Many of us know the value of having a pet in the house, many of us have experienced the joys of snuggling up beside our furry companions. But have you considered that having a pet could improve the overall health of your elderly loved ones?Read More
In 2010, pneumonia, combined with influenza, was the eighth leading cause of death in the United Sates, according to the National Center for Health Statistics. On top of this, 1 out of 20 adults who get pneumonia dies, according to the Centers for Disease Control. This makes preventing pneumonia in the elderly a serious matter.
"Pneumonia is an inflammation of the lungs usually caused by bacteria, viruses, fungi or other organisms," says Dr. Norman Edelman, the chief medical officer for the American Lung Association. This inflammation causes an outpouring of fluid in the infected part of the lungs, affecting either one or both lungs. The blood flow to the infected portion of the lung (or lungs) decreases, meaning oxygen levels in the bloodstream can decline.
"This decline is more likely to happen in an elderly, sick, and/or debilitated 85-year-old. The body attempts to preserve blood flow to vital organs and decrease blood flow to other parts of the body such as the GI tract," says Dr. Joseph Mylotte, a professor of medicine at the School of Medicine and Biomedical Sciences at the University of Buffalo. "The effects [of pneumonia] are widespread even though the infection is localized to the lung." The complications of pneumonia in the elderly can be life-threatening, from low blood pressure and kidney failure to bacteremia, an infection that spreads to the bloodstream.
Elderly people are more susceptible to pneumonia for several reasons. Often they already suffer from co-morbid conditions such as heart disease, which means they don't tolerate infection as well as younger people, says Mylotte. Age also causes a decrease in an older person's immune system response, so his defenses are weaker. "Some virulent organisms can cause infection in younger people, but the infections can be worse in older people," says Mylotte.
Pneumonia is caused by more than thirty types of organisms; these different strains mean that symptoms can vary from case to case. However, the following symptoms can signal a bout of pneumonia:
- Malaise or feeling weak
- Green or yellow sputum
- Pain in the chest
- Shortness of Breath
Often, a person may think she is simply suffering from the cold or flu. Also, it is widely believed that the signs of pneumonia in the elderly can differ from the general population. An older patient might not have a fever. "The symptoms and signs are sometimes not as specific. They may be more sleepy and lethargic, or lose their appetites, or they may suffer from dizziness and fall. If there is underlying dementia, they might not be able to tell you how they feel. But it's all related to something going on in the lung," says Mylotte.
People are often exposed to the organisms that cause this disease, but the lungs' defense mechanisms usually protect people from infection. Sometimes these organisms break through a person's immune system, infecting the lungs' air sacs. Each lung has a major airway (bronchus) that divides into twenty-two tubes; these tubes further divide into more than one hundred thousand tiny tubes (bronchioles) that end in clusters of tiny air sacs (alveoli), where the transfer of oxygen to the body's bloodstream takes place. When a patient has pneumonia, the affected air sacs become inflamed and filled with fluid. This leads to breathing problems, a lack of blood flow to the infected sections of the lungs, and a decrease in the bloodstream's oxygen level.
PNEUMONIA CAUSES & DIAGNOSIS
Simple diagnostic tests can confirm a case of pneumonia in the elderly. A doctor who listens to a patient's lungs may hear bubbling sounds called rales and rattling sounds called rhonchus, which signal infection and inflammation in the lungs. A pulse oximetry test computes the blood's oxygen levels. A chest x-ray or CT scan is often the definitive diagnosis, telling the physician where the infection is and the degree of the illness. Sometimes a doctor will have the patient's phlegm or blood analyzed to decipher which organism is responsible for the infection.
Although pneumonia can be caused by more than two dozen organisms, pneumonia in the elderly is usually caused by bacteria or viruses. The streptococcus (or pneumococcal) pneumonia bacteria is responsible for an estimated forty thousand deaths every year, according to the Centers for Disease Control. The elderly are more likely to catch this strain of pneumonia. Streptococcus pneumonia can come on slowly or suddenly. It can damage the lungs, cause bacteremia in the bloodstream, and meningitis in the brain.
Viruses also trigger this disease, and are thought to cause about 50 percent of pneumonia infections in the general population. Usually viral pneumonia is less severe, but complications can include bacterial pneumonia.
Atypical pneumonia-causing organisms-such as mycoplasma and chlamydia-rarely cause pneumonia in the elderly. In the nursing home population, a small percentage of people suffer from severe pneumonia strains caused by organisms such as Gram-negative bacteria and Staphylococcus aureus, which can quickly end in death or with the patient on a respirator, says Mylotte.
PNEUMONIA TREATMENT & MANAGEMENT
Patients are treated for pneumonia depending upon which organism triggered the disease. Your loved one's medical provider can ascertain this through analyzing a phlegm or blood sample.
