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Seniors Have Different Nutritional Needs October 05, 2017 20:21

Eating well is important at any age-  adequate nutrition is necessary for health, quality of life and vitality. Unfortunately, for a variety of reasons, many seniors are not eating as well as they should, which can lead to poor nutrition or malnutrition, easily being mistaken as a disease or illness.

Our bodies change as we get older, including perceptual, physiological and and general age-related conditions — such as dental or gastrointestinal conditions. These changes all influence the performance of our body as a whole, which in turn, influences our eating, nutritional intake and overall health.

Perceptual Changes

Perceptual changes later in life can also influence our nutrition, such as changes in hearing, smell and taste:

Hearing: Diminished or loss of hearing also affects our nutrition and food experience. The difficulty and frustration from the inability to hold a conversation with our eating partner out at a restaurant or at a social function can limit one’s food experience.

Smell: The loss of smell can also have a huge impact on the types of food one chooses to eat as there is a loss of satisfaction that can lead to poor food choices.

Taste: One of the most common complaints is in regards to the diminished taste in food. As taste buds decrease, so does our taste for salty and sweet — often times making food taste more bitter or sour.

Physiological Changes

One reason nutritional needs change is due to physiological changes that occur later in life:

Energy: Expenditure generally decreases with advancing age because of a decrease in basal metabolic rate and physical activity, thus decreasing caloric needs.

Function: Our bodies also begin to experience a decrease in kidney function, redistribution of body composition and changes in our nervous system.

Other Aging-Related Changes

Other changes in body function may impact nutritional intake, such as:

Dentition: The makeup of a set of teeth (including how many, their arrangement and their condition). The loss of teeth and/or ill-fitting dentures can lead to avoidance of hard and sticky foods.

Gastrointestinal Changes: Chronic gastritis, constipation, delayed stomach emptying and gas, may lead to avoiding healthy foods, such a fruits and vegetables — the food categories that should be more emphasized rather than eliminated.

These factors alone may contribute to why 3.7 million seniors are malnourished and shed light on the importance of educating caregivers and aging seniors as to specific dietary need options, as well as, catered senior diets and nutritional needs.

More on malnutrition soon.....


What is the 'Senior' Flu Shot? October 05, 2017 14:07

Basically, it's a stronger flu shot.  Four times stronger to be precise.

This flu vaccine could significantly reduce the risk of hospitalization among especially vulnerable seniors, a large, random clinical trial has found.

Vaccines typically don’t work very well in older people—a problem because the flu can lead to serious respiratory infections in frail patients such as elderly nursing home residents.

“…the rate of hospitalization for any reason, respiratory or otherwise, was significantly lower in the high-dose group…”

While a prior study showed that older individuals could respond better to the high-dose vaccine, it focused on relatively healthy older adults, says lead author Stefan Gravenstein, professor at both the Warren Alpert Medical School and the School of Public Health at Brown University.

It still needed to be established that it would help even the frailest folks, like those who reside in nursing homes.

In this study, a quarter of the sample was over 90. DId the high-dose vaccine also work better than regular-dose vaccine in the population we consider least able to respond. This paper says yes, it can.

The study compared hospitalization rates among more than 38,000 residents of 823 nursing homes in 38 states during the 2013-14 flu season based on Medicare claims data. Just under half the homes, 409 to be exact, administered the high-dose vaccine while the other 414 provided a standard dose.

In the end, the hospitalization rate for respiratory illnesses among high-dose patients was 3.4 percent compared to 3.8 percent among standard-dose patients over the six months after vaccination. Statistical analysis revealed that the relative risk of hospitalization for respiratory illness was 12.7 percent lower for the high-dose group.

Moreover, the rate of hospitalization for any reason, respiratory or otherwise, was significantly lower in the high-dose group as well. For every 69 people given the high-dose vaccine vs. the standard-dose vaccine, one more person stayed out of the hospital during the flu season.

“Respiratory illness as the primary reason for hospitalization accounted for only about a third of the reduction in hospitalization that we measured,” says Gravenstein.

For many patients, the vaccine appeared to help prevent hospitalization for other problems also, including cardiovascular symptoms.

