Category Clinical Care

By Meredith Kimple

When an older loved one is diagnosed with dementia or Alzheimer’s disease, we must prepare ourselves for a thousand changes. Among the many difficult adjustments we make to preserve a sense of normalcy, perhaps one of the most challenging is finding engaging activities for our loved ones.

Your parents and grandparents may once have enjoyed playing instruments, watching movies, reading novels, solving crossword puzzles, cooking, or dancing. However, cognitive impairment often renders these and other activities either too difficult or entirely impossible; tasks that require concentration, coordination, and memory may become a source of frustration and confusion rather than enjoyment.

While we all want our older loved ones to participate actively in the world around them, finding such opportunities isn’t always an easy undertaking. For those of us who care for someone with Alzheimer’s or dementia, it can be extraordinarily difficult to balance the demands of daily life with supervising and entertaining our loved ones. Activities that they once enjoyed, the activities that we first attempt, may no longer provide them with a sense of fulfillment.

Whether you’re facing this challenge for the first time or are convinced you’ve tried everything, hopefully the following list will give you some fresh ideas.

1. Household Chores

While many of us would agree that household chores don’t exactly scream “fun”, they can provide our loved ones with a genuine sense of accomplishment. When we ask our parents or grandparents to assist us with these daily responsibilities, we give them an opportunity for active participation in their environment. Being allowed to contribute can make them feel useful and necessary, and this does wonders for their self-image. The trick is finding tasks that are easy enough for them to complete, which will depend largely upon the severity of your older loved one’s cognitive impairment. Watering the plants, setting the table at meal times, collecting the dirty dishes, polishing silverware, dusting, sweeping, and making their bed are just a few examples of tasks that are simple and straightforward; you may have to help them complete these assignments, or even “re-do” them, but the important thing is that your older loved one feels included.

2. Organization

One popular activity for those who have dementia or Alzheimer’s disease is the sorting and organization of various objects. Give them a box filled with different colored beads, miscellaneous buttons, or coins; have them sort these items into groups based on similarity. This activity not only offers them a clear, specific objective, but also engagement with colors and textures that stimulate the senses, which can help to keep them interested for a prolonged period of time. You can also have them organize mismatched pairs of socks, or have them help you sort papers and old photos.

3. Food Preparation

Depending on the degree of their cognitive impairment, your loved one may be able to prepare simple dishes with your help and supervision. For their safety, do not let them use a knife, the stove, or the oven by themselves; there are plenty of recipes that do not require the use of these appliances, but you will have to help them measure, cut, and cook. If you don’t have the time for them to assist you with meals, or you are concerned about their cleanliness, assign them responsibility for preparing their own afternoon snacks. Peanut butter on celery or crackers, pre-sliced veggies and dip, and instant pudding mix are all easy and safe to prepare.

4. Arts and Crafts

Painting, knitting, scrapbooking, decorating ornaments, and other crafts are an excellent way for our older loved ones to express themselves. If they are not interested in creating their own art, coloring books are a great alternative; they don’t have to come up with an idea for the picture, but they can color the printed image however they’d like. These activities can be performed alone or with the whole family, so they’re incredibly versatile.

5. Music

Music not only stimulates the mind, but also brings old memories to life. If your older loved one used to play an instrument or simply loves listening to music, putting on a favorite CD or the radio can provide hours of relaxation. While you can certainly play music that has lyrics, classical or instrumental music may be the more relaxing option, since there are no words for them to follow.

6. Images

It’s difficult to see our bookworm loved ones struggle to finish novels; being unable to follow or remember the details of a story may make reading a frustrating task. Instead, provide them with books of photos that pertain to an old interest or a favorite place; there are plenty of subjects to choose from, including kittens, Renaissance paintings, and the Irish landscape. If they remember family, or even if they don’t, you can give them family photo albums to look through. Magazines and catalogs with plenty of pictures are also a great choice.

7. Videos

While you probably do not have the time to sit and watch television with your senior loved one all day, taking an hour or half an hour to spend with them may make this solitary activity more fun. Sitcoms, game shows, and nature documentaries do not rely on a plot or complicated story, so these may be better options. Old home movies are another great way to relive memories; your senior loved one may not remember everyone or everything they see, but they’ll still enjoy watching these filmed moments (especially cute baby videos). If you see a funny YouTube or Facebook video, share it with them! They may not understand what is happening, but the important thing is that you make an effort to include them in something you enjoyed.

