Category Healthy Lifestyle

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

“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

We all understand the importance of exercise when it comes to maintaining our health, but engaging in beneficial physical activity can become more daunting and difficult as we age. Alternative, gentler forms of exercise, like dancing or swimming, can still be taxing on an older body. Many physical activities hurt more than they help, and instead of building or maintaining a senior’s endurance, they exhaust, strain, and weaken their bodies.

Tai Chi, an ancient Chinese exercise that evolved from martial arts, may offer us a method by which balance and strength can be fortified without fatigue.

Over last few decades the popularity of mind-body exercises like Tai Chi and yoga has increased dramatically, and among a variety of age groups. These physical activities are not about raising heart rate, breaking a sweat, or meeting specific time goals; while you will improve your flexibility and balance by participating in these exercises, the aim is to look inward and get in tune with your own body.

Tai Chi in particular is an excellent option for seniors who, for any number of reasons, find exercising difficult. There are many different types of Tai Chi, but most are performed by moving slowly through a series of poses while engaging in deep breathing. Spatial perception becomes impaired with age, making it more difficult for seniors to keep their balance while moving and increasing their anxiety about falling. Tai Chi as a practice emphasizes the individual in relation to the space around them, which fosters greater awareness of one’s body and movements in day-to-day life. Beyond merely strengthening their physical stability, participating in Tai Chi can help restore confidence in their bodies, thereby assuaging their fear of falling.

Research has shown that Tai Chi, though movement-oriented, is also gentle on the joints. In fact, the motions employed in Tai Chi are similar to physician-prescribed exercises to help manage arthritis. The poses are made through fluid, purposeful movements that are not physically taxing on the body and which are meant to relax the participant. When performing Tai Chi the muscles are not tense, and throughout the exercise deep, even breathing is used to focus the body and mind.

There is evidence that Tai Chi reduces stress levels and blood pressure, improves strength, and can make recovery from falls and cardiovascular events easier. But more importantly, it seems to offer a safe, rewarding way for seniors to become reacquainted with their physicality. Aging is an emotionally difficult and physically draining process that we all undergo, and the change in our abilities can be very disheartening. Suddenly running up a flight of stairs is no longer possible. Stepping off the curb becomes a nasty fall. Our backs refuse to let us engage in our preferred physical activity. We are forced to be more cautious in order to navigate a less accessible world.

Practicing Tai Chi can help seniors feel more at home in bodies that are constantly changing. It can restore confidence and inspire self-love. Yes, we won’t always be able to run five miles or hike a mountain trail or bike across town. But our bodies are still amazing, still valid, and still capable of remarkable feats of strength. We just have to approach them differently, and Tai Chi is a wonderful way to foster a deeper awareness of your own body.

Many senior centers offer Tai Chi classes, and while there are YouTube videos and DVDs available for practicing in your own home, you should learn the basics with a certified instructor. This way you can be sure that you are performing the movements correctly and not straining your body. If you or a senior loved one are unable to stand, Tai Chi has been and can be adapted to a sitting position. If you have a pre-existing medical condition you should consult with your physician to make sure that you are well enough to engage in Tai Chi exercises.

If you’re interested in Tai Chi and want to know what it looks like in practice, this video shows a certified instructor leading classes!