An increase in the amount of prescribed and over-the-counter medications we take seems par for the course as we age; the more candles on our birthday cakes, the more likely we are to develop severe health problems that require consistent treatment. The effects of taking multiple medications simultaneously is known as polypharmacy, and often these can lead to an ADE, or an “adverse drug event.”

So how can the taking of various medications cause such a harmful reaction? Aren’t the medications doctors prescribe tested and considered safe?

Problems arise when a physician is not aware of all the medications their patient is taking, as they may unknowingly prescribe a drug that interacts poorly with something the patient already uses. Commonly used over-the-counter drugs, like acetaminophen and aspirin, can be dangerous when taken in combination with certain medications, and they often go unmentioned when a physician asks about a patient’s daily regimen. Additionally, it is estimated that 50% of seniors take at least one medication or supplement that is unnecessary.

But age itself is often responsible for these adverse reactions.

An older body may have more fat and less water than a younger body, which can change the way a drug is distributed; because there is a greater amount of fat, a drug may stay longer in the body than intended. Additionally, our liver and kidney functions tend to function less efficiently as we age, which can reduce clearance and make metabolizing and benefitting from a drug all the more difficult.

Add high blood pressure, diabetes, cardiovascular disease, high cholesterol, and other diseases which often require medication to manage, to a body which has a harder time processing said medication. While not all negative reactions to polypharmacy are life-threatening, there is the potential for an ADE if caution is not exercised in the prescription of medicine to the elderly.

Here are a few of the effects polypharmacy can have on the body:

1. Non-adherence.

Medication non-adherence is, as the name suggests, when an individual does not take their medication as prescribed, or at all. A person may never take the drug in the first place, or they may take too much or too little of it, meaning they put their lives in danger by not adhering to the guidance of a medical professional. While there is no single, cut-and-dry cause of non-adherence, polypharmacy can contribute to this problem among the elderly. The more medications they have to keep track of, the more difficult it may be for them to take the appropriate dosage, or to add a new, necessary drug to their regimen. Straying from their treatment plan can result in the worsening of their condition or hospitalization. At worst, non-adherence can lead to a fatal ADE.

2. Cognitive and Functional Decline

There is some evidence to suggest that polypharmacy (in this case, taking more than 5 medications) increases the likelihood of both delirium and dementia. Cognitive impairments could lead to medication non-adherence, which could in turn cause a senior’s condition to worsen. Polypharmacy also seems to inhibit bodily functioning as a whole, and seniors taking a great number of medicines may experience difficulties in performing essential daily tasks.

3. Fragility

Research shows that there is a potential connection between polypharmacy and an increased risk of falling. For the elderly, a fall is not merely a painful stumble; it can cause significant health problems, like a broken hip, that can be extremely difficult to recover from. Frequent falling is associated with both increased morbidity and increased mortality, and should never be taken lightly when it occurs in an elderly person. Polypharmacy may escalate falling episodes in those who are already frail and at risk.

The concerns listed above are only a few of the negative effects polypharmacy can have on the elderly body. But it can also take a toll on an elderly person’s wallet. Medications are not cheap, and even with coverage, taking upwards of five different drugs can be a financial strain. If a senior does experience an adverse drug event, hospitalization and drug therapy can compound already steep medical expenses.

How can we ensure that our senior loved ones do not suffer the negative effects of taking multiple medications?

Certain medications are essential. The older we are, and the older our parents and grandparents are, the more likely we are to develop medical conditions that require drugs to manage. This is unavoidable, and there is no cause to be suspicious of the medication prescribed by doctors for these serious health problems.

That said, we need to make sure we give our regular physicians as clear a picture as possible of our medication regimen. We need to encourage our elderly loved ones to do the same, and not only where prescription drugs are concerned. Every supplement, nasal decongestant, cold remedy, and over-the-counter pain relief taken should be made known to the doctor.

Polypharmacy seems to be especially prevalent among seniors who live in nursing homes, largely because they often have multiple comorbidities and are prescribed more medication by physicians. There is some concern in the medical community that with the abundance of medicinal treatments and drugs on the market, doctors may be over-prescribing to older adults with various health conditions. As more of the population ages, better techniques for assessing a person’s medication needs may be developed, and more research will be devoted to reducing the negative effects of polypharmacy.

People are living longer than ever before, and while that is certainly something to celebrate, we are also taking prescribed medication for a longer amount of time. Many of us will take more than one prescribed medication. Seeing a doctor regularly to assess and re-asses the number and necessity of the medications we use is crucial; and this goes for our senior loved ones too. As they age and their bodies change, their medications may need to be changed or reduced; it’s vital that they see a physician at least once a year, and that if they see more than one, that they provide them all with as comprehensive a list of their medications as possible.

Contributed by Meredith Kimple

By Meredith Kimple

An apple a day keeps the doctor away.