8. Outings

Sometimes, the best thing is just to get out of the house and go do something fun! Bring your older loved one with you to run errands, like grocery shopping or picking the kids up from their various activities. If you have the time, take them window-shopping; smell candles and soap, touch interesting fabrics, and admire sparkly jewelry. Stores provide a lot of interesting sights and textures, and walking around from aisle to aisle gets in a bit of exercise too! Visit botanical gardens, the planetarium, or have a picnic in the park.

Finding fulfilling activities for our cognitively impaired loved ones is no simple task. We may find that at first they love one activity, only to watch them grow disinterested as they experience further cognitive decline; or, like most of us, they still crave variety. Through the unsettling changes that Alzheimer’s disease and dementia bring, one of the most important things we can do is to reinforce our older loved ones’ comfort and sense of self-worth. It is beyond painful to watch the people we love standing in a confused daze, bored, isolated, and at a complete loss for how to spend the hours we race through; there is a sense that they have infinite time, and nothing to fill it.

As challenging as finding ways to include them can be, leaving them lost and detached from their surroundings is twice as difficult. We should strive to provide them with plenty of opportunities through which to interact with the world, and to feel a sense of pride in their accomplishments. When they complete or contribute to a task, no matter how small, we should cheer for them, and cheer loudly.

In the mad scramble for normalcy, we tend to forget that “normalcy” is itself merely a series of adjustments. Instead of futilely wishing for things to remain the same, let’s focus on giving our older loved ones a sense of belonging, through every adjustment.

By Meredith Kimple

We have all fallen at one time or another.

Whether we trip on the edge of a rug or an uneven walkway, slip on a wet floor or a patch of black ice, a fall always ends in a combination of shock, pain, and humiliation (particularly if other people witness it). Mid-fall, we are suddenly aware that there are limits to our bodily control; but standing up after the incident, bruised and a bit shaken, we dismiss that feeling of temporary vulnerability until we experience our next mishap.

That is, if we’re younger and physically fit. For the elderly, the impact of a fall extends beyond the event itself.

It is estimated that more than one out of four adults over the age of 65 falls each year, and that is based only on falls that have been reported. Falling not only takes a critical toll on an elderly person’s body, it can also increase their hospital visits, medical expenses, and do irreparable damage to their confidence.

Why are the elderly at greater risk of falling?

There are several factors that contribute to an older person’s increased risk of falling, including:

• Balance and Motor Impairments

Age-related physical changes may affect an older person’s gait and ability to balance. A lack of exercise, muscle weakness, arthritis, and other medical conditions can also leave older people highly susceptible to falls.

• Vision

Poor eyesight, an outdated eyeglasses prescription, as well as glaucoma and changes in depth perception, can all increase the likelihood of a fall.

• Wrong Footwear

Wearing shoes that are impractical and / or uncomfortable can sabotage an older person’s sense of balance. Slippers, flip-flops, high heels, and smooth-soled shoes provide little traction and support, making walking twice as difficult and falls twice as likely.

• Medications

Certain medications may cause confusion, unsteadiness and dizziness, all of which can lead to falls. Taking four or more medications also increases an older person’s risk of falling.

These are not the only risk factors, but they are a few of the more prominent ones. Other health conditions, sudden drops in blood pressure, poor diet, and advanced age can influence an older person’s stability while moving.

Because approximately six out of every ten falls occurs in the home, we may be especially concerned for our senior loved ones who live alone. If they fall and are unable to get up or access their phone, they could remain hurt and helpless for a prolonged period of time.

The following are a few of the steps we can take to help our senior loved ones minimize their risk of falling.

1. Adapt the Home

Since the majority of falls happen within the home, making the necessary modifications to your senior loved one’s living space is very important. Installing handrails (particularly in the bathroom and on the stairs), removing clutter and wires that might be tripped over, securing rugs to the floor, and improving lighting are just some of the changes that can be made to lower an older person’s risk of falling. Mobility aids, like a walker or a wheelchair, may be helpful for moving within the home and out in public.

2. Exercise

Though an older person who struggles to maintain their balance may not be able to engage in vigorous physical activity, there are certain gentle exercises that can help improve motor function, like Tai Chi and swimming. Tai Chi in particular provides seniors with a stronger awareness of their bodies, which can reduce their fear of falling, restore their confidence, and improve their balance. If these physical activities are too difficult or strenuous, a physical therapist can help your senior loved one develop an exercise regimen that is tailored to their abilities.

3. Consult A Medical Provider

Encourage your senior loved one to report any falls to their doctor. Falling may be an indication of a new health problem, or it could be caused by one or more medications; keeping their doctor informed will help ensure the best decisions are made for their health. Their physician can also assess their fall risk and provide additional ideas for minimizing it.

