Archives June 2017

By Meredith Kimple

Often when we consider the health issues that plague the elderly population, we tend to think of those that are strongly associated with advanced age, like dementia or heart disease. However, there are certain problems that, because of their seeming prevalence across all age groups, might be overlooked or underestimated when they occur in an older person.

One such problem is the urinary tract infection, or UTI.

Urinary tract infections are painful at any age, but for our senior loved ones, they can be particularly difficult and dangerous. A UTI is, generally, any infection in the urinary system, and while it typically begins in the urethra and bladder, it can spread to the kidneys if it goes untreated. The primary cause is the spread of gastrointestinal bacteria from the anus to the urethra; because the anus and urethra are in much closer proximity on the female body, it is estimated that 40 to 60% of women develop a UTI in their lifetime.

Older individuals are also especially susceptible to UTIs. There are several reasons for this, including:

• Urine Retention.

Compared to younger individuals, the elderly tend to have weaker bladder muscles, making it difficult for them to empty their bladders completely. Bladder prolapse and certain medications can also lead to urine retention.

Incontinence, coupled with an older person’s inability to clean themselves thoroughly, increases the likelihood that bacteria will enter the urethra.

• Health Conditions.

Certain pre-existing health conditions, like diabetes or kidney stones, increase a senior’s chances of getting a UTI. A weakened immune system and poor hygiene can also substantially increase their risk.

• Decreased Estrogen (Women).

Post-menopause, a decrease in estrogen level can allow for the cultivation of bacteria in the vagina and urethra, which in turn can cause infection.

To further complicate matters, the typical symptoms of a urinary tract infection do not always appear in older individuals. Rather than painful, frequent urination, pelvic pain, and fever, they may exhibit changes in their mental state and behavior. UTI symptoms in the elderly are often misconstrued as the onset of dementia or Alzheimer’s disease, and include behavioral changes, confusion, heightened irritation, falling, and dizziness.

A urinary tract infection brings pain and discomfort regardless of age, but for our senior loved ones, it poses greater danger. If a UTI is left untreated for a prolonged period of time, there is a significant risk that the infection will spread to the kidneys or the bloodstream, which can ultimately lead to organ failure and death. This is especially problematic if an older person has dementia or Alzheimer’s disease, as the behavioral and mental changes a UTI brings may be more difficult to detect.

How can we, as their friends and family, help our senior loved ones protect against a urinary tract infection?

1. Encourage Good Hygiene

In a previous blog post we discussed the importance of helping our older relatives maintain good hygiene. Making sure that they can comfortably bathe and clean their privates properly is one way to ensure that they are not spreading harmful bacteria to their urethra.

2. Ensure Regular Water Intake

Drinking plenty of water throughout the day helps to keep urine clear, and prevents the accumulation of bacteria in the bladder.

3. Maintain a Bathroom Schedule

Using the bathroom as soon as they feel the urge to urinate will help ensure that they are emptying their bladders as much as possible. If feasible, monitor the frequency of their bathroom visits and remind them to use it if they go several hours without a trip.

If your senior loved one is at a higher risk of developing a urinary tract infection, then preventative efforts may not be sufficient. Luckily, UTIs can be easily treated with antibiotics when caught early; this is why it is of the utmost importance that we remain vigilant for any of the warning signs. If you notice a sudden and alarming mental or behavioral change in an older loved one, suggest that they see their physician to rule out infection.

Because the symptoms of a urinary tract infection present differently in the elderly, we should educate our older loved ones so that they know what to watch for and can take the proper precautions. If they have a cognitive impairment, they may require more active observation, either from you or their caregiver; they may have difficulty communicating and recognizing their own symptoms, so if you suspect a UTI, it is better to err on the side of caution.

As we age, our immune systems weaken, leaving us especially vulnerable to infection. Though UTIs are certainly not unique to the elderly strata of the population, they should be taken seriously when they occur; though they are not life threatening in and of themselves, urinary tract infections pose a significant risk of death if left untreated. Our senior loved ones cannot easily withstand the strain a major infection inflicts on an older body; it would be a mistake to underestimate the impact a UTI can have beyond the urinary system. Though we may not be able to prevent them, having a grasp of the symptoms and communicating these concerns to our older loved ones can only help to protect the quality of their health.

