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Alzheimer’s: Signs & Symptoms

 

Alzheimer’s disease (AD) is the most common type of dementia seen in older adults. An estimated 5.4 million Americans of all ages had Alzheimer’s disease in 2012. Nearly half (45%) of people over the age of 85 have AD. By 2050, the number of individuals age 65 and over with Alzheimer’s could range from 11 million to 16 million unless science finds a way to prevent or effectively treat the disease. One in eight older adults has AD, and it is the sixth leading cause of death in the United States (Alzheimer’s Association, 2012). Those affected with AD may live from 3–20 years or more after diagnosis, making the life span with this disease highly variable.

Risk factors

Advanced age is the single most significant risk factor for AD (Alzheimer’s Association, 2012). More women than men have AD, but this is because women live longer than men, not because gender is a risk factor. Family history and heredity are also identified risk factors for AD, as are head trauma and poor cardiac health.

Warning Signs

Alzheimer’s disease is characterized by progressive memory loss. The person affected by AD is gradually less able to remember new information and memory lapses begin to affect daily function. It is a terminal disease that over its course will eventually leave a person completely dependent upon others for care.

Diagnosis

Initially, the clinical progression of the disease is slow with mild decline; however, deterioration increases the longer the person lives, with an average life span of 8 years after diagnosis (Cotter, 2002; Fletcher, Rapp, & Reichman, 2007). The underlying pathology is not clear, but a growth of plaques and fibrillary tangles, loss of synapses, and neuronal cell loss are key hallmarks of AD that interfere with normal cell growth and the ability of the brain to function. Absolutely definitive diagnosis is still through autopsy, although clinical guidelines make diagnosis easier than decades ago when less was known about the disease. Primary care physicians generally make the diagnosis through a thorough history, physical exam, cognitive testing, and labs. New criteria for diagnosis include staging the disorder and biomarkers (beta amyloid and tau in the cerebrospinal fluid and blood) (Alzheimer’s Association, 2012b). An MRI of the brain may be ordered to rule out other causes of symptoms.

The clinical course of AD is divided into several stages, depending on the source consulted. In the early course of AD, the person may demonstrate a loss of short-term memory. This involves more than common memory loss, such as where the keys were put, and may involve safety concerns such as forgetting where one is going while driving. The inability to perform math calculations and to think abstractly may also be evident. In the middle or moderate phase, many bodily systems begin to decline. The person may become confused as to date, time, and place. Communication skills become impaired and personality changes may occur. As cognitive decline worsens, the person may forget the names of loved ones, even their spouse. Wandering behavior as well as emotional changes, screaming, delusions, hallucinations, suspiciousness, and depression are common. The person with AD is less able to care for her- or himself and personal hygiene suffers. In the most severe and final phase, the person becomes completely dependent upon others, experiences a severe decline in physical and functional health, loses communication skills, and is unable to control voluntary functions. Death eventually results from body systems shutting down and may be accompanied by an infectious process. Although there is no single test, and the diagnosis may be one of exclusion, early diagnosis is important to maximize function and quality of life for as long as possible. Persons experiencing recurring and progressing memory problems or difficulties with daily activities should seek professional assistance from their physician.

Treatment

Treatment for AD is difficult. There are several medications (such as Aricept, Namenda, Razadyne, and Exelon) that may help symptoms (such as memory), but they do not slow the course of the disease. There is currently no cure; however, research continues to occur in pharmacology, nonpharmacology, and the use of stem cells to manage symptoms and perhaps one day eradicate the disease.

Treatment will focus on symptom management, particularly in the areas of behavior, safety, nutrition, and hygiene. Behavioral issues such as wandering and outbursts pose a constant challenge. Many long-term care facilities have special “memory care” units to care for Alzheimer’s patients from the early to late stages of the disease. These units provide great benefits such as consistent and educated caregivers with whom the patient or resident will be familiar, a safe and controlled environment, modified surroundings to accommodate wandering behaviors, and nursing care 24 hours a day. Additionally, nurses are present to manage medications and document outcomes of therapies. However, many family members wish to care for their loved ones at home for as long as possible.

Thus, another important aspect of care in AD is care for the caregivers. Howcroft (2004) suggested that “support from carers is a key factor in the community care of people with dementia, but the role of the caregiver can be detrimental to the physical, mental, and financial health of a carer” (p. 31). She goes on to say that the caregivers of persons with AD would benefit from training in how to cope with behaviors that arise in these patients and how to cope with practical and legal issues that may occur.

Research has shown that ongoing skills are needed by family caregivers to deal with the progressive decline caused by AD. In fact, “a 63% greater risk of mortality was found among unpaid caregivers who characterized themselves as being emotionally or mentally strained by their role versus noncaregivers” (National Conference of Gerontological Nursing Practitioners & National Gerontological Nursing Association, 2008b, p. 4). Adapting to stress, working on time management, maximizing resources, and managing changing behavior were all skills caregivers needed to develop in order to successfully manage home care of their loved ones. When interventions and resources were not used by caregivers in the early stages of the care recipient’s AD, the risk of a healthy patient being institutionalized due to caregiver burden was higher (Miller, Rosenheck & Schneider, 2012). Caregivers needed not only to acquire knowledge and skills, but also to make emotional adjustments themselves to the ever-changing situation.