Falling at an advanced age is more than a little painful or embarrassing; one out of five falls results in serious injury, and once an older person has one, their chance of having another increases significantly. A fall can lead to broken bones, hip fractures, head injuries, a decline in overall health, and, not surprisingly, a crippling fear of falling. If you notice your older loved one suddenly uses furniture or walls to maintain their balance when walking, or if they mention that they fell recently, encourage them to discuss these developments with their doctor.

Instability significantly undermines an older person’s sense of control over their own body, so as their family and friends, we should be there to provide reassurance, suggestions, and a listening ear.

By Meredith Kimple

In a previous blog post, we discussed the importance of monitoring and supporting our older loved ones’ emotional health. Depression is more prevalent in the elderly population than we might think, and yet, it is frequently overshadowed and unconsciously dismissed in the face of more prominent physical and cognitive illnesses. Without undermining the enormous impact diseases like Alzheimer’s and cancer have on an older body, I would like to once again emphasize the importance of, and acknowledge the challenge in, promoting senior mental health.

We all have our fair share of worries. Giving a presentation in front of an assembly, paying our children’s college tuition bills, watching the Heels play Duke, mulling over the state of the world – any of these things can cause us to break into a sweat. Though very unpleasant, worrying is perfectly normal, and in fact, fear can prove to be a powerful motivator when it comes to thoroughly preparing for the future.

But there’s a big difference between the occasional worry and an anxiety disorder.

An individual who has an anxiety disorder lives in a state of excessive, prolonged anxiety, to such an extent that it impedes their ability to function. Though they tend to appear most strongly in the years between adolescence and middle adulthood, anxiety disorders can develop at any time.

It is estimated that anxiety disorders affect about 15% of older adults every year. In the past, research seemed to indicate a decline in anxiety disorders with age, but in recent years, there has been greater recognition of the condition’s occurrence in the elderly.

So what causes anxiety disorders in older people?

There are several factors that can leave our older loved ones susceptible to an anxiety disorder. Though the majority of older people who have an anxiety disorder have had it since their youth, certain aspects of the aging process can worsen or even cause this condition. Many of the illnesses and diseases that affect the elderly population, like heart disease and diabetes, can aggravate an anxiety disorder; even some medications can cause older adults to experience chronic anxiety.

Anxiety disorders frequently occur alongside other psychiatric illnesses, particularly depression. As they age, seniors undergo countless physical changes, suffer the loss of friends and family, sacrifice their independence, and experience feelings of loneliness and uncertainty. These events and adjustments are emotionally taxing, leaving many older people vulnerable to both depression and anxiety.

While anxiety disorders are not fatal, they can exacerbate other physical and psychiatric illnesses, increasing the likelihood of hospitalization and decline. Compromised mental health can, at its best, lower an older adult’s quality of life and harm their self-confidence.

Anxiety disorders can be difficult to spot in older individuals, in part because seniors are often reluctant to vocalize their symptoms. This may come either from ignorance or from a fear of being labeled “mentally ill”; for centuries, mental illness has been unfairly stigmatized, and your older loved one may be afraid to admit their anxiety, even if they suspect they are suffering from that condition.

To further complicate matters, other medical conditions may mask the usual physical symptoms of anxiety; headaches, muscle tension, and pain can be misidentified as part of a pre-existing problem. Cognitive impairment can make identification all the more difficult; a person with Alzheimer’s disease or dementia may exhibit behaviors that could easily be mistaken for the symptoms of an anxiety disorder, and they may be unable to communicate or understand their feelings.

As their loved ones, how can we determine if they actually have an anxiety disorder?

Different disorders present different symptoms, but Generalized Anxiety Disorder (GAD) is the dominant variation among older adults. If your senior loved one has trouble sleeping, is restless, tired, and tense, and has spent at least six months worrying about everything from their relationships to their finances, they might have GAD. It is important to note that these behaviors must impede their normal day-to-day functioning, and their worrying must be uncontrollable. Things happen that cause all of us to worry, but an individual with an anxiety disorder experiences excessive, often irrational worry for a prolonged period of time.

If you suspect that a senior loved one is suffering from an anxiety disorder, it is very important that you act as soon as possible. First, try talking with them about any recent changes in their lives, and ask them about their feelings; having your support may help them to honestly share their concerns with you. However, they may be more willing to speak to a doctor they know and trust. Calling your older loved one’s primary physician can help to rule out other health issues; as mentioned above, anxiety can be aggravated by certain diseases, conditions, and medications. Anxiety disorders are treatable, both with medication and cognitive behavioral therapy.