By Meredith Kimple

Our sense of smell is something we rarely think about until we’re greeted by a particularly nice, or particularly nasty, scent. The olfactory sensory cells in our noses enable us to appreciate the colorful aromas of the world around us; without them, we could enjoy neither the gentle fragrance of a spring flower, nor the familiar taste of our favorite meal. The ability to detect odor is a gift that many of us assume we will always have, but as with hearing loss, the aging process can alter even our most basic capabilities.

Presbyosmia, or age-related loss of smell, occurs in approximately 60% of adults over the age of 80. There are several theories as to the role the aging process plays in olfactory impairment:

1. Changes to the Olfactory Bulb

The olfactory bulb is an organ located in the forebrain that processes smell. There is evidence that as a person ages, the fibers and receptors that inform the bulb are significantly decreased.

2. Loss of Sensory Cells

Aging seems to impede an individual’s ability to replace depleted olfactory sensory cells.

3. Health Conditions

Certain health conditions that are prevalent among the elderly population, including Alzheimer’s disease, dental problems, and even some medications can inhibit an older person’s sense of smell.

We would all agree that being unable to detect scent is far from ideal, but we might not be aware of the extent to which an impaired sense of smell can negatively impact an older person’s life. There are numerous medical problems that appear with age, and these more glaring issues can eclipse less conspicuous ailments. You can live without the ability to smell the world around you, but this does not mean we should ignore the unique set of dangers such a condition can bring.

An elderly person who has an impaired sense of smell will have trouble determining if perishable foods have gone bad; they may ingest something expired and not realize it until they become sick. Because much of what we perceive to be taste is actually smell, food loses a lot of its flavor when one’s olfactory system is compromised. To combat blandness, an older person may add too much salt or sugar to their meals, which, over a prolonged period of time, can exacerbate pre-existing health problems like high blood pressure or diabetes. Most concerning of all, an older person with an impaired sense of smell cannot detect odors that could indicate a gas leak or a fire; in a worst-case scenario, a senior could lose their life because they do not perceive the typical warning signs.

Of course, these examples exclude perhaps the most detrimental effect of an impaired sense of smell. Not being able to appreciate the little things in life, like the taste of good food or the scent of the earth after it rains, can lead to depression; smell is strongly connected to memory, and to no longer have such a powerful connection to scents can be disheartening and lonely, to say the least. Not being able to enjoy the world around them with their friends and family can lead to even greater isolation.

A recent study found that there seems to be a compelling association between older women’s social lives and their olfactory function. Researchers examined data collected in 2005 and 2006 by the National Social Life, Health and Aging Project; the 3,000 participants were women between the ages of 57 and 85. They found that individuals whose olfactory abilities were unimpaired tended to be more socially active than their peers who had compromised olfactory function. Though the results are intriguing, researchers have not yet determined the connection between olfactory ability and a woman’s social life.

Despite the study’s lack of conclusiveness, it does illustrate a possible relationship between sense of smell and social isolation. Because an impaired olfactory system can alter the way in which older people experience and interact with the world around them, it is perhaps not a stretch to suggest that the inability to smell increases their feelings of alienation.

If you are concerned that your senior loved one has lost the ability to smell, encourage them to speak to their doctor. While there is no cure for age-related loss of smell, we can help our loved ones adapt their lives. Counseling with a licensed professional can aid our older relatives and friends in coping with the emotional weight of an impaired sense of smell.

While there are more concerning ailments to watch for when it comes to our senior loved one’s health, we should never write off any changes their bodies undergo during the aging process. Just because they can survive with an impaired sense of smell, doesn’t mean that they should have to cope with it alone. Though certainly not fatal in and of itself, a compromised olfactory system can lead to dangerous situations. We must not make the mistake of thinking that an advanced age brings with it an unconditional resignation to a lesser quality of life; there may not be anything we can do to return what they’ve lost, but we can be there to offer our love and support. Our older loved ones deserve reassurance that what they are experiencing, while incredibly difficult, is normal, and that they are still relevant and appreciated.

“Stop and smell the roses,” we’re told.

But there is more than one way to enjoy a rose.

Stopping to experience the seemingly frivolous, beautifully humble things around us is always possible, no matter our limitations.

By Meredith Kimple

Our elderly parents start to wear the same outfit for three days in a row.

We may notice that their hair is unusually messy, that there is always food stuck in their teeth, or that they have started to smell. Our senior loved ones’ hygiene, or lack thereof, is of great concern to us, especially if they were typically well groomed in the past. We may feel embarrassed for them, or worry that their dignity will be compromised if they live in a state of uncleanliness, and these fears are certainly valid.