Nope, the flu vaccine won’t give you the flu

Gravenstein says the finding of a significant reduction in hospitalizations was particularly notable because the predominant flu strain during the 2013-14 season, A/H1N1pdm, was believed to be less virulent in older people who had spent a long lifetime building up immunity to similar strains.

“That there was differential protection in this context both underlines the potential importance of even low-virulence or less transmissible strains to older populations and the fact that vaccines may afford relevant effectiveness among frail older persons even when A/H1N1 predominates,” the authors write.

The study did not find a significant difference in the rate of death. Researchers speculate that while the standard-dose vaccine might not have been strong enough to stave off illness entirely, it may still have been sufficient to prevent deaths in combination with hospital care.

But a significant reduction in hospitalizations can still be a benefit, Gravenstein says, even though the high-dose vaccine is more expensive than the standard-dose vaccine. Especially for older, frail patients, reducing otherwise necessary trips to the hospital can maintain a higher quality of life.

Ultimately, Gravenstein says, the study should provide nursing home leadership with useful information to consider as they plan for future flu seasons.


Is Your Doctor Aware of How Expensive are the Drugs He/She Prescribes? September 06, 2017 12:22

FYI...This is NOT medical advice. Talk to your health care provider.

In 2013, pharmacy benefits manager Express Scripts estimated that the United States wasted $418 billion on “bad medication-related decisions”—with $55.8 billion alone on high-priced medications when more affordable drugs could have been used instead.

Expensive is simply not always better.

Here are ten prescriptions that are usually very expensive, even with insurance. All of them have cheaper alternatives that work just as well.

  1. Vimovo. This is a mixture of the anti-inflammatory naproxen and generic Nexium, which is esomeprazole. Here’s an idea: instead of paying hundreds of dollars for this, get generic naproxen 500 mg tablets and 20 mg tablets of esomeprazole and there you have it: your own Vimovo for just pennies.

  2. Dexilant. This is a very expensive brand-name proton pump inhibitor (a class of drugs that includes Prilosecand Protonix). A number of studies have compared the various proton pump inhibitors to one another and while some differences have been reported, they have been small and of little clinical importance. Do yourself a favor and give lansoprazole or pantoprazole a try instead.

  3. Benicar. Used for high blood pressure, this is an expensive brand-name angiotensin receptor blocker (ARB) in a class that has many generic options. Benicar is certainly no better than the cheaper drugs in the class (valsartan and losartan are examples). Plus, Benicar can produce a “sprue-like enteropathy” which gives you severe chronic diarrhea and weight loss, and can occur months to years after starting the drug. Hmmm.

  4. Vytorin. This is a mixture of simvastatin and Zetia (ezetimibe). Unless you’ve recently had a heart attack, you don’t need to waste money on this and here is why: statins, like the cheap generic simvastatin alone, are the first choice in virtually all patients with high cholesterol in whom the goal is reduction of cardiovascular risk. People have been paying for Vytorin for years and yet it remains “uncertain” whether the combo of simvastatin and Zetia that makes up Vytorin provides additional clinical benefit. A recent study showed benefit in people hospitalized after heart attack but for most people, stick with just the simvastatin part and don’t bother with the combo.

  5. Bystolic. There is no evidence this beta blocker is better than two similar generic options, metoprolol and carvedilol. Bystolic is what is known as a “beta 1 selective” beta blocker used for the treatment of high blood pressure and it does provide a survival benefit in patients with heart failure. Sounds great, right—but wait. In heart failure patients, there are three beta blockers that have shown survival benefit. You guessed it: metoprolol, carvedilol, and Bystolic. Metoprolol and carvedilol are generic and much cheaper so there is no reason to pay money here.

  6. Zafirlukast (Accolate). Though available as a generic, it is still much pricier than the other option in the same class, montelukast (Singulair). There is no proof that zafirlukast is any better than montelukast for asthma, and in fact, montelukast is usually preferred because it is used once daily and can be taken at any time in relation to meals.