We know this adage is far from accurate, but what if we substitute “apple” with “multi-vitamin”?

Daily supplements can fill the gaps in our nutrition and fortify our diets. Convenient and easy to take, they may not keep the doctor away, but they certainly make taking care of our health a little simpler.

But as we get older, should we be taking so many vitamins?

As we age, additional supplements are often suggested to accommodate for the minerals we may get less of or that our bodies do not absorb as easily, such as fiber, vitamin D, and calcium. Approximately half of adults over the age of 65 take multiple daily supplements to maintain a healthy lifestyle. But recently there have been increased questions regarding the necessity of such intensive vitamin regimens for seniors.

First and foremost, older adults should only be taking vitamins with the approval of their regular physician. There are those who believe that the supplements often recommended to seniors are unnecessary, as an improved diet can provide as many health benefits, if not more, than a pill.

Let’s take a look at the pros and cons of senior supplement use.

The Pros:

Supplements may just be easier. This may seem like a given; it is much easier to take a pill or gummy than to eat two pounds of broccoli. However, for some seniors, prepping and cooking fresh vegetables just isn’t possible. A decreased appetite or difficulty chewing can make getting the recommended servings of produce a challenge. Taking supplements can help ensure they get the recommended amount of vitamins and minerals every day, no matter their eating habits. Supplements should accompany and bolster a healthy diet rather than replace healthy eating, but for those who are unable to do so, they may be of some help.

High cost of high-quality fresh produce. Not everyone can afford to buy fresh produce, let alone prepare it, and a bottle of vitamins may be cheaper and easier to manage. Supplements can be better than not receiving any nutrients at all, so they may offer a solution to those who cannot afford the cost of healthy eating.

Dietary habits are hard to adjust. Changing one’s regular diet is far from easy, but for some seniors it can pose an even greater challenge. Seniors with memory difficulties may find the necessary lifestyle changes disruptive and hard to adjust to. Adding vitamins to their daily routine may be easier than changing their eating habits, although good nutrition should remain a priority.

The Cons:

The FDA regulates both prescription drugs and over-the-counter cold medication, but it is not obligated to approve dietary supplements for public consumption. This poses a few problems: on the one hand, because they are not regulated, there is no guarantee that they are safe to use. Additionally, this lack of supervision raises questions about the effectiveness of supplements in maintaining our health. For older adults, taking a multitude of unnecessary supplements that their bodies don’t absorb can mean wasted money or, if they ingest too many, serious health concerns.

Supplements are intended to be just as their name suggests: supplementary. Support for a healthy diet, not a substitute. Dietary changes have a greater impact on our overall health, and fresh fruits and vegetables provide benefits beyond what can be attained from a vitamin. Healthy, balanced nutrition is the best way to get all the vitamins and minerals we need to function properly.

Supplements are not neutral.  We don’t normally think of supplements and vitamins as being potentially dangerous. While there is no concrete evidence to show that they actively damage our bodies, they can interact poorly with medication. Certain prescription drugs are rendered ineffective by supplements, and it is very important to check with your doctor before taking them.

This is not meant to discourage everyone from taking vitamins. In all matters pertaining to health their regular physicians should be consulted, and this is no different; none of us should blindly pop vitamins without the approval of a doctor. If they recommend a certain vitamin or other supplement, then please take it.

There are medical professionals who maintain that as we age we don’t need to increase our supplement use. They claim that there is little evidence that older bodies produce fewer of the necessary minerals, and that they do not “fix” any health problems. Supplements do not always work, and in some cases, our bodies do not absorb the vitamins properly.

Above all, doctors agree that a healthy diet offers the most benefits. Instead of immediately reaching for a calcium supplement, incorporate more low-fat dairy products into your diet. This may not be enough, but starting with nutrition is almost always a good course of action. Taking a handful of supplements daily may not be as helpful for seniors as previously thought, and taking supplements that have not been approved by a physician may even be harmful.

“A multivitamin a day keeps the doctor away.”

Maybe. But based on the advice of health professionals, try the apple.

“Is this normal?”

As a Care Advisor to many seniors, I am asked this question a lot.  After all, most of us are loathe to face what we perceive as the inevitable physical changes that come with aging, and we spend lots of time and money trying to curb the effects of time on our aging bodies.  Yet even as we are urged to keep buying the products and services that promise to stave off wrinkles and increase our energy, we do seem to endorse the idea that perhaps our hearing is going to go, our joints will become arthritic, or our eyes will grow cataracts as the moments tick by.  So we are often caught in a state of confusion about just how much change is normal, and what kinds of changes signal the onset of a serious or life-threatening condition.