Such findings suggest that nurses should focus a good deal of time on educating caregivers of persons with AD to cope with, as Nancy Reagan put it, “the long good-bye.” Scientists continue to explore the causes of AD and hope in the near future to be able to isolate the gene that causes it. In the meantime, results from a fascinating longitudinal study (called the Nun study) on aging and AD, which used a group of nuns who donated their brains to be examined and autopsied after death, has suggested that there is a connection between early “idea density” and the emergence of AD in later life. That is, essays the nuns wrote upon entry to the convent were analyzed and correlated with those who developed AD. It was found that those with lower idea density (verbal and linguistic skills) in early life had a significantly greater chance of developing AD (Grossi, Buscema, Snowdon, & Antuono, 2007; Snowdon, 2004). The nun study has allowed researchers to examine hundreds of brains so far in nuns who died between 75 and 107 years of age and discover other important facts such as a relationship between stroke and the development of AD in certain individuals, and the role of folic acid in protecting against development of AD (Snowdon, 2004). Scientists from a number of fields continue to research the causes and possible treatments for AD and the Nun study project is continuing at the University of Minnesota. Snowdon’s research suggests that early education, particularly in verbal and cognitive skills, may protect persons from AD in later life.

For more information on Alzheimer’s disease, visit the Alzheimer’s Association website at: http://www.alz.org/

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 |2020-08-16T19:20:42-05:00September 10th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Alzheimer’s: Signs & Symptoms

Guest Blog: When Should Seniors Stop Driving?

On a list of the greatest fears many seniors have, failing health, hearing loss, and falling often rise to the top. One major fear that few actually talk to their families and doctors about though is losing the ability to drive. In fact, a new AAA study found that over 80 percent of older drivers never discuss their safe driving ability at all with their care networks or medical professionals.

For many seniors, driving is the hallmark characteristic that defines independence. Being able to drive allows seniors to travel, to run their own errands, to get out of their house and socialize. Losing that ability to drive doesn’t just strip those things away, but it also requires seniors to ask for help and coordinate transportation, all of which can leave them feeling like a burden on their caregivers.

What is the danger then? Well not only do older drivers who have outlived their ability to safely drive a vehicle endanger their passengers and other drivers on the road, they put themselves at increased risk for injury and even death. Because older adults typically have more fragile bones and higher rates of chronic illness that can complicate an injury recovery, they are more likely to get hurt or even die in a car crash than younger adults.

Talking About Driving with Your Aging Parent

The bottom line is that simply conducting a dialogue about driving doesn’t mean a senior will lose their license or be held back from driving. In fact, it is quite the opposite. Just as using a cane for walking empowers a senior with mobility limitations to keep moving, talking about safe driving can empower seniors to take helpful steps that keep them safe on the road.

For example, the Senior Driving division of AAA offers loads of helpful resources, tools, and information that connect seniors with local refresher courses on defensive road wise driving, help them understand how medicine can affect safe driving, and much more.

If you need to have a conversation with your aging parent about safe driving, experts recommend approaching it from a place of compassion and empathy. Instead of accusing them of being an unsafe driver, confess the concerns you feel about their safety on the road and ask them about their own perspective. Discuss helpful driving tools, safe driving refresher classes, and even consider attending a senior driving expo together.

By |2020-07-19T21:44:42-05:00July 24th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: When Should Seniors Stop Driving?

Guest Blog: Managing Back Pain as You Age

Like other critical parts of the musculoskeletal system, the spine experiences some wear and tear over the decades. Does this mean back pain is inevitable as you get older? Not necessarily.

What Happens to Your Spine as You Age?
The spine itself is composed of a series of stacked bones called vertebrae. Small joints between each vertebra allow for the spine’s range of movement and little rubbery discs with jelly-like centers inside make sure bones don’t rub against one another (they also serve as the spine’s shock absorbers).

Over time, these disks can dry out, shrink, and wear away, causing the spine to compress. This is known as degenerative disc disease. Sometimes the space surrounding the spinal cord will start to narrow too; this is known as spinal stenosis. Arthritis and osteoporosis may also affect the spine as you age leading to joint degradation and even spinal fractures.

Any of these age-related conditions can contribute to back pain, especially when bones start rubbing against one another and nerves get pinched. The body may even go as far as to grow bone spurs in an effort to stabilize a degenerating spine.

Preventing and Managing Back Pain
So, is there anything older adults can do to prevent it or at least manage the pain and discomfort that comes with those types of conditions? Definitely.