Crippling anxiety may not be life-threatening in and of itself, but it can keep our older loved ones from living their lives to the fullest. Fear is powerful, and it is, above all, incredibly isolating. Age brings a plethora of rich experiences, some of which are wonderful and uplifting, and some of which serve to reinforce negative thought patterns. If there is nothing to counter these doubts and fears, our loved ones are in danger of losing their resolve to live and participate actively in the world around them.

You might think that at the end of our lives, many of our daily worries would abate. But the lives of our senior loved ones are often far from carefree, and they may have fewer coping strategies. Anxiety disorders cannot be managed without professional intervention, and we must be there to encourage them to seek help. In supporting and caring for their mental health, we are bolstering both their physical wellness and self-esteem through times of tremendous change.

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

“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.

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.

By Meredith Kimple

While some of us pursue healthier choices for a fit physique, many of us are also concerned with keeping our bodies functioning at their best. A part of this maintenance should include eating foods that support our brain health.

In our youth, we are blessed with excellent cognitive function naturally, but as we age, we must actively bolster the brain’s faculties to maintain sharpness. Certain foods have been linked to memory improvement and are beneficial to our body’s overall wellness; by adding them to our diet, we may be able to stave off cognitive decline and preserve our mental health well into old age.

So, what are these exotic miracle foods?

It may disappoint you to learn that they are things you already eat! And even if you don’t eat them now, they are easily obtained:

1. Blueberries

There have been a number of studies that show the positive effect these little berries have on cognitive function. Blueberries are full of compounds called anthocyanins, which promote anti-inflammation in the body; research suggests that blueberries help boost neural signaling in the brain and may even improve short-term memory loss.

And the best part is, they can be added to just about anything. Put them on your morning cereal or oatmeal, add them to salads and smoothies, or just grab a handful for a refreshing afternoon snack.

2. Fish

A study at the University of Pittsburgh found that participants who ate baked or broiled fish at least once a week had brains with a larger volume in the areas associated with memory. Omega-3 fatty acids are prevalent in oily fish, like salmon, and have been found to aid in the memory of facts and object recognition. Omega-3 is also great for heart health, so incorporating fish into your diet can bring twice the benefits.

Fresh fish that is baked or broiled is preferable to fried, but try swapping out a meat dish for fish at least once a week.

3. Walnuts

These meaty nuts even resemble a human brain! Packed with Vitamin E, they may help slow or prevent cognitive decline. A UCLA study found that adults who ate walnuts showed consistently greater cognitive function than those who did not, regardless of ethnicity, gender, and age. While more research is needed to verify those results, walnuts are a great source for healthy fat, and like salmon, contain Omega-3, making them beneficial for heart health as well.

4. Leafy Greens

Bad news for those of us who loathe spinach.

Whether it’s kale, spinach, or collards, leafy greens are bursting with nutrients like Vitamin K and beta-carotene that help slow cognitive decline. A recent study showed that eating as few as two servings of leafy greens a day gave participants the cognitive function of someone 10 years younger, compared to those participants who ate none.

And if you have a real aversion to your greens, never fear. These powerful nutrients can also be found in brightly colored fruits and vegetables! Still, trying to add more greens to your meals is highly recommended.

5. Green Tea

We know that green tea is full of antioxidants, but recently a university in China conducted a study to show that it may in fact be beneficial for spatial learning and memory too. Green tea contains an antioxidant called ECCG (epigallocatechin-3 gallate) that produces highly adaptive neural progenitor cells. This cell production seems to improve both impaired spatial memory and object recognition. Green tea may therefore be helpful in slowing or even improving aspects of cognitive degeneration.

Brewed green tea has stronger properties than canned or bottled, and is very easy to find. If you’re someone who drinks coffee or black tea frequently, try swapping it out for green tea from time to time. It will give you energy while helping you preserve cognitive function.

6. Eggs

Eggs have long been dubbed “brain food.” They contain a large amount of choline, a nutrient that aids in the communication between cells in the brain and the body. Choline can help to preserve brain chemistry as the body ages, which can protect against cognitive decline.

Vegetable omelets are a great way to incorporate multiple brain foods into one simple dish.

These are just a handful of the foods that can provide our brains with some protection against cognitive decline; other foods that can promote healthy cognitive aging include tomatoes, broccoli, avocados, and dark chocolate.

Planning meals in advance and having these foods handy can ensure that we eat in a way that is not just beneficial to our bodies, but to our minds. And these are not recommended to seniors only; there is some evidence that the longer we eat brain-healthy foods, the stronger our guard against cognitive decline. By incorporating these nutrients into our diets, we and our older loved ones can take an active role in maintaining our cognitive function for as long as possible.