For a case of viral pneumonia, some patients may receive antiviral medications, but these are not commonly prescribed. And antibiotics are not used because they aren't effective against viruses. Bouts of viral pneumonia usually heal without medication, provided the patient rests, eats healthy food, and takes in plenty of fluids. If new symptoms arise, it is important to contact your loved one's doctor, as bacterial pneumonia is a possible complication.
Bacterial pneumonia is always treated with antibiotics. If a patient is in the hospital, it is typical for the hospital to follow strict treatment guidelines. These guidelines are part of pay-for-performance programs, meaning the doctor will get paid a better rate if she follows the guidelines, says Mylotte. Both the American Thoracic Society (www.thoracic.org) and the Infectious Diseases Society of America (www.idsociety.org) have standard treatment guidelines available on their respective websites. These are based on where the patient acquired the disease-in the community, in the nursing home, in the hospital-and these guidelines can be found on each organization's website. Whether at home or in the hospital, patients are usually administered a once-a-day therapy. Effective antibiotic treatments include respiratory fluoroquinolones such as moxifloxacin, says Mylotte, although there are several antibiotic therapies that work as well as these.
Treating bacterial pneumonia has become more complicated due to antibiotic resistance: The organisms that cause this disease mutate and can become resistant to drug treatment. This is one reason that it is important for a patient to finish her entire course of antibiotics; stopping treatment early actually encourages antibiotic resistance. Up until a few years ago, antibiotic resistance associated with bacterial pneumonia had been increasing, but it has recently decreased, according to Mylotte.
Both mycoplasma and chlamydia pneumonias are also treated with antibiotics. Mycoplasma pneumonia is also known as walking pneumonia. If your loved one has this strain, he or she usually will have milder symptoms, but it can take four to six weeks to heal completely.
Most pneumonia patients heal at home. About 15 to 20 percent of people with community-acquired pneumonia are treated in the hospital, while about 20 to 30 percent of people withnursing-home acquired pneumonia are also admitted to a hospital, according to Mylotte.
Whether a patient stays at home or in a hospital, she may take medications to ease fever, aches, and coughing bouts. Because coughing actually helps rid lung infection, this action shouldn't be entirely reduced. However, if the patient isn't getting any sleep, a low-dose cough suppressant can be prescribed. Patients with severe strains may need oxygen therapy to increase blood-oxygen levels. Caregivers should make sure a loved one is receiving proper hydration, eating at least a small amount of healthy food, and reporting worsening or new complications, says the American Lung Association's Edelman.
Complications that can arise from pneumonia include:
- Bacteremia: The possibly deadly infection invades the bloodstream and can infect the body's organs.
- Pleurisy and Empyema: With pleurisy, the membrane that covers the lungs (pleura) becomes inflamed. Empyema occurs when fluids causing inflammation become infected.
- Lung Abscess: A pus-filled cavity can develop in the infected lung area.
- Acute Respiratory Distress Syndrome (ARDS): When the lungs become severely injured due to pneumonia, respiratory failure can occur. Treatment includes the use of a mechanical ventilator (vent) and supplemental oxygen.
Pneumonia in the elderly as well as younger people occurs when a person's immune system is weakened. Although it can be transmitted via the air or hand-to-hand contact, if a person's immune system is strong he can fight off this infection. Preventing this disease with the following steps can keep it at bay:
- Pneumococcal Vaccine: This vaccine helps prevent twenty-three different strains of bacterial pneumonia (although there are many more strains of bacterial pneumonia out there). "It doesn't always engender a good immune response in adults, so it doesn't always work well," says Mylotte. He also points out the vaccine is effective for a shorter amount of time in older people. Experts recommend getting your first dose when you are in your 50s and your second dose at age 65, and then a new dose should be administered every five years.
- Influenza Vaccine: This vaccine is just as important as the pneumococcal vaccine. It doesn't work as well in elderly people, says Mylotte, but if an older vaccinated person gets the flu, it is usually a milder case. Pneumonia is often a secondary infection after an initial bout of influenza; people who receive this vaccine have less risk of developing pneumonia as a flu complication. Older adults should get a flu shot every year.
- Hand Washing: "I always tell people to wash their hands as much as they can. If your hands aren't raw in the wintertime, you are not doing a good job," says Mylotte.
- Dental Hygiene: Pneumonia infections can occur around infected teeth, says Edelman, so dental work should be kept in good repair.
- Good Health Habits: Exercise, rest and healthy eating can all increase resistance to pneumonia.
Edelman also recommends that frail elderly people who are already susceptible to infection should stay away from anyone who has the flu or a bad cold. Of course, preventing pneumonia in the elderly is always preferable to treating it. But if you suspect your loved one is suffering from pneumonia, quick intervention can be a life-saving occurrence.