There is one insidious and under-recognized change associated with aging, however, that many people consider to be inevitable, which might be the very physical issue that has the potential to set us on a course toward progressive decline, loss of function and loss of independence: reduced muscle tone and strength.  Sure, we tend to just accept that we will just not be able to run as fast as we did in our 20s, or be able to bench press 145 lbs. We get up in the morning with some aches and pains. . . and what we chalk up to stiffness.  And that is just . . . well, part of getting older, isn’t it?

Does everyone lose muscle mass?  

Generally, yes.

Gradual loss of muscle mass is a naturally occurring process associated with aging, and it happens to everyone.  This is known as sarcopenia. There are physiologic changes that cause this, and these changes occur for a variety of different reasons.  But not all sarcopenia is created equal. Some people maintain enough muscle mass and the strength they need to remain active and independent into their senior years, while others lose muscle mass and strength at a faster rate.  We all know physically fit and active people in their 90s, and might also see others who seem much older in their 70s.

Up until about age 30, the body is typically in a state of muscle building.  Thereafter, most people begin to lose a percentage of muscle mass at a rate of 3-8% per year.  After about age 50, the process accelerates, with a possible 30-50% decline in muscle mass occurring between 40 and 80 years of age.   The loss of muscle mass may not be as apparent in middle age, as decline in muscle tissue is often offset by gain in fat tissue (especially in the midsection) due to hormonal shifts.  It is estimated that over 50% of older adults in their 80s suffer from sarcopenia.

Why do we lose muscle mass as we get older? 

We lose muscle mass as we age for a variety of reasons.

Many studies have been done on different aspects of muscle loss, but the one thing experts can agree on is that muscle loss is due to a combination of complex interrelated system changes within the aging body.

The muscle building pathways are affected when we age.  For example, research has demonstrated that a major contributor to sarcopenia in aging is that the body’s muscle building pathway is less sensitive and less responsive to ingestion of essential amino acids, which are the building blocks of proteins which are essential to the maintenance of muscle tissue.  Other research has focused on the reduction in the number of motor units in aging skeletal muscle, and others have directed attention to hormonal changes that affect muscle building processes in the body. Anabolic, or “building”, hormones such as testosterone and growth hormone are known to decline in aging, and such declines in these hormones and others have also been linked to declines in muscle mass and strength.  Hopefully new research will reveal ways to interrupt or prevent the progression of muscle loss and strength that leads to undesirable outcomes for older adults.

Lifestyle.   A person’s pattern of living can also influence the degree to which a person experiences muscle loss and loss of strength.  Of course, as we might predict, inactivity and a sedentary lifestyle would contribute to muscle loss and decline in muscle strength over time.   However, dietary intake and exposure to other environmental factors may also contribute to the overall problem.   Most adults take in less calories as they get older, and those calories may be comprised of even less protein which contributes to muscle loss.

What amount of muscle loss is considered “normal”? 

Surprisingly, there has been a lack of consensus in scientific circles over exactly what amount of muscle loss in aging is “normal” and what amount of muscle loss should be considered something for which we should seek some sort of clinical intervention.   New efforts to quantify muscle loss and find reliable ways to measure it are under way.  Only with a standardized approach and specific diagnostic criteria can researches develop a body of credible data on which treatment recommendations can be based.

The international scientific community has recognized that more and more people will face the adverse outcomes associated with loss of muscle mass with aging, and has recently proposed that new standards be set forth so clinicians can make recommendations and provide treatment to prevent or slow down the progression of sarcopenia.

• Foundation for the National Institutes of Health (FNIH) Sarcopenia Project
• European Working Group on Sarcopenia in Older People (EWGSOP)
• International Working Group on Sarcopenia

Through the FNIH sarcopenia project, these groups have focused their efforts on establishing standards for measurement of muscle mass and function.

Should I be concerned about sarcopenia if it is a natural part of the aging process? 

Yes, and here is why:

Adverse health outcomes are associated with sarcopenia.  Loss of muscle mass and strength has been associated with many adverse health outcomes in older adults.  Specifically, declining muscle mass in older adults has been associated with:

• Decline in independence and mobility
• Reduced ability to handle the stress of an injury or other major health event
• Increased risk of Type II diabetes
• Diminished quality of life
• Increased risk of falls and poor health outcomes
• Increased risk of disability
• Increased risk of hospitalizations
• Increased risk for fractures due to comorbidity of osteoporosis and lower bone mineral density (FN: Creating Diagnostic Criteria)
• Increased health costs
• The prediction of earlier mortality    

Are there things I can do to prevent or slow down the muscle loss associated with aging? 

One review of 17 studies on exercise and dietary supplementation in muscle loss and aging revealed that there is little consensus regarding how much exercise or dietary supplement and it will combinations is necessary to result in the best benefits for older adults.

Thus, although there is a lack of consistent data on which to provide recommendations that are evidence-based, there are some general principles that do emerge. It is generally widely accepted that resistance training and increasing dietary protein are both beneficial approaches to correcting muscle loss in older adults. It’s just the specifics now that need to be hammered out by the research and medical communities.