However, if our senior loved ones suddenly stop taking care of themselves, we need to examine the underlying causes for this change. While shifts in self-care practices are often par-for-the-course as a person ages, this does not mean we should take them lightly.

Why do many older people have poor hygiene?

There are a number of reasons, but we’ll look at three of the primary problems:

1. Physical Challenges

Tasks that were once easy have become difficult and dangerous due to age-related physical limitations. Your senior loved one may not be as steady on their feet, so getting out of a bathtub or shower, while wet, could lead to slipping and falling. They may have trouble brushing their teeth, flossing, and doing the laundry; their solution might be to simply ignore these activities until they are absolutely necessary. Whether self-care tasks are physically difficult or daunting for our older relatives, their hygiene suffers for it.

2. Cognitive Impairment

Seniors who have Alzheimer’s disease or dementia often forget to bathe or perform other basic self-care tasks. They may not remember how to take a shower, and certain parts of the process can be confusing or terrifying. They may believe that they have already performed that part of their routine, even if they haven’t.

3. Psychological Changes

Depression can destroy a person’s motivation to practice self-care and other hygiene-related tasks. Elderly depression is often overlooked and underestimated, but it is not at all uncommon, as seniors are forced to adjust to many difficult changes and events. Grooming activities may also be an area in which our older loved ones attempt to exercise control; they might feel powerless or frustrated by a recent lack of independence, and as a result, neglect cleaning as a form of rebellion.

We must first identify which of these factors are impacting our senior loved ones’ ability to perform essential hygiene tasks; each of the aforementioned issues requires a different approach.

If an older person finds bathing physically difficult, there are tools to help make the process easier and less strenuous. A shower chair is an excellent option for seniors who have trouble standing for long periods of time or who have a poor sense of balance; installing railings in the bathroom can also lessen their risk of falling. A hand-held showerhead and a loofah on a stick can help them clean areas that would otherwise be too hard to reach due to their mobility constraints. Modifications like these will allow them to retain independence for as long as possible, but eventually they may need assistance with bathing and other hygiene-related tasks.

Cognitive impairments often prevent older people from properly taking care of themselves; those who have dementia or Alzheimer’s disease may require the involvement of others to ensure that they are practicing good hygiene. Establishing a routine is very important, but that alone is not always enough. Those suffering from cognitive impairments may not know how to bathe, or the process may terrify them to the point that they neglect it entirely; if you are their primary caregiver, you may need to assist them with these tasks. Though it can be difficult, creating a comfortable environment and responding to their needs will help to reduce their anxieties and give them a sense of security.

If you are concerned that your senior loved one has stopped practicing self-care because of depression, express your concerns to their regular physician, who will know how best to proceed. Depression is by no means uncommon among the elderly; many feel isolated and overwhelmed by the difficult and painful changes that age brings. Helping them get involved in activities or taking them on regular outings may improve their mood and give them a reason to practice good hygiene; however, depression is not something people can simply “get over.” Therapy and medication can go a long way towards helping older individuals manage their depression, but it often remains a work in progress. Similarly, feelings of powerlessness can lead our older loved ones to resent our well-meant concerns over their hygiene. Choosing whether or not to bathe or change clothes may be their way of grappling for control over some small aspect of their lives.

Patience, understanding, and a willingness to listen are key when it comes to addressing these problems. Though cleanliness is important in its own right, not practicing good hygiene can cause more serious health issues, like rashes, sores, and even infections. Beyond that, engaging in self-care is tied to our self-esteem. An older individual who does not bathe or maintain cleanliness might think that it no longer matters if they appear or smell their best. They may not feel the need to practice good hygiene because they have been removed from the social sphere they once occupied; they may not think such activities are “worth the trouble.”

For the sake of their dignity, safety, and self-respect, we as their loved ones must support and encourage them. This does not mean that we unflinchingly hold them to our standards of cleanliness; while not always ideal, a sponge bath is better than not bathing at all, and wearing the same shirt two days in a row won’t kill them.

Rather, our commitment to helping them maintain good hygiene should be a commitment to reinforcing their worth. Starting a conversation about cleanliness is very difficult, and the reality is, our senior loved ones might be offended if we raise our concerns. Present your worries and then offer to help them make adjustments so that the process of self-care becomes easier and enjoyable once more.