Category Medication Management

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.

Of the many incurable diseases which plague humanity, none may experience so prevalent a rise in a few decades’ time as Alzheimer’s. As those of the “Baby Boomer” generation age, it is estimated that as many as 13 million Americans could develop the disease by 2050; the global escalation of Alzheimer’s and the absence of any concrete treatment is disheartening, to say the least.

But in the last few months Alzheimer’s research has yielded potential methods by which the disease may be reversed.

In June, the exciting findings from a study produced by the Buck Institute for Research on Aging and the UCLA Easton Laboratories for Neurodegenerative Disease Research were published, showing the first objective evidence that Alzheimer’s can be reversed. Ten participants, most in the early stages of the disease, followed a personalized program incorporating dietary changes, sleep improvement, supplement usage, and regular exercise, among other things.

The study was designed to test the hypothesis that Alzheimer’s, like cardiovascular disease and HIV, can benefit from a combination of therapies tailored to the patient and their specific needs. A drug may only treat one aspect of the disease, which would ultimately prove ineffective if, like some researchers believe, Alzheimer’s is the result of a series of molecular interactions and not simply a disease of “toxicity”. Dr. Dale Bredesen, a professor at the Buck Institute and UCLA Easton Laboratories, likens a brain affected by Alzheimer’s to a roof with 36 holes; while medication could patch up one hole, there are 35 other holes that require a combination of various treatments.

Following their personalized programs, nine of the ten participants saw significant improvement, and in some cases, they were able to retain the functions lost in their initial decline. Those who had been forced to quit their jobs because of memory impairment were able to return to work with improved performance.

Though the results of the study are very encouraging, they have not yet been replicated in a larger sample size. While nine out of ten improving is astounding, it is worth noting that the participant who did not improve was in the later stages of the disease. All other participants were either in the very early stages of Alzheimer’s, or in a pre-Alzheimer’s stage; these 36-point therapeutic programs may primarily benefit those who are diagnosed early. Most participants tested positive for the APOE4 allele, which put them at an increased risk of developing the disease; as the majority of Alzheimer’s cases in the United States are caused by APOE4, Dr. Bredesen encourages people to have this same test so that they can begin preventative measures as soon as possible.

And just last month, Tel Aviv University published the results of a study to observe the APOE gene’s role in Alzheimer’s disease. APOE moves lipids in and out of cells, but can appear in one of two forms: the effective APOE3 and the impaired APOE4. Researchers studied the APOE4 gene in mice, and found that its presence led to memory and learning difficulties, as well as damaged synapses in the brain. They then activated ABCA1, an enzyme that can help APOE4 with the transport of lipids through cells; this process reversed the impairment of APOE4 and, amazingly, seemed to reverse the impaired mental faculties of the mice.

While neither of these studies offers us an immediate solution to Alzheimer’s disease, the progress evident in their results are exciting and should give us hope for the future. It goes without saying that Alzheimer’s is extraordinarily complex, and the answer to the disease will be equally so. There is no such thing as an overnight cure, or a wonder drug. There are no foolproof diets or other health programs that can guarantee protection.

But a few decades ago researchers had no idea of the role APOE4 plays in the development of Alzheimer’s. There was no evidence that a multi-therapy approach to the disease could have any impact, let alone lead to a reversal of memory impairments. And these new developments in Alzheimer’s research have only occurred in the last few months; the prognosis of the disease can only improve over time, and by exploring multiple potential methods, the odds that a variety of treatments may be found increase.

In the meantime, all we can do is continue to take care of our bodies to the best of our ability, and ensure that our senior loved ones do the same. There is still so much we don’t understand about Alzheimer’s, and our efforts to eat healthily, keep our minds sharp and bodies fit, may not be enough to prevent development of the disease. But maintaining a healthy lifestyle, making sure we get enough sleep, exercising, and staying positive can only help us as we age.

Contributed by Meredith Kimple

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.

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.