In the meantime, pursuing good exercise and nutrition habits in general is likely to be helpful in spite of a general lack of consensus on specifics:

• Exercise.  The great panacea. We all know this by now, right?
• Resistance training. This means working with weights (even your own body weight is often sufficient,) and bands to provide resistance to the muscle groups.
• Strength training. This means the goal is to increase the amount of weight your muscle groups can move over time.
• Increase dietary intake of protein: Current recommendations have been shown to be inadequate to maintain or contribute to muscle building. New recommendations suggest that optimal protein intake for older adults should be 1.0 to 1.2 g/kg of body weight per day.

Dr. Deborah Gordon recommends an interval training program and describes her views on sarcopenia here. The bottom line is to keep moving, and be sure that the moving involves some resistance to the muscles moving through space.  Check with your doctor before engaging in any kind of exercise and get recommendations that are uniquely suited to you.

By Meredith Kimple

From our first trips to the dentist as children, we are drilled with reminders to brush our teeth, floss daily, and stay away from candy (to our dismay). Oral health is a component of our wellbeing that we maintain largely out of habit, and is so entrenched in our routine that we often give little thought to it. All of the careful brushing, polishing, flossing, and swishing is done to preserve the beauty and utility of our teeth.

But recent studies suggest there may be a more pressing reason to take care of our smiles.

There is evidence that a positive correlation exists between poor oral health and a greater degree of cognitive decline in the elderly. In one study, the presence of gum disease corresponded to a six-fold increase in the speed of cognitive decline among participants. The theory is that the bacteria generated by gum disease and poor oral hygiene triggers the body’s inflammation system; in defending against foreign bacteria, inflammatory molecules also target the human body. Previous studies have suggested that such attacks on the body, and on the brain, lead to an increased rate of cognitive decline in individuals with dementia and Alzheimer’s.

Generally, tooth loss and gum disease become more prevalent as we age, so even greater care must be taken when performing oral hygiene-related tasks. This can be difficult for our older loved ones for a number of reasons, but for those who have dementia or Alzheimer’s, maintaining oral health may be neglected entirely. If the theories that link gum disease with cognitive decline are, in fact, accurate, then this creates a dangerous cycle. If those with dementia and Alzheimer’s neglect their oral health, gum disease is all the more likely, and if the bacteria leads to inflammation, they may suffer more rapid cognitive decline. This decline may make taking care of their teeth even more difficult for them, leading to further instances of gum disease and tooth loss.

And the cycle repeats.

While medical professionals do see the potential in future studies of this correlation, at the moment there is not enough consistent evidence to suggest the veracity of these theories. However, we know that the bacteria produced by oral infections can enter the bloodstream and cause harm to the body, especially to the cardiovascular system. When a loved one is diagnosed with Alzheimer’s or dementia, preserving their oral health may not be our first concern. But maintaining it can have positive effects on their overall wellbeing.

Whether you are the primary caregiver or you utilize at-home assistance, here are some ways to help keep your loved one’s gums and teeth healthy:

• Brush teeth at least twice a day. This may be difficult depending on what stage of the disease your loved one is in, but anything is better than nothing. Using an electric toothbrush may make things easier and remove plaque and food particles more effectively. If using toothpaste is too challenging, use a wet toothbrush rather than stopping altogether.
• Floss daily if possible. Plaque and food build-up between teeth can be hard to reach with a toothbrush and can lead to gum disease. Try using a flossing tool rather than string; this will make it easier for your loved one to do it on their own or for you to do it for them without being too invasive.
• Use mouthwash regularly. Make sure they do not swallow it, and if there is a danger that they might, even swishing and rinsing their mouths with water can be beneficial for cleaning out food particles.
• Make regular dental appointments. Take your loved one to the dentist often, and discuss any concerns you have about their dental health. Their dentist will be able to spot any early signs of gum disease, and can devise a treatment plan with you.

Pay close attention for these signs of gum disease, and make an appointment immediately if you notice any of the symptoms.

It may be that gum disease and tooth loss have no bearing on cognitive decline, but for our loved ones who have dementia or Alzheimer’s, maintaining oral health is vital. If they begin to lose teeth, chewing can become even more difficult, and dentures may add to their discomfort. The bacteria produced by gum disease can trigger the body’s inflammation system and can have a negative impact on their cardiovascular health.

The earlier we take preventative measures to maintain our oral health, the better for our overall health. For our older loved ones, caring for their teeth may become more difficult for a variety of reasons, and they may neglect their typical oral routine. Suddenly forgetting to brush their teeth may be an early indicator that they are experiencing cognitive decline, and so it is of the utmost importance that we take these changes in our loved ones seriously.

