Archives May 2017

By Meredith Kimple

“Trust your gut.”

How often have we heard that phrase? Such advice implies that the gut is the source of our deepest instincts, of an innate, pure knowledge; it subscribes to the belief that our “gut feelings” are uninhibited by the restrictions of rationality or the flaws in reason. However, the reality is that a strong connection exists between gut and mind, to the point that the enteric nervous system is often referred to as “the second brain.”

Taking care of your gut is extremely important for all people, but for seniors, it can literally mean the difference between sickness and health. The bulk of the body’s immune system lies in the gut, and the bacteria contained there produce the majority of the body’s serotonin, a neurotransmitter that stabilizes our mood.

As we age, an imbalance in the microbiota of our gut can leave us vulnerable to infection, sickness, digestive issues, and even depression. Aging in and of itself does not cause this imbalance, but certain aspects of the aging process can have a negative impact on the variety of our gastrointestinal bacteria. An increase in the medications one takes, health conditions that arise and worsen with age, and a poor diet can reduce or alter the diverse flora of the human gut.

Probiotics are live bacteria that can help to restore or preserve the balance in the gut, and can be obtained either through eating fermented foods, like yogurt, or by taking dietary supplements.

Although they do not entirely prevent illness and infection, probiotics can lessen the duration and severity of certain conditions, like inflammatory bowel syndrome (IBS), diarrhea caused by viruses and antibiotics, colds, allergies, and even eczema. Seniors are often more susceptible to gastrointestinal issues because their gut health has been compromised by antibiotics; a daily probiotic can help strengthen their immune systems while reducing their abdominal discomfort.

Not only are probiotics a safe, effective way to maintain bacterial balance in the gut, but new research shows they may also improve cognitive function.

For years, the aforementioned connection between mind and gut has given scientists reason to believe that probiotics might also provide cognitive benefits. Previous studies on mice revealed that both memory and learning faculties were strengthened by probiotic use, but there was still very little evidence that the same results could be achieved in human subjects.

Last year, researchers from Kashan University of Medical Sciences and Islamic Azad University conducted a 12-week study to observe the impact of probiotics on the cognitive function of 52 men and women with Alzheimer’s, aged 60 to 95. One group received milk treated with probiotic bacteria, while the other received milk that had not been treated; at the beginning and end of the study, participants had their blood drawn and were subjected to the MMSE questionnaire, a tool for measuring cognitive function.

The group that received the probiotic-fortified milk saw a modest, though significant, increase in the average of their scores at the end of the study; the average score of the control group actually decreased slightly. Though probiotics did not remedy participants’ cognitive impairment, this was the first study to offer evidence of their impact on cognitive function.

The study shows that there does seem to be a powerful connection between mind and gut, and one that is much stronger than previously thought. While more evidence is needed to bolster these incredible results, such an outcome can only lend additional merit to probiotics’ long list of benefits to the human body.

Probiotics are not miracle workers, but they can help our senior loved ones maintain a healthy gut; they make digestion smoother, strengthen the immune system, stabilize and improve mood, reduce IBS and IBD-related discomfort, and might improve cognitive function. In past blog posts, we’ve looked at health issues that are perhaps more obvious; when we think of senior health, many of the same conditions probably come to mind. Heart disease. Alzheimer’s disease. Dementia. Diabetes.

Of course, these conditions are very important, and they deserve to be discussed and studied. But there are other aspects of senior health that are not given top priority in our hierarchy of concerns; they are things we might take for granted, or which do not seem quite so significant in the face of more devastating ailments.

A healthy gut is, in many ways, a pillar of our overall health. If there is an imbalance in the microbiota of their gastrointestinal system, our senior loved ones may be vulnerable to illness and discomfort. Encourage them to add fermented food products like yogurt to their diet, or talk to them about taking a probiotic dietary supplement; their physician can recommend the probiotic that will best suit their needs, and should always be consulted before adding one to their regimen.

It’s not enough to just “trust our gut.”

We have to take good care of it, too.

By Meredith Kimple

As technology evolves at a break-neck speed, we often hear cautionary reminders that we are becoming too reliant on our cellphones, tablets, and computers. While there is nothing wrong with encouraging us to detach from these objects, such warnings ultimately sell the truly helpful aspects of new technology short.

