Dr. Mauk’s Boomer Blog

Background

Although gastroesophageal reflux disease (GERD) is common among older adults, the true prevalence is not known. Many patients with GERD-related symptoms never discuss their problems with their primary care provider. GERD is thought to occur in 5–7% of the world’s population, with 21 million Americans affected (International Foundations for Functional Gastrointestinal Disorders, 2008). It is found in both men and women.

Signs and symptoms

Pathophysiological changes that occur in the esophagus, hiatal hernia, and certain medications and foods increase the risk for GERD. Obesity (Corely , Kubo, Levin et al., 2007) and activities that increase intra-abdominal pressure such as wearing tight clothes, bending over, or heavy lifting have also been linked to GERD (MedlinePlus, 2005a). The cardinal symptom of GERD is heartburn; however, older adults may not report this, but rather complain of other symptoms such as pulmonary conditions (bronchial asthma, chronic cough, or chronic bronchitis), a hoarse voice, pain when swallowing foods, chronic laryngitis, or non-cardiac chest pain (Pilotto & Franceschi, 2009). The chronic backflow of acid into the esophagus can lead to abnormal cell development (Barrett esophagus) that increases the risk for esophageal cancer.

Diagnosis

Older adults often have atypical symptoms, making the diagnosis of GERD very challenging. As people age, the severity of heartburn can diminish, while the complications, such as erosive esophagitis, become more frequent. Therefore, endoscopy should be considered as one of the initial diagnostic tests in older adults who are suspected of having GERD (Pilotto & Franceschi, 2009). Examination of the esophagus, stomach, and duodenum through a fiber-optic scope (endoscopy) while the person receives conscious sedation, allows the gastroenterologist to visualize the entire area, identify suspicious areas, and obtain biopsies as needed. Helicobacter pylori (H. pylori), a chronic bacterial infection in humans, is a common cause of GERD, affecting about 30% to 40% of the U.S. population. Testing for H. pylori can be done during the endoscopy or by other tests (Ferri, 2011).

Treatments

The objectives of treatment for GERD include: (1) relief of symptoms, (2) healing of esophagitis, (3) prevention of further occurrences, and (4) prevention of complications (Pilotto & Francheschi, 2009). Lifestyle and dietary modifications are important aspects of care. It is widely recommended that persons with GERD should stop smoking, limit or avoid alcohol, and limit chocolate, coffee, and fatty or citrus foods. Medications should be reviewed and offending medications modified, since certain medications decrease the lower esophageal sphincter (LES) tone, allowing acid to backflow into the esophagus. These include anticholinergic drugs, some hormones, calcium channel blockers, and theophylline. Avoidance of food or beverages 3–-4 hours prior to bedtime, weight loss, and elevation of the head of the bed on 6-to-8 inch blocks are some other interventions that may help alleviate symptoms. Pharmacological treatments with antacids in conjunction with histamine 2 (H2) -blockers (Tagmet, Zantac, Axid, and Pepcid) are used for mild GERD. If these are ineffective in controlling symptoms, then the proton pump inhibitors (PPIs) are the next drugs of choice. These include medications like Nexium and Dexilant. With lifestyle modifications and appropriate medications, older adults can manage their GERD symptoms so that quality of life is maintained.

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. Burlington, MA: Jones and Bartlett Publishers. Used with permission.

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Romance is an exciting prospect to pursue during the retirement years. In fact, a study conducted by Merrill Lynch and Age Wave revealed that 69% of retirees find romantic activities a priority during the golden years.

Of course, proper retirement planning is needed in order for couples to make time for love. It can’t be stressed enough that 70% of people age 65 years and above is expected to receive some form of long term care in the future. And a long term care insurance (LTCI) basically covers that particular need.

Now, the great thing about planning early for long term care is that not only will partners be able to receive care when they need it. Couples preparing together can also strengthen their relationship. A stronger bond with each other effectively prevents any arguments that spouses may encounter in the future. Planning, in a way, sets one’s hopes and expectations for the romantic ride in the next couple of years.

As a couple, setting your sights on some romantic retirement activities can be a motivational tool for you both to prepare for your tomorrows. Here are some suggestions you may want to do together:

Travel

Experience unforgettable moments by exploring new places. It doesn’t need to be far – the important thing is you’re together in a strange and exciting place!

Higher Education

Bring back the wonders of school romance by pursuing higher education. Aside from having the chance to pass love notes in class, the knowledge gained from school can be used for possible business opportunities during retirement.

Movies

Retirement means more time with each other. So grab some popcorn and enjoy watching some romantic movies together.

Cooking

Food is the way to a man’s (or even a woman’s) heart. Enjoy whipping up some meals for each other.

Health

Keeping fit is better when done with a partner. Even something as simple as walking together in a park should keep you and your date fit and happy.

Go on a Date

Even single retirees can join in the fun.  Retirement can be a good time to meet, mingle, and spend time with a new and special friend.

And the list goes on. No matter which activity you and your spouse may want to do, an LTCI will grant the security in case something dire happens. Make sure to get a suitable LTC coverage for your romantic retirement getaways today.

Author Bio: Violet Swenson is the Online Content Director at LTC Global Agency, a reliable provider of long term care insurance since 2002. Our strong partnerships with top companies across the country help us deliver the most competitive products in the industry.

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When seniors develop diseases affecting cognition, like the various kinds of dementia, caregivers typically make an effort to make their living environment as safe and comfortable as possible.  Sometimes caregivers make lots of changes to a senior’s living space, with the best intentions of helping them.  However, this can have a two-sided effect, because seniors with mentally deteriorating illnesses can find change to be a confusing or frightening thing.  Caregivers might change the entire layout of a house, remove everything that could be a hazard, or add numerous locks to provide security.  Changes like these can actually prove to be disorienting for a senior, in addition to being helpful.  So the question becomes, how much change can seniors with Alzheimer’s handle?

It’s typical to find instances where seniors have lived in the same home for decades, and have a curious ability to navigate the living space with a sort of muscle memory after memory-harming diseases like Alzheimer’s set in.  Routine is very important to the delicate psyche of an elder with dementia, so finding the perfect balance of what to change for their own good can be tricky.  Making abrupt overwhelming makeovers to their home’s layout can make them flustered and end up actually making  it more difficult for them to get around, adding to their impaired cognition. So it is best to maintain an environment that is familiar as much as possible.  And make any alterations subtly and slowly over time.

The necessity to make changes will depend of the severity of a senior’s individual case.  If the Alzheimer’s is in the mid to late stages and a senior is wandering out of the home constantly, then immediate action to prevent hazard is surely appropriate.  Installing door alarms or adding locks can be great helps. If a senior with dementia typically kept a messy household, then the mess may add to their unease or make it easier to trip and fall.  De-cluttering their living space can be advantageous in these cases.

Thus, change will surely be necessary at times.  Though it is advisable to make changes as gradually and calmly as possible, to avoid overwhelming or distressing what was comfortable, normal, and assuring to the mind of a loved one with dementia.  Routine is key for security in these instances.  It may also be helpful to make sure you let them see when you move something, or set their things some place, to help then more easily adapt to the change.