Study: Elderly’s Family Caregivers Need Help, Too

By Rachel Bluth

Republished from Kaiser Health News.

Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones, reported a study released Tuesday.

Nearly 18 million people care for a relative who is 65 or older and needs help, yet “the need to recognize and support caregivers is among the most significant challenges” facing the nation’s swelling elderly population, their families and society, according to the report from the National Academies of Science, Engineering, and Medicine. Describing family caregiving as “a critical issue of public policy,” a committee of experts in health care and aging said the next presidential administration in 2017 should direct a national strategy to develop ways to support caregivers, including economically.

According to the report, people who help elderly family members with three or more personal tasks a day devote 253 hours a month to caregiving — almost the equivalent of two full-time jobs.

Five years is the median duration that family members care for older adults with high needs, the report said.

For some Americans who accept that responsibility, that can mean taking a less demanding job, foregoing promotions or dropping out of the workforce.

Lost wages and benefits average $303,880 over the lifetimes of people 50 and older who stop working to care for a parent, according to a study cited in the report. That’s not all: A lower earnings history also means reduced Social Security payments for caregivers when they become eligible.

A possible fix for that problem, proposed by researchers in 2009, is to provide caregivers with a Social Security credit for a defined level of deemed wages during a specified time period, the report said.

Leave programs do exist for some workers shouldering caregiving duties, but many lack such job protections.

The federal Family and Medical Leave Act doesn’t cover 40 percent of the workforce. It allows eligible employees to take 12 weeks of unpaid time off to care for certain family members, but the law only applies to those who work federal, state and local governments and private companies with more than 50 employees. But ineligible family relationships for leave include sons- and daughters-in-law, stepchildren, grandchildren, siblings, nieces and nephews. Many workers can’t afford to give up their incomes for 12 weeks.

In 2011, 17 percent of caregivers didn’t take leave because they feared losing their jobs, according to a national survey cited in the report.

The report recommends that family caregivers receive status as a protected class under existing job discrimination laws and that employers get guidance and training on ways to support workers caring for family members.

Beyond the economic costs of caregiving, the report notes that the social and physical toll of caregiving should get more attention than it does.

“If their needs are not recognized and addressed, family caregivers risk burnout from the prolonged distress and physical demands of caregiving, and the nation will bear the costs,” the report said.

Instead of delivering “patient-centered” care, health care providers should adopt “family-centered” models that include checking with caregivers to ensure they are healthy and capable of filling the role. The report also recommended wellness visits, counseling sessions and better training for caregivers who must understand increasingly complicated medical instructions.

Dealing with feeding and drainage tubes, catheters and other complicated medical devices causes stress, and the study’s authors noted that caregivers report “learning by trial and error and fearing that they will make a life-threatening mistake.”

The study was funded by 13 private foundations, the Department of Veterans Affairs, and an anonymous donor that requested the National Academies undertake the research in 2014.

KHN’s coverage of late life and geriatric care is supported by The John A. Hartford Foundation. KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation.

by Meredith Kimple

It’s estimated that Alzheimer’s disease affects about one in ten seniors over the age of 65, and 1 in 3 seniors over the age of 85. With those statistics in mind, the prevalence of Alzheimer’s can make developing the disease seem an inevitability. However, recent research suggests that certain dietary changes may significantly lower a person’s risk of developing the disorder.

The MIND diet*, created by nutritional epidemiologist Martha Clare Morris, combines the DASH and Mediterranean diets for an eating plan that promotes better brain health and may decrease one’s chance of developing Alzheimer’s. From 2004 until 2013, Dr. Morris studied the eating habits of over 900 participants aged 58 to 98 in order to determine the efficacy of the MIND diet in Alzheimer’s prevention.

The results of the study show a positive correlation between adherence to the MIND diet and a decreased risk of developing Alzheimer’s. Participants who followed the diet moderately saw their Alzheimer’s risk decrease by about 35%, while those who followed it strictly had a decrease of 53%!

The MIND diet is composed of 10 food groups that promote brain health:

1. Whole grains (3 servings a day) Substitute whole wheat breads for white, choose brown rice or quinoa in place of white rice, and have oatmeal or a whole-wheat cereal in the morning.

2. Leafy green vegetables (at least 1 serving a day)  Spinach, kale, collards, broccoli and cabbage are fine choices. The MIND diet suggests meals be made up primarily of vegetables.

3. Other vegetables (at least 1 serving a day)  Carrots, peas, peppers, tomatoes, radishes, sweet potatoes, beets and more.

4. Nuts (at least 1 serving a day)  Nuts are recommended for daily snacks and provide essential healthy fats that can improve brain function.

5. Beans (1 serving every other day)  Beans can be added to soups, stews and salads, so they are very versatile and easy to work into your current diet.

6. Berries (at least 2 servings a week)  Add berries to your morning cereal or oatmeal, or eat them as is for a healthy snack or dessert. Eating a variety of berries can help with brain function.