Older people may be the most resistant to these developments, and understandably. But there’s a new incentive to invest in your interactive screen of choice; recent research shows that activities like regularly using email may help protect against dementia.

The Mayo Clinic conducted a study that followed nearly 2,000 cognitively normal individuals over the age of 70 for a span of four years. Participants received neurocognitive evaluations every 15 months for the duration of the study, and were ultimately labeled either cognitively normal or mildly impaired. Researchers found that individuals who engaged in certain activities at least once or twice a week experienced less cognitive decline than those who only performed them a few times a month, if that.

What were these activities?

You might guess something like puzzles or knitting, or perhaps regular social interaction, but the activity that had the greatest bearing on participants’ cognitive health was computer use.

Those who used a computer a few times per week lowered their risk of new-onset mild cognitive impairment by roughly 30 percent; other activities, including arts and crafts, social interaction, and games, brought a 20 percent decrease. Even participants who were genetically predisposed to developing cognitive impairment or Alzheimer’s disease saw some benefit from engaging in weekly computer use.

The results of the study corroborate earlier findings that certain mentally stimulating activities can offer a degree of protection against mild cognitive impairment. You might think that in order to take full advantage of these benefits, these activities must have been performed for many years. However, research suggests that beginning these practices at a more advanced age can still decrease one’s risk.

Another study showed a possible connection between mentally stimulating activities and a reduced risk for suffering delirium, a state of sudden confusion that the elderly sometimes experience after a major procedure. Researchers found that the 32 percent of participants who developed post-operative delirium engaged in fewer leisure activities than their counterparts who were not delirious. The activities that most reduced their risk for delirium were reading books, playing computer games, and using email. Researchers concluded that the more time older individuals invested in these leisure activities, the less likely they were to develop delirium after surgery. Because delirium can increase an older person’s risk for decline and dementia, regular engagement in mentally stimulating activities may be vital for preserving their cognitive health.

In both studies, computer use played a surprising role in lowering seniors’ risk for developing a cognitive impairment. But why might this surprise us? Reading, even when done on the computer, helps to keep our minds sharp. Using a computer requires practice and to a certain extent, keen concentration.

Yet, since the advent of in-home television, society has denounced the convenient practice of gleaning information from screens.

Though we rush to buy the newest smart phone upgrade and gladly spend hours on social media, deep down, we harbor a fragment of guilt. As a culture, we simultaneously glorify and decry the ever-changing face of technological advancement. Feelings towards the latest innovations are highly charged, and perhaps most so among the elderly population.

Our senior loved ones grew up without computers and cellphones, and depending on their age, without television. While many older people have embraced the most recent developments in technology, others are frustrated and afraid of it. Part of this may be an ornery loyalty to the traditional ways of doing things, or a belief that computers and smartphones offer nothing to their demographic. However, these dismissals may attempt to mask an inability to use the technology.

Because computer-related activities seem to have a positive effect on seniors’ “cognitive reserve”, encouraging our loved ones to jump on the bandwagon may help to preserve their mental faculties. We should do everything we can to help them feel comfortable using a computer; search for local classes geared towards senior learning, and offer to demonstrate basic applications, like email.

While computer usage is certainly not the only mentally stimulating activity, being able to access email and search the Internet provides a link to public life. It’s a great way to keep in touch with long-distance friends and family, stay up-to-date on the news, or watch TV shows and viral videos. Computers can help seniors with limited mobility maintain a strong connection with the world, and this inclusivity may help boost their self-esteem.

If we each made a list of things we couldn’t live without, we’d probably have a number of entries in common: food, water, our cellphones, our computers, and perhaps, our cars.

Driving enables us to live independently, but for many of us, it is a privilege that we take for granted; when we are no longer able to drive, we become acutely aware of our powerlessness. As we age, our bodies undergo inevitable physical changes, and some of those changes involve visual acuity, reflexes, muscle strength and mobility–all physical attributes that are necessary for safe driving.