Experts recommend taking actions to relieve some of the burden your spine bears during daily activity. This includes:

  • Exercising to strengthen your back and core to more properly support the spine
    Practicing good posture when sitting, using the computer, texting, etc.
    Wearing a back brace for added posture support and lumbar compression
    Eating a healthy diet rich with anti-inflammatory foods that help you maintain a healthy weight and combat systemic inflammation in they body – think fresh fruits, vegetables, whole grains, nuts, seeds, legumes, and lean proteins
    Reducing stress on the back. This may mean utilizing lumbar cushions when driving, updating your mattress to better support your spine when sleeping, and avoiding activities which exacerbate your back pain

Additional Thoughts
Of course, it is also important to remember that acute back pain can also stem from something as simple as a muscle strain. Lifting something heavy, straining your arms and neck reaching for something in an awkward position, even sitting for a long period of time in an uncomfortable chair – any of these things can cause back pain and inflammation.

By |2020-06-22T11:40:41-05:00June 29th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: Managing Back Pain as You Age

Guest Blog: 4 Ways You Can Find Affordable Homecare

Home care is often preferred by seniors. An overwhelming 90% of seniors want to age in place. It is also affordable compared to nursing homes and assisted living facilities. However, hiring a caregiver may still be out of reach for many families.

1. Home Care Agency

A popular option for hiring a caregiver is through a home care agency. Hiring a caregiver through an agency allows seniors to have personalized one-on-one attention and flexible pricing (choosing less hours means saving on costs). You are also not responsible for any employer obligations like payroll tax and being held liable for any injuries that happen at home. However, this means that agencies pass administrative costs to the family which may still be unaffordable.

2. Family Caregivers

Did you know that there are an estimated 40 million unpaid family caregivers in the United States? Family caregivers perform a wide range of duties like paying bills, running errands, and helping with light household chores. Many family caregivers dedicate on average 20 hours a week towards providing care and some take time off work as well—resulting in a loss of earnable income. While being a family caregiver can save you money, your loved one may have needs that go beyond what you can support.

3. Local Classifieds

You can hire a caregiver directly through your local classifieds or online directory. Hiring a caregiver directly, and not through an agency can provide more affordable home care for your loved one, but there are some extra hurdles. You will need to personally interview and screen potential candidates. This involves meeting with the caregiver, verifying their references, and performing a background check. If your loved one needs care immediately, this process may be difficult and time consuming to do properly.

4. eCaregivers

After learning about using eCaregivers, you can find private caregivers with rates starting at $10-$14/hour for care, versus $20-$24 with an agency, helping you save thousands of dollars in a year while still ensuring quality home care for your loved one. All of the caregivers on eCaregivers have passed a background check so you have a peace of mind that you’re hiring a vetted caregiver for your loved one.

 

About the Author

Peter Kang is a writer for eCaregivers. He is inspired by his caregiver experience with his late grandfather and role model, a Korean War veteran, to help families find affordable care for their loved ones. Follow Peter on Facebook and Twitter.

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By |2020-04-06T10:59:55-05:00April 14th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Guest Blog: 4 Ways You Can Find Affordable Homecare

Simple Ways to Find Purpose as you Age

Having a purpose in life impacts its quality regardless of our age. A recently published study on Purpose of Life (PIL) in older adults found that people with purpose experienced fewer disability problems and chronic conditions. PIL is defined as a life with goals, direction, and meaning. People with a high PIL were found to be resilient, healthy and with social support, faith, and good knowledge of health-related matters. Here are some simple ways of keeping these factors in your life as you age.

1. Join an Age-Friendly Gym
Find a gym that has programs for elders. If you don’t know many fitness centers that offer such programs, use an online tool like this facility locator on the International Council of Active Aging website. The map shows the available options in a city by name, number, address, and allowed gender. Next to the name of the center, there are icons to show what type of services they offer. Besides fitness centers, you can use the tool to find other services as well, including recreation centers, retirement living facilities, YMCA, community services, etc. Here are 5 places you can visit to stay in shape and find new friends.

2. Become a Volunteer
Consider becoming one of the many elderly who volunteer. Some popular forms of volunteering include fundraising, teaching, mentoring, and preparing/distributing food. Retired individuals are a good fit for volunteering programs because they come from a variety of businesses and sectors. For instance, your input can be valuable for a fundraiser if you have spent your career in marketing and have a strong connection in the community that takes years to develop. Sites like Volunteer Match list opportunities in a variety of areas and for people of different age groups.

You can also offer your services as a mentor to young people in general or in your field of expertise. For food related jobs, check at your local food banks and at any local food service companies. Volunteering can offer both physical and mental benefits. When choosing a form of volunteering, make sure that it engages you, so you don’t find the work to be tedious and boring.

3. Visit Your Favorite Places
Start signing off the places you have on your travel bucket list. Hit the road, take the plane, rail, or ship. Don’t allow a limited budget to come in your way – look for discounts. A variety of discounts are available, including airfare, dining, clothing, grocery, and entertainment discounts. Here is a list of some of these discounts. Go through them to plan your trip for less. If your travel appliance have gone out of shape, use a home warranty to fix or replace them for free.

4. Learn Something New
Join a class at your library or senior center to stay mentally agile and find people who share the same interests. Check courses at your community college as well. Take a driving course if you feel like your driving skills need a little sharpening. Continue the process of learning.

By |2020-01-26T09:04:48-05:00January 26th, 2020|Dr. Mauk's Boomer Blog, News Posts|Comments Off on Simple Ways to Find Purpose as you Age
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