7. Poultry (at least 2 servings a week)  Chicken and turkey are excellent choices when you want to have a meat-based dish for lunch or dinner. While the MIND diet places greater emphasis on vegetables, poultry is a brain-healthy option for getting in your recommended protein.

8. Fish (at least 1 serving a week)  Fish is another good source of protein while following the MIND diet.

9. Olive oil  Instead of using butter, cook your food with olive oil. Food tastes just as good without the additional fat.

10. Wine (1 glass a day)  Wine lovers rejoice! A glass of wine once a day can be great for your brain health.

The MIND diet asks that you keep the following 5 food groups to a minimum when planning your meals:

1. Red meat:   Beef, sausage, steak and burgers are fine on occasion, but try to substitute them with chicken or turkey alternatives whenever you can.

2. Butter and margarine: (less than a tablespoon a day)  Use a vegetable-based butter substitute on breads, and use olive oil for cooking.

3. Cheese: (less than 1 serving a week)  This is perhaps one of the most difficult foods to limit, but do your best to avoid cheese. There are dairy-free cheese substitutes available if you really miss it.

4. Sweets and pastries: (less than 1 serving a week)  Try to limit your sugar intake and treat yourself to a favorite dessert only once a week.

5. Fried or fast food: (less than 1 serving a week)   Eliminate fried or fast foods from your diet. Baked dishes can be more flavorful and are much better for you.

The MIND diet may seem too restrictive at first glance, and if that’s the case, try easing into it slowly. Instead of taking away, add in. Eat more leafy greens, vegetables and whole grains. Snack on nuts and berries instead of chips or pretzels. Once you start making changes you may feel more comfortable substituting and restricting foods in the unhealthy categories. Whatever you can do in the moment is worth it for your health. Though the MIND diet is geared toward brain health and Alzheimer’s prevention, it may also improve cardiovascular function, lower blood pressure, and lead to weight loss.

While the MIND diet has not been named a foolproof tool for Alzheimer’s prevention, the results of Dr. Morris’s study indicate that dedicated adherence to such an eating plan may significantly lower one’s risk. The study took into account other factors that contribute to the development of Alzheimer’s, but found that what we eat seems to have the greatest impact on our mental health. Though the nutritional specifics of the MIND diet need further development as research continues, the current dietary suggestions it offers have proven effective for those participants who followed them the longest.

The prevalence and mystery of Alzheimer’s disease can make us feel powerless to prevent it. While there is still so much that doctors and health professionals have yet to determine about the disease, the MIND diet offers us the opportunity to minimize our risk and take control of our bodies in the present moment. Eating well is a choice that gives us some of that power back, and in making that choice, we are allowed some say in the functioning of our minds.

*Before trying a new diet, it’s always best to discuss any changes in your diet with your health care provider to make sure that it is right for you.

With a bigger spotlight, the stigma surrounding men and mental health has eased, but there is still quite a void of understanding to be filled.  Men often will manifest depression in slightly different ways than women.  Depression in men can be exhibited not just by “down” feelings, but also by irritability and anger.   In this informative 5 minute Youtube video from the Harvard Health Minute Library, hear Dr. William Miller, Assistant Professor of Psychiatry at Harvard Medical School speak about men and depression.

American comedian and actor W.C. Fields once said, “The best cure for insomnia is to get a lot of sleep.” If only it was that easy! Many of us have endured nights in which sleep refuses to visit, and some of us have encountered sleeping difficulties for a prolonged period of time.

The adverse effects of insomnia are detrimental to the functioning of all people, but for the elderly, they are especially so. Without sufficient sleep, older adults may:

• Increase their risk for certain diseases, like diabetes or cardiovascular disease
• Have difficulty concentrating, and as a result, endanger their lives or the lives of others via car / domestic accidents
• If clinically depressed, worsen their condition

Why do seniors in particular tend to suffer from insomnia?

As we age, our circadian rhythm (the internal system which regulates our periods of sleepiness and wakefulness) can change, meaning that we tire in the early evening and wake in the early hours of the morning.

However, it’s important that we don’t conflate aging with insomnia; depending on the length of time an older person has had trouble getting an adequate amount of sleep, insomnia can indicate a more serious problem. If an older loved one is experiencing chronic sleep deprivation, make sure to consult a doctor.

Here are some tips that may help improve your or someone you love’s sleep:

1. Move. A sedentary lifestyle requires little energy, and as a result, it may be harder to sleep at night. Aerobic exercise, dancing, or even walking at least three hours before you go to bed can refocus your mind and tire you out for a good night’s sleep.

2. Refrain from drinking. This means no caffeine or alcohol in the evening, and no drinking a large amount of any fluid before bed. Many seniors can’t sleep because a full bladder wakes them up throughout the night; not only is this disruptive to their sleep cycle, but it can be dangerous, as they might fall in transit to or from the bathroom.