There's an old saying about the eyes being windows to the soul. But the latest medical and dental research shows that the mouth truly is a window into one's overall health. Looking out for a loved one's health means not only keeping an eye on their nutritional intake and physical capabilities, but also on their teeth and gums. Senior dental problems can be common, from dry mouth to periodontal disease, and since oral health directly impacts the health of the rest of the body, these issues need to be taken seriously. Taking care of elderly teeth and gums is just as important as heart or digestive health.
COMMON DISEASES WITH ORAL SYMPTOMS
Researchers have found that many diseases in the rest of the body have oral symptoms. With careful examination of the teeth, gums, and tongue, dentists have found evidence of heart or liver disease, eating disorders, diet deficiencies, anemia, diabetes, arthritis, HIV, osteoporosis, and even some autoimmune diseases. "We're now realizing how they're interrelated," explains Dr. Cynthia M. Carlsson, assistant professor of geriatrics and gerontology at the University of Wisconsin School of Medicine and Public Health.
Not only does the mouth tattle on the rest of the body, oral health can actually affect overall health.
For example, recent studies show a correlation between gum disease and heart disease. In fact, risk factors for periodontal disease and cardiovascular disease are similar: smoking, stress, poor diet, excessive weight gain, and low exercise levels. One study suggests that people with severe periodontal disease face double the risk of fatal heart disease, and severe periodontal disease also is associated with higher rates of stroke in some studies. And in certain circumstances, a tooth infection has the potential to cause bacterial endocarditis, which is an infection of the heart's inner lining or the heart valves. Bacteria in the bloodstream can lodge on the valves or damaged heart tissue, and it could be serious enough to damage, or even destroy, the heart valves.
Periodontitis also appears to share risk factors with chronic degenerative diseases such as ulcerative colitis, and lupus. If a patient has severe gum disease, they may be advised to take antibiotics before undergoing invasive dental procedures such as gum surgery or tooth extraction.
Conversely, other diseases can affect the mouth. For example, diabetes affects healing, so if a diabetic senior has gum disease, it may take quite a bit longer to treat that gum disease.
Researchers now urge both doctors and dentists to be alert to overall health problems when taking care of elderly patients and encourage behaviors that will promote a healthy body from head to toes.
MAKING ORAL HEALTH A PRIORITY
It's easy for someone to let oral health slide a bit when they're distracted by other ailments. Perhaps arthritis makes tooth brushing painful, or they can't stand at the bathroom sink very long. "They're maybe not quite as vigilant because of their frailty, which leads to a quick decline in oral health, and this could be a detriment to systemic health," explains Dr. Marsha A. Pyle, director of the Training Center for Geriatric Oral Health and associate dean of Education at the Case School of Dental Medicine in Cleveland, Ohio. "You can't just treat dental disease in isolation."
It's best to brush after every meal, says Pyle, not just in the morning and at night. If a patient is at risk of periodontal disease, a dentist can prescribe special toothpastes or gels that help combat dental disease, as well as a daily treatment of high-fluoride gel or anti-bacterial rinse.
Carlsson advises encouraging your loved one to visit their dentist on a regular basis either to have their teeth cleaned or to have their dentures refit. Missing teeth or dentures that don't fit well can lead to potentially serious senior dental problems. "They may aspirate the food, where food goes down into the lungs and causes pneumonia," Carlsson says. Besides encouraging good nutrition and regular dental visits, watch him eat to see if he's avoiding something, and try to notice if any of his teeth look loose or broken.
Ill-fitting dentures can be a culprit in poor nutrition among seniors. When a person loses his natural teeth, his jaw bones begin to shrink away, leading to the jaw continually "remodeling" itself. Dentures that once fit well start slipping. So, a senior may start limiting the kinds of food he eats because it's too hard to eat, or because he's embarrassed that others may see him having trouble chewing.
"And it happens during a really important stage of a person's life. These really frail seniors really need their nutrition," Pyle says.
If a senior does lose her natural teeth, instead of traditional dentures, she could have implant-supported dentures. These implants are attached to the jaw bone, and a special denture snaps onto the implants. These implant-supported dentures fit more snugly than traditional dentures, so eating different foods shouldn't be a problem.
A less drastic measure places a softer material on the gum side of traditional dentures so they're more comfortable.
Just a few decades ago, 50% of all seniors had no natural teeth remaining, according to Pyle. That number has now dropped to 27% of those over age 65. "It's not a natural part of aging, I'm happy to say," says Pyle. "People now are aging with a full set of teeth."
Whether or not your loved one has his natural teeth or dentures, a little help from you can go a long way toward ensuring that he maintains good dental hygiene. A healthy smile may affect a person's confidence and self-image, but, more importantly, it will pay off not only in her oral health, but in her overall health as well.
