.

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L.
Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.

For more information on Hypothyroidism, visit the NIH:
http://www.nlm.nih.gov/medlineplus/ency/article/000353.htm

 

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By | 2017-09-21T10:33:23+00:00 September 21st, 2017|News Posts|Comments Off on Hypothyroidism Warning Signs and Treatment

Simple ways to make a bathroom fall proof

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The NIH Senior Health reports that one in three people over the age of 65 experience a fall each year. Because of the non-porous, easy clean surfaces, more than 80% of these falls happen in the bathroom. The proper equipment will help to keep everyone safer. Be sure to check your loved one’s for the following:

Grab Bars. One of the simplest solutions to preventing bathroom falls is to install grab bars. Choose bars that have a grip-like surface and contrast to the color of the shower, so they are easily visible. Anchor these bars to the studs behind the wall for the best support. Have your loved one step into the tub and show you where the best place to install a safety bar is located. Adding a grab bar next to the toilet is another simple way to prevent falls.

Non-Skid Surfaces. Placing a non-skid floor mat in front of the shower and sink soaks up excess water and prevents slips. Adding a non-skid shower mat to the bathtub will prevent your loved one from sliding on the slippery tub surface when bathing. For additional safety, place non-skid adhesive strips around the sink and vanity area.

Raised Toilet Seat. Adding a raised toilet seat prevents your loved one from losing her balance and falling while trying to sit on the toilet or get up. It is also helpful for those who are losing strength.

Lighting. Many seniors lose depth perception, having brighter lighting will help your senior to judge distances better, such as stepping into the bathtub. Adding motion lights on the path to the bathroom, as well as in the bathroom, will help your loved one to see where she is walking. Having plenty of lighting will help your loved one to locate toiletry items quicker and easier as well.

Declutter. Because many older people end up needing to use a walker or cane, it is important to make sure walking paths are clean and clutter-free. It is important to keep items such as towels off the floor and out of the way as much as possible. The less items your loved one can get hooked on, the safer the home will be.

Preventing a fall from happening is ideal. However, there are times when accidents happen. Consider getting your loved one a medical alert system as an additional layer of safety. The best systems offer waterproof pendants, so they can be worn while bathing. If your loved one does fall, she can press the button and get help immediately, which may save her life.

By | 2017-09-19T09:16:33+00:00 September 19th, 2017|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Simple ways to make a bathroom fall proof

Chronic Sinusitis

Sinus pain

Background

One of the common health complaints of the elderly is chronic sinusitis. About 14.1% of Americans 65 and older report suffering from chronic sinusitis; for those 75 years and older, the rate is slightly lower at 13.5% (American Academy of Otolaryngology, 2012). Age-related physiological and functional changes that occur can cause restrictions to the airflow. This results from irritants blocking drainage of the sinus cavities, leading to infection.

Warning Signs

Symptoms include a severe cold, sneezing, cough (that is often worse at night), hoarseness, diminished sense of smell, discolored nasal discharge, postnasal drip, headache, facial pain, fatigue, malaise, and fever (Kelley, 2002). The person may complain of pain around the sinus areas, and swelling and redness of the nasal mucosa may be evident.

Diagnosis

Allergies, common cold, and dental problems should be ruled out for differential diagnosis. When symptoms continue over a period of weeks and up to 3 months and are often recurring, chronic sinusitis should be suspected. A CT scan of the sinuses will likely show areas of inflammation.

Treatment

Treatment for chronic sinusitis is with antibiotics, decongestants, and analgesics for pain. Inhaled corticosteroids may be needed to reduce swelling and ease breathing. Irrigation with over-the-counter normal saline nose spray is often helpful and may be done two to three times per day. The person with chronic sinusitis should drink plenty of fluids to maintain adequate hydration and avoid any environmental pollutants such as cigarette smoke or other toxins. Chronic sinusitis is a condition that many older adults wrestle with their entire life. Avoidance of precipitating factors for each individual should be encouraged.

For more information on Sinus Sinusitis, visit The Mayo Clinic at:
http://www.mayoclinic.com/health/chronic-sinusitis/DS00232/DSECTION=risk-factors/

Adapted from Mauk, K. L., Hanson, P., & Hain, D. (2014). Review of the management of common illnesses, diseases, or health conditions. In K. L. Mauk’s (Ed.) Gerontological Nursing: Competencies for Care. Sudbury, MA: Jones and Bartlett Publishers. Used with permission.

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By | 2017-09-11T12:15:57+00:00 September 11th, 2017|News Posts|Comments Off on Chronic Sinusitis
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