3. Get some sun. If a senior spends the majority of their time indoors, make sure his or her rooms are well-lit in the daytime. Try to spend some time outside every day; the sunlight can help regulate your sleep cycle.

4. Relax yourself before trying to sleep. Unwind with a book, listen to music, write in a journal or meditate. Don’t go to bed until you’re ready to fall asleep.

5. Routine. A consistent set of pre-sleep practices can be extremely beneficial. Go to bed at the same time each night if you can, and perform the same hygienic tasks in the same order (brush your teeth then wash your face then comb your hair, etc.). Do something that you only do right before you go to bed, so that when you do it, your body will know it’s time to go to sleep (spray your pillow with a calming scent, turn off the light by your bed, say a prayer or a poem you’ve memorized, etc.).

6. Cold, dark and quiet. Create the ideal sleeping environment by closing the curtains and turning the lights off. Turn a fan on or turn the heat off; it can be hard to fall asleep if you’re sweating under the covers! Turn off the radio and television. Without these distractions, your body and mind can relax.

7. Think good thoughts. Anxiety and fear can keep us from getting the sleep we need. But if we don’t sleep well, how can we face the challenges the next day brings? As you get into bed, imagine that you’re sliding into a space where your problems and worries are suspended. There is a time to tackle tasks and difficulties, but it’s not during the middle of the night; the things that make you anxious will be there in the morning, so give tomorrow’s you a good start by getting the rest your body needs. Write a story in your head, keep a journal of your anxieties, and take long, deep breaths using your diaphragm. If anxiety regularly impacts your life, it may be beneficial to speak with a psychologist.

8. Keep naps short and regular. It’s normal to burn out mid-afternoon, and if your body needs sleep, don’t feel bad about taking a nap. However, sleeping too much during the day can make you restless at night. To get the most out of your naps, keep them short (no more than 30 minutes) and take them in the afternoon (well before evening). If possible, set a time in your schedule for a daily nap, and then your body will adjust and your sleep at night won’t be affected. 

The real difficulty of insomnia in older adults is that it can occur for a variety of reasons, some of which cannot be remedied via a change in lifestyle and sleeping habits. Pain from pre-existing medical conditions, gastrointestinal and continence issues, sleep apnea and certain medications can cause chronic sleep deprivation.

Depression has also been linked to insomnia in the older adult population. 

If an older loved one is suffering from chronic insomnia, it’s important not to dismiss the condition as normal. Recent studies have shown that insomnia can be a symptom of depression in the elderly; to make matters worse, insomnia can also worsen clinical depression.

It’s difficult for families as seniors age to determine which of their bodily and behavioral changes are “normal.” There are certain ideas that we accept: that seniors will eat less, sleep less or understand less as a product of their age. And while the body undergoes significant transformations in its later years, these assumptions of normalcy may prevent our loved ones from receiving the proper treatment.

Insomnia is one of those issues that is, perhaps, taken for granted in the elderly. But we can’t dismiss this prevalent condition as normal or expected. At worst, being proactive in helping them with their insomnia can mean that the hours they do get sustain them; at best, it can bring to light other, even more serious conditions like depression, and they can get the therapy or treatment they need.

If an older loved one is experiencing chronic insomnia, consult a doctor; there are various medications and treatments that can be prescribed to help seniors get the sleep they need to function at their best.

Contributed by Meredith Kimple

It has been some time since I have had the opportunity to check in here at our blog. Since that time, my Dad declined in a heart-breaking spiral which can be typical in the last stages of Alzheimer’s, and we said good-bye to him on August 22, 2015. Over the last months, we wrestled with the pain of watching Dad lose function and mobility day by day, and toggled between spending our time savoring what we knew to be our final days with him and making frantic attempts to prevent him from slipping away. In that short time, Dad’s care needs began to exceed what even our own Aegis caregivers could safely provide in the home, so we hastily arranged for his transition to a skilled nursing facility nearby. The “paper” transition was smooth, but the Dad transition was not.

At every turn, we tried to handle the demands of our own families and the challenges that came with Dad’s confusion and frustration in his new environment. We experienced the gnawing second-guessing of whether we had done the right thing (there was no other choice, was there?), and the guilt (newness and unfamiliarity had to be the worst possible thing for a person with dementia, didn’t it?), but also gained a small measure of peace that Mom (87) was finally getting a full night’s sleep, and not pushing herself to the brink of a major health crash. Dad was also going to have more access to more comprehensive services that a facility could provide to try to preserve as much of his functioning as possible. Yet, it was still wrenching to see my parents physically separated for the very first time after 64 years of marriage. They had always shared that same bed, and the thought of Dad calling my mom’s name when we weren’t there, even for just a few hours, was devastating.