  7. Celecoxib (Celebrex). Celebrex, used for arthritis, has just recently become available as generic celecoxib so it’s still quite expensive and many folks pay a high price for it. However, meloxicam (Mobic), another Cox-2 inhibitor similar to celecoxib, is much cheaper and also works well for the treatment of osteoarthritis and rheumatoid arthritis.

  8. Pristiq. This is an expensive brand-name SNRI antidepressant used for depression and fibromyalgia. There is no evidence that Pristiq is any better than the cheaper generic duloxetine (Cymbalta) for fibromyalgia. For depression, there are two generic SNRI options in this class, venlafaxine and duloxetine. You should try those first before paying for Pristiq.

  9. Pataday. These antihistamine eye drops are used for red, itchy eyes related to allergies. Patanol and Pataday are expensive brand name eye drops in this class which includes azelastine (Optivar) as a good generic option that is much cheaper. Pataday carries the advantage of once daily dosing compared to twice a day but is it worth the cost?

  10. Avodart. Two 5-alpha-reductase inhibitors are approved in the US for symptoms related to enlarged prostate: Proscar (finasteride) and Avodart (dutasteride). One is cheap, one is not. In a large one-year study, finasteride and the more expensive Avodart worked just as well for reduction in prostate volume, urinary flow rate and urinary symptom scores, and adverse effects were similar. Don’t waste your money on Avodart when you can save on finasteride.


Many Seniors Face Isolation, Hunger August 31, 2017 16:09

Even the most healthy and active among us, if fortunate to live long enough, may face some of the biggest threats of aging: hunger, isolation and loss of independence. With an average life expectancy nearing 80, living longer means more years spent in the struggles that accompany old age. Add to that the increase in geographic separation of our families and the result is millions of seniors left behind, hungry and alone.

While we all celebrate the increase in lifespan, maintaining health while aging comes at a price. Without support from programs like Meals on Wheels, millions of seniors are forced to prematurely trade their homes for more costly alternatives.

THE REALITY

  • 10.2 million seniors in America face the threat of hunger - that's 1 in 6!
  • 15.2 million seniors are isolated, living alone
  • 18.4 million seniors have difficulty paying for basic living needs
  • The senior population is projected to double by 2050

These Foods Have More Sugar Than You Think April 19, 2017 15:23

Processed sugar is a killer. That is a proven fact. (Look at this.) food manufacturers put in certain foods for flavor, especially 'low-fat' options. The following list of 'sugary' foods you should look at if you want to control your sugar consumption. For reference, there are about 33 grams of sugar in 12 ounces of Coca-Cola. 

1. Pasta Sauce - 6-12 grams per half-cup

2. Granola Bars - 8-12 grams per bar

3. Yogurt - 17-33 grams per 8-ounce cup

4. Instant Oatmeal - 10-15 grams per 'fruit-flavored' packet.

5. Breakfast Cereal- 10-20 grams per cup (even popular oat and bran brands.)

6. Packaged Fruits - 33 grams per cup of canned fruit in light syrup.

7. Bottled Tea - 32 grams per bottle, leading brands of lemon-flavored iced tea.

8. Dried Fruit - 25 grams , a small box of raisins.

9.- Fancy Coffee Drinks - 30-60 grams of added sugar per 16 oz.

10- Pomegranate Juice - 62 grams per bottle of this 'heart-healthy' drink.

Bottom line- Read the labels!

According to the American Heart Association (AHA), the maximum amount of added sugars you should eat in a day are:

  • Men: 150 calories per day (37.5 grams or 9 teaspoons).
  • Women: 100 calories per day (25 grams or 6 teaspoons).

Geriatricians Can Help Aging Patients Navigate Multiple Ailments February 27, 2017 09:59

Geriatricians are “experts in complexity,” said Dr. Eric Widera, director of the geriatrics medicine fellowship at the University of California, San Francisco.

No one better understands how multiple medical problems interact in older people and affect their quality of life than these specialists on aging. But their role in the health care system remains poorly understood and their expertise underused.

Interviews with geriatricians offer insights useful to older adults and their families:

Basic knowledge. Geriatricians are typically internists or family physicians who have spent an extra year becoming trained in the unique health care needs of older adults.