Physical Changes

• Hearing loss and vision impairments that result from age can make driving significantly more difficult.
• Pain in the legs, arms, and neck can hinder an older driver from reacting as the situation requires, because their movement may be restricted.
• Some health conditions and the medications used to manage them might impact a senior’s ability to safely drive.

Cognitive Changes

• Elderly people generally have a harder time multi-tasking than younger adults. Because driving involves absorbing and processing a variety of visual stimuli, older people may not be able to concentrate to the degree necessary for quick decision-making on the road;
• Dementia and other cognitive impairments can impede a senior driver’s ability to determine where they are going, as well as their knowledge of driving mechanics.

Whether it’s a change in vision, decrease in mobility, or an inability to concentrate, these age-related impediments can put the lives of older drivers at risk. After the age of 70, fatal crash rates tend to increase. This is not to say that all seniors should stop driving once they reach a certain age; the onset of risk factors for an accident differs among older drivers, and some are still able to drive long after others have had to surrender their keys.

Most seniors do not willingly cease to drive. As new health conditions and limitations become part of their reality, the idea of sacrificing their independence becomes unthinkable. In giving up the ability to move and do as they please, some seniors may suddenly be faced with the belief that they have become “old,” and in the worst sense of the word. They may feel irrelevant or isolated without a car, and their self-esteem may plummet.

Usually, an older person will stop driving either because of an accident that warrants the removal of their license, or as the result of some sort of familial intervention. But how do we start that difficult conversation?

Remember first and foremost that your older loved one’s feelings about driving are valid. You are suggesting that they sacrifice a precious freedom, and although you are absolutely in the right, you have to anticipate and respect their resistance to such a massive change.

Provide them with concrete examples of their dangerous driving: dents in the car, citations, running a red light or stop sign, nearly colliding with other drivers at an intersection. Remind them that not only are they putting their safety at risk when they operate a vehicle, but the safety of other drivers as well.

If they refuse to consider your points, try enlisting the help of their doctor.  A doctor can order tests to determine whether or not your loved one should continue driving, and their recommendations may be taken more seriously. Recruit other family members and your loved one’s close friends to give your appeals more weight; if more than one person thinks they should give up driving, they may have a harder time dismissing your concerns.

To ease their fears, propose alternative transportation options. If you live close by, offer to drive them to appointments and other outings. Help them find a driving service or public transportation. It is vital that they don’t feel cut off from the world; if they live in a rural or suburban area where driving by car is the only way to get around, it might be time to consider moving them to an area where there are more transportation options for them to utilize.

If you help them find a substitute for driving that still provides them with a sense of independence, the transition will be slightly less difficult. But giving up their ability to drive will be a major adjustment, so offer them plenty of support and encourage their desire to be self-sufficient.

The good news is that cars are safer than they used to be, and many older adults take initiative with certain precautions, like not driving at night. As a significant portion of the population ages, we need to find new ways to tackle the problem of compromised driving. Whether there are more frequent and strict tests to determine driving capabilities, or whether it’s something decided among families, we’ll need to develop better procedures for assessing eligibility.

If public transportation is broadened and improved in this country, cars will not be quite as essential to one’s independence. Perhaps as the older generations age we will see these steps taken to fill a widespread need; in the meantime, what we can offer our senior loved ones is support, understanding, and patience.

By Meredith Kimple

When a senior loved one is diagnosed with Alzheimer’s disease, we are suddenly barraged with a variety of new questions and concerns. How will they carry out their daily tasks as the disease progresses? How rapidly and to what extent will their comprehension be compromised? What medical care will they need, and should they enter an assisted living facility or move in with family?

What if they wander outside the home and become lost, or worse, hurt themselves?

An estimated three out of five people diagnosed with Alzheimer’s exhibit wandering behavior, and across all stages of the disease. We might have certain preconceived notions about what wandering entails. But people who suffer from Alzheimer’s are not necessarily on autopilot when they wander, and they do not always attempt to leave the house. As with other aspects of the disease, there has been no general consensus about what causes those with dementia to wander; it often begins as a result of boredom, perceived necessity, frustration, or stress.