We are so grateful that Dad’s needs were well-served and he received professional and compassionate care until his death. And I am grateful, too, that our out of town family members bore the news of the advancing changes with understanding. No shaming. No resentment. Just a collective wistfulness and profoundly joyful appreciation for the life of a man who by many would be called a quiet hero. I know it’s what he was and continues to be for me and our family–an example of deep faith and integrity.

For each person, for each family, the path takes it own kind of turn, but it is never easy. On a routine basis we expertly transition families or help families enable their loved ones to age in place with abundant support. Yet because we have had to weather these very storms ourselves, we get it.  We never take for granted that although it might look smooth on the outside, families will still need support to cope with deeply intimate challenges.  It is our promise that we are here to provide it.

I’d like to tell you that Aegis Care Advisors was a long time in the making, and was rolled out with strategic military precision, but if I did, I would be lying. We took a somewhat circuitous route to get to this spot, and as often is the case in life, we are guided by the meanderings of personal experience.  So I feel like now is probably a good time to share a little something about my Dad.  He is 88, and has Alzheimer’s disease.

My Twitter feed lights up with purple these days, as the ENDALZ logo pops up minute after minute, recounting the celebrity appearances for a popular event meant to raise funds to fight Alzheimer’s disease. If I were a more healthy-minded person, I would be excited and proud of the people toiling over this effort, but I struggle to cheer this on, since I am still angry. We have been victimized by this thief, and our family has felt the chronic helplessness of being forced to stand by while our Dad is stolen from us — little by little — no matter how tightly we try to hold him in our grasp. Along with his intellect, a lifetime of professional knowledge in the field of textile chemistry, and his fatherly wisdom, the thief has stolen my Dad’s story. And over time, as the stealthy stalker was making away with golden pieces of treasure that is my Dad, I was ignoring my own weak promptings to gather in the nuggets of my parents’ earlier lives, and I failed to do important things like ask how he felt when he asked  Mom for their first date, or how he managed to get himself to South Bend alone at the age of 18 to pursue his Masters’ Degree in Chemistry at Notre Dame. Now, like the lover rushing to intercept the train at the platform, my heart sinks as I feel the crushing weight of regret that I have arrived too late.

We do have the well-worn stories that we yearned to hear told and retold over the years, like the turbulent time when brain cancer took Dad’s youngest brother, our would-be uncle Jimmy, at the age of 11, whose last days were spent in a hospital room with a singular, dismal view of a building bearing an advertisement for a coffin company. Or the time when Dad, in the days when young children were allowed to be adventurers, benevolently spruced up a neighbor’s car with a fresh coat of paint after coming across a can and brush found in their garage–doing so with the bright-eyed, whimsical earnestness of the 4 year old artist eager to present a lovingly crafted gift. But now these stories are like bulky pixels that make us want to rush to focus and readjust the picture into crisper clarity. We are desperate to bring into view the rich, brilliant colors and detail of the rest of the story, but the thief has craftily and irreparably scrambled the settings to do this.

Now we feel cheated. And violated. And afraid.

So we push ahead in our helplessness, and offset our heavy hearts with a larger counterweight of gratitude for this father, son, husband, friend, and disciple. We remember how Dad was–the coach, the advisor, the business man, the prayer giant. The guy who let you know that faith in God, honesty, integrity, and strength of character were paramount. The guy who was always in your corner. But today, I think maybe Dad is telling us his greater story more eloquently now than ever. No day goes by without Dad’s kindness and gentle, loving spirit shining through–a flash revealing the authentic man. The wide and warm smile, the willingness to chuckle and be playful remains while Dad continues his valiant quest to somehow convey to us the drama unfolding, yet locked, inside his brilliant mind. His gestures and words are strung together to form a language that we struggle to make sense of much of the time, but he speaks a language today that outshines and outperforms any form of conventional wording. He beams with recognition and love when we walk in to greet him, with an expression that is unfailingly joyful, hopeful, grateful, and unconditional, but the greatest expression of this must be witnessed first-hand when Mom comes in after short respite times, as the love Dad has for her, the mother of their seven children, and wife of 64 years, defies any form of written description. Underneath all of this, you cannot miss the relentless desire my Dad has to continue to share. He wants to share his moments with others, with us–he wants to just “be with.”

Dad was always one to advise us and encourage us to take on as many challenges as we could withstand and recognize opportunities in front of us. So hopefully that’s what we are doing now–sharing what we have with whomever might find what we say and do to be valuable. In the end, we are all here to need each other.

So Dad, thank you. You have revealed that you are the opportunity in front of us–our opportunity to share back, reassure you with our presence and care; and in this way, your life is perhaps even more eminently valuable now than it ever has been. And — you continue to be brilliant, for in this way, you have managed to foil, outsmart and outmaneuver your thief.