None of the foods in this list are miracle workers, and none are foolproof drugs that can guarantee protection. Research has yet to provide answers that can satisfy all of our questions, but it confirms what has been previously theorized; it is no coincidence that many of the foods that are beneficial to our brains are also good for our hearts, and for our overall health.

So as we enter a new year, consider adding these brain-empowering foods to your diet, rather than focusing only on what you can remove.

By Meredith Kimple

How many times do we get teased for a little snoring at night?

While all snoring has the potential to annoy those around us, some snoring might be indicative of sleep apnea. This chronic, but treatable, condition impairs an individual’s ability to breathe regularly while asleep, either via an obstruction in the upper airway (obstructive sleep apnea) or as a result of the brain failing to trigger a breath (central sleep apnea).

Despite sleep apnea’s presence across all age groups, it is especially prevalent among seniors. As we age, our throat muscles and tissue are more relaxed, so that when we sleep our airway can become obstructed; being overweight can also increase our risk of developing the condition. At best, sleep apnea’s effects on the senior body are limited to daytime sleepiness and an increased difficulty concentrating. At worst, the body’s inability to breathe while sleeping can be fatal.

But there may be another risk for seniors who have sleep apnea.

Two studies have linked sleep apnea with early onset cognitive impairment in the elderly. The Journal of the American Medical Association published a study that observed the relationship between sleep apnea and cognitive impairment in approximately 300 healthy, elderly women over a span of five years. None of these women had any memory problems prior to the start of the study, but a third suffered from sleep apnea, averaging 15 instances of breathlessness per hour. At the end of the study, more than a third of the women had developed dementia or were experiencing memory troubles. The participants who had sleep apnea made up 44 percent of the women who developed cognitive impairments, while those who did not made up only 31 percent.

The researchers concluded that, even considering other factors like weight and age, sleep apnea had the greatest impact on the results of the study. The connection between the two conditions has to do with the blood oxygen levels of each participant; the episodes of breathlessness caused by sleep apnea cut off the oxygen supply to the brain, which, when occurring multiple times an hour over many years, can impair a senior’s cognitive function. Those participants who had low blood oxygen levels because of sleep apnea were more likely to develop dementia.

Another study published in Neurology shows evidence that the breathing disruptions of sleep apnea can have a massive impact on seniors’ cognitive health. Dr. Ricardo Osorio, of NYU’s Center for Brain Health, and his colleagues observed a group of 2,000 individuals aged 55 to 75, ranging from those who were cognitively normal to those who had Alzheimer’s disease. The participants were questioned about their snoring and sleep apnea, and then bi-annually over the next two to three years, they returned to monitor any cognitive changes.

The majority of participants who reported having sleep apnea developed mild cognitive impairments, and more astonishingly, their symptoms emerged 12 years earlier than in those who don’t suffer from respiratory disruptions at night. Dr. Osorio noted that those who were treating their sleep apnea with a CPAP machine seemed to experience cognitive decline at around the same age as those who do not have the condition.

It goes without saying that more research is needed to cement the link between sleep apnea and impaired cognitive function, but given the positive correlation evident in the aforementioned studies, recognizing and treating the condition as soon as possible can’t be a bad idea.

If you or a senior loved one snores at night, how can you determine whether or not it really is sleep apnea?

The following are some of the more common symptoms:

• Loud snoring, particularly when lying on their back
• A long pause in breathing, anywhere from a few seconds to over a minute, followed by choking or gasping
• Daytime grogginess
• Difficulty concentrating and remembering
• Waking up with a headache and / or dry mouth
• Sharp mood swings and heightened irritability

But the only way to know for sure is to have a sleep study done at a hospital or clinic. That said, you could always monitor an older loved one by recording their snoring at night; this way you can listen for any irregular breathing.

There’s also a smartphone app in development that can monitor the breathing of a person with sleep apnea.

Once your loved one has been diagnosed with sleep apnea, there are a variety of treatments by which to manage it. The most common method is to use a CPAP machine, a mask connected to an apparatus that helps maintain regular breathing throughout the night. Wearing a mask may be uncomfortable or difficult to put on at first, but it’s important to help them with these adjustments to ensure that they receive the treatment they need.

If you do notice the above signs in an older loved one, it’s very important that you talk with them. Those who have sleep apnea often are totally unaware that they snore and stop breathing while they’re asleep, so it’s crucial that you inform them and encourage them to talk to their physician. Sleep apnea may have a significant impact on seniors’ cognitive functioning and overall health, but luckily it’s easily treated.