What are the warning signs that your senior loved one might have a tendency to wander? The reality is that anyone with dementia has the potential, but the following are a few of the signs that usually precede wandering:

1. Restlessness.

They might find it difficult to stay in one place; they might walk around the house without purpose, pace in the same vicinity for an extended period of time, or engage in repetitive movements.

2. Confusion.

Your senior loved one might become disoriented when entering an environment that is either new or altered in some way. They may get lost in areas that offer too much stimulation, like the grocery store or the mall. But they also may have difficulty in identifying familiar places, like the rooms in their own home.

3. Repetition of Tasks.

They may continuously perform the same task without actually completing it; for example, they may think they are organizing their room, but are only moving the same few items around over and over again.

4. Following an old routine.

A person with Alzheimer’s may try to return to a past residence or the site of a former job, or attempt to run unnecessary and irrelevant errands.

5.  Delayed Return.

If they regularly go for walks, they may take longer than usual to arrive home; this might be a sign that they are starting to lose their way while walking, or forgetting the route that leads back to their house.

Wandering is not dangerous in and of itself; if it occurs within the safety of the home, under supervision, it poses few threats. However, when a person with Alzheimer’s wanders outside alone, they are rendered completely vulnerable to a number of risks. They might become confused and lose track of the way home, or they may not recognize their surroundings at all. Others may try to rob or take advantage of them while they are lost, and, worst of all, they may be seriously injured.

In order to keep our loved ones safe, there are several concrete steps we can take to limit their wandering:

1. Establish a regular routine.

Structure can be very beneficial to people with Alzheimer’s. A daily routine may help combat boredom and stress, both of which can trigger wandering in those with dementia. If you notice that the wandering occurs at a certain time of day, plan activities to occupy their attention during that period.

2. Provide security.

Anything we can do to assuage their fears and reassure them that they are not lost is very important. Make sure that they are never left unsupervised in the home or out in public, and try to avoid crowded, noisy places that might disorient them. Be patient if your loved one insists on going to an old residence or office, and instead of invalidating their desire, tell them that they should stay with you at home for the time being. Hide all car keys so that they can’t drive off.

3. Adapt the environment.

Install alarms and locks that are either out of reach or out of sight. Obscure doorknobs by covering them in fabric or painting them to match the door. Hide the door behind a curtain. Reduce in-home dangers by blocking the stairs with a baby-gate and removing clutter from the floors.

4. Help them meet basic needs.

Wandering may at times be motivated by the need to eat, drink, or use the bathroom. Ensuring that they meet these needs regularly may help prevent some of their wandering.

It’s best to have a plan in place in the event that your senior loved one does wander and become lost. Know your surroundings; make sure that you can contact your neighbors, and familiarize yourself with any physical dangers in the vicinity, like stairs, hills, busy roads, or bodies of water. Keep in mind any places that your loved one may try to reach, such as the site of an old job, a former residence, or their place of worship. Search for no more than 15 minutes before calling the police. Consider buying identification jewelry that includes your loved one’s name, address and your phone number; people with Alzheimer’s may not remember these details while lost.

A recent study published in the journal Neuron has helped to shed light on the biological origin of wandering behavior. Researchers found that course-plotting capabilities are compromised by the build up of tau protein in the entorhinal cortex (EC), a part of the brain largely responsible for memory and navigation. Within the EC, there are nerve cells called excitatory grid cells that fire as we move through a space; these grid cells form a map of the environment around us that enables us to find our way in any area.

They observed the impact a build-up of tau had on the excitatory grid cells of mice; the protein only damaged the excitatory cells, creating a severe imbalance in the mice’s internal grids. The findings support the theory that tau in the EC does contribute to wandering in those with Alzheimer’s disease.

Though further research is needed, the results of the study offer the possibility for treatment in the future; researchers believe that they may one day be able to correct the imbalance with the right therapy. Dr. Karen E. Duff, who co-led the study, even thinks that the results of the study may make it possible for navigation-based cognitive tests to be administered as a screening for early stage Alzheimer’s.

Wandering is a behavior that can make us, as caregivers and relatives, feel utterly powerless. Alzheimer’s can transform aspects of our loved ones in what seems like the blink of an eye; we make adjustments, and we do everything possible to create the semblance of order in the midst of constant, inexplicable change.