They’re among the rarest of medical specialties. In 2016, there were 7,293 geriatricians in the U.S. — fewer than two years before, according to the American Geriatrics Society.

Geriatricians can serve as primary care doctors, mostly to people in their 70s, 80s and older who have multiple medical conditions. They also provide consultations and work in interdisciplinary medical teams caring for older patients.

Recognizing that training programs can’t meet expected demand as the population ages, the specialty has launched programs to educate other physicians in the principles of geriatric medicine.

“We’ve been trying to get all clinicians trained in what we call the ‘101 level’ of geriatrics,” said Dr. Rosanne Leipzig, a professor of geriatrics at the Icahn School of Medicine at Mount Sinai in New York City.

Essential competencies. Researchers have spent considerable time over the past several years examining what, exactly, geriatricians do.

A 2014 article by Leipzig and multiple co-authors defined 12 essential competencies, including optimizing older adults’ functioning and well-being; helping seniors and their families clarify their goals for care and shaping care plans accordingly; comprehensive medication management; extensive care coordination; and providing palliative and end-of-life care, among others skills.

Underlying these skills is an expert understanding how older adults’ bodies, minds and lives differ from middle-age adults.

“We take a much broader history that looks at what our patients can and can’t do, how they’re getting along in their environment, how they see their future, their support systems, and their integration in the community,” said Dr. Kathryn Eubank, medical director of the Acute Care for Elders unit at the San Francisco Veterans Affairs Medical Center. “And when a problem arises with a patient, we tend to ask ‘How do we put this in the context of other concerns that might be contributing?’ ”

Geriatric syndromes. Another essential competency is a focus on issues that other primary care doctors often neglect — notably falls, incontinence, muscle weakness, frailty, fatigue, cognitive impairment and delirium. In medicine, these are known as “geriatric syndromes.”

“If you’re losing weight, you’re falling, you can’t climb a flight of stairs, you’re tired all the time, you’re unhappy and you’re on 10 or more medications, go see a geriatrician,” said Dr. John Morley, professor of geriatrics at Saint Louis University.

“Much of what we do is get rid of treatments prescribed by other physicians that aren’t working,” Morley continued.

Recently, he wrote of an 88-year-old patient with metastasized prostate cancer who was on 26 medications. The older man was troubled by profound fatigue, which dissipated after Morley took him off all but one medication. (Most of the drugs had minimal expected benefit for someone at the end of life.) The patient died peacefully eight months later.

Eubank tells of an 80-year-old combative and confused patient whom her team saw in the hospital after one of his legs had been amputated. Although physicians recognized the patient was delirious, they had prescribed medications that worsened that condition, given him insufficient pain relief and overlooked his constipation.

“Medications contributing to the patient’s delirium were stopped. We made his room quieter so he was disturbed less and stopped staff from interrupting his sleep between 10 p.m. and 6 a.m.,” Eubank said. “We worked to get him up out of bed, normalized his life as much as possible and made sure he got a pocket talker [hearing device] so he could hear what was going on.”

Over the next four days, the patient improved every day and was successfully discharged to rehabilitation.

Finding help. A geriatric consultation typically involves two appointments: one to conduct a comprehensive assessment of your physical, psychological, cognitive and social functioning, and another to go over a proposed plan of care.

The American Geriatrics Society has a geriatrician-finder on its website — a useful resource. Also, you can check whether a nearby medical school or academic medical center has a department of geriatrics.

Many doctors claim competency in caring for older adults. Be concerned if they fail to go over your medications carefully, if they don’t ask about geriatric syndromes or if they don’t inquire about the goals you have for your care, advised Dr. Mindy Fain, chief of geriatrics and co-director of the Arizona Center on Aging at the University of Arizona.

Also, don’t hesitate to ask pointed questions: Has this doctor had any additional training in geriatric care? Does she approach the care of older adults differently — if so, how? Are there certain medications she doesn’t use?

“You’ll be able to see in the physician’s mannerisms and response if she takes you seriously,” Leipzig said.

If not, keep looking for one who does.

 Judith Graham- Kaiser Health News, 

Geriatricians Can Help Aging Patients Navigate Multiple Ailments