The truth is that we may not be able to keep our loved ones from wandering. Despite our best efforts, they may still slip away from us. But understanding where this behavior comes from can only help to prepare us for those terrifying moments. There are steps we can take to better ensure their safety, and in preparing for the worst, hopefully we can acquire some peace of mind.

Obesity is on the rise in the United States with an estimated 36.5 percent of adults affected; this means that approximately one-third of the adult population has the condition. Rates are highest among those between the ages of 40 and 59, as well as those over the age of 60. It is widely known that a substantial excess of fat in the body can lead to a host of health troubles, including type 2 diabetes, heart disease, and even some forms of cancer.

For older adults, an inability to maintain a healthy body weight can have an additional consequence; new research has shown a potential link between obesity and cognitive impairment later in life.

A recent study conducted by scientists from the Indiana University Center for Aging Research has revealed a possible connection between a high BMI (body mass index) and a weakened reception to memory training. Researchers observed roughly 2,800 cognitively normal participants over a span of ten years, the majority of whom were white and female with an average age of 74 years. For the duration of the study, scientists compared the degree of progress made by those with a normal BMI, those who were overweight, and those who were obese.

Results indicated that while a high BMI seemed to have little to no impact on reasoning or processing speed training, it significantly affected the benefits a participant gained from memory training; those who were considered obese received approximately one-third the benefit attained by their lower BMI counterparts. Though scientists are not sure exactly how obesity brings such an outcome, Dr. Daniel O. Clark, primary author of the study, referenced imaging studies that showed an association between obesity and a faster loss of hippocampal volume. The hippocampus is the part of the brain that is responsible for memory, and the implication is that older individuals who are obese may not have the same capacity to benefit from memory training as those who have a lower BMI. Dr. Clark also references prior research indicating that safe, intentional weight loss can actually lead to improvements in memory.

While not directly related to obesity, another recent study has found evidence that sedentary adults with no genetic risk factors for dementia have the same likelihood of developing the condition as those who do. Individuals who carry a variant of the genotype “apolipoprotein E” have a greater risk of developing dementia than those who do not, but researchers found that people who are primarily sedentary, but not carriers, exponentially increase their risk by their inactivity.

People who have a sedentary lifestyle, whether by choice or because of a medical condition, may have trouble maintaining a healthy body weight, and prolonged inactivity often leads to obesity. For a variety of reasons, seniors may have greater difficulty fitting exercise into their lives than the young or middle aged; they may have a disability or other impairments that make any physical activity impossible, they may tire more easily, or they may not be able to exercise the way they used to and become discouraged. If they aren’t active or eating well, they will put on weight very quickly, which in turn may put them at an increased risk for dementia.

How can we help our older loved ones build safe, effective exercise into their daily routine?

The good news is that health professionals estimate an intentional weight loss of as little as 5 to 10 pounds can yield significant benefits for a senior. There is no need for strenuous exercise to see at least some improvement. With this in mind, there are plenty of exercise options for those with mobile impairments and those who need a gentler form of physical activity.

There is a post on this blog about the benefits of Tai Chi for the elderly; this thoughtful exercise is perfect for older adults who are still mobile but who may not feel confident in their ability to balance. Tai Chi can also be adapted for seniors who are not secure enough to stand while performing the motions.

Water activities are another great way to get our older loved ones moving again. Walking around in a pool and swimming are forms of exercise that do not strain the joints and free the senior body from the limitations imposed by gravity.

If none of these are feasible, encourage your senior loved one to talk with their doctor about seeing a physical therapist. A physical therapist will help them develop a safe and effective exercise regimen tailored to their level of ability.

All exercise should be approved by your older loved one’s doctor before they add it to their routine.

Having a lower body weight provides a number of benefits to seniors; with fewer pounds to carry, walking is less strenuous. They may feel more alert and more in control of their bodies. Their risk of diabetes and heart disease may decrease. Certainly, the fact that obesity may negatively impact cognitive function is only the newest incentive to maintain a lower weight. Because obesity can lead to and exacerbate multiple severe health issues, it is crucial that we help our parents, grandparents, and older loved ones access the resources they need to keep as active as possible.