DRY MOUTH: A COMMON ISSUE FOR SENIORS
According to Pyle, one of the major senior dental problems is dry mouth. "If they have a chronic disease managed by medications, one of the side effects is dry mouth. There are 400 medications known to cause dry mouth," Pyle says, including medications for common problems such as high blood pressure and depression.
While a small amount of gum recession is normal as seniors age, dry mouth increases that recession dramatically, leaving the mouth more susceptible to root area cavities. And those root surface cavities advance more quickly on the soft surface of a tooth.
There are many ways to treat dry mouth including:
- Increase liquid intake
- Rinse mouth frequently with water
- Use a commercially available saliva substitute
- Use specially-formulated toothpastes, chewing gum, or non-alcohol-based mouthwashes
- Apply lip moisturizer frequently
- Suck on tart, sugarless hard candies
- Avoid dry, salty foods
by Elinor Ginzler, AARP.org
As your family members or loved ones age, so does their home. It is good practice to step back occasionally and examine the home to see how well the living arrangement supports your loved ones’ daily needs and activities. There are many steps you can take to ensure that your family members stay safe and comfortable in their home.Often these changes can be made with little or no cost, while they also make the home more user-friendly and welcoming. In this column, I note some safety tips to evaluate in your loved ones’ homes, so you can help them successfully age in place.
I’ve written before about the numbers: Nearly 90 percent of olderAmericans want to stay in their current home as they age. Overwhelmingly, that’s where people want to live if they need care as they get older. But sometimes, features in your loved ones’ homes can be their biggest obstacle to remaining independent. As a caregiver, I know the safety of your loved one is your primary concern. By taking small but-practical steps, including the modifications I describe below, you can transform your loved ones’ “home sweet home” into “home safe home.”
No-Cost Changes for Home Safety
- Remove all scatter and throw rugs, which can lead to falls.
- Open blinds and curtains, and raise shades during daylight hours to increase natural light inside the home.
- Place electrical, phone and computer cord, along walls, where they will not trip anyone. To avoid the risk of fire, do not run the wires under carpeting.
- Remove clutter fromthe staircases and hallways to prevent trips and falls.
- Set the hot-water heater to 120 degrees to prevent scalding and to reduce energy consumption.
While all of the above can be done without spending money, you might find some changes are hard for your loved one to accept. For instance, Mom may like her scatter and throw rugs because they add color to her rooms. It’s important that you explain to her why you are suggesting removing these trip hazards. Tell her you want her to consider the change because you’re worried about her falling and seriously hurting herself. Be creative in how you approach the conversation – perhaps suggest that she could move the rug from the floor to the wall or add throw pillows on a chair or sofa to add color without safety risk.
Low-Cost Changes for Home Safety
As you make these no-cost changes, I suggest you look around your parents’ house to see whether or not you could take additional steps to ensure the safest possible home. Here are some low-cost changes ($35-$75) and will make a home even safer:
- Increase lighting by using the highest-watt bulbs possible for fixtures or lamps.
- Place double-sided tape or carpet mesh under area rugs to prevent slipping.
- Install offset hinges on all doors to add 2 inches of width for easier access.
- Replace traditional light switches with easy-to-use, rocker-style switches.
- Install night lights in hallways between bedrooms and bathrooms.
- Replace knobs on cabinets and drawers with easy-to-grip D-shaped handles.
- Add anti-slip strips in the bathtubs and showers.
- Mount grab bars in the bathtubs and showers, and place a sturdy water-proof seat in the shower so your loved one can sit down while bathing or showering.
- Install a handheld adjustable shower head for easier bathing.
- Install handrails on both sides of each stairway to support your loved ones’ sure footing.
You can find low-cost tools and products at your local hardware or home improvement store. It's important that you or a contract or properly install all the updates, so find a reputable handyman to help you if you need assistance.
It might be hard for your loved one to consider certain features, such as the installation of grab bars in the bathroom. “I don’t want those things,” Mom might say. “It’ll look like a hospital room.” This is the time to speak from your heart. Use “I” statements. Tell her you worry about her and you want her to be safe in her home. Add that grab bars come in a range of colors and finishes that can match the decorating scheme of any bathroom. Tell her the days of “institutional-looking grab bars” are long gone. Go with her to the store to look at what’s now on the market.
In addition to the changes listed above, always remember to have a properly rated fire extinguisher in the kitchen area, and fire and carbon monoxide detectors on all floors of each house.
AARP recently developed a video, “There’s No Place Like Home.” (Watch: Part One, Part Two.) It documents how easy and affordable it can be to update kitchens and bathrooms to dramatically improve home safety. You can show the videos to your parents to help them understand that they can easily improve their safety and your peace of mind.
Since your loved ones likely want to live at home as long as possible, consider more extensive changes to the home so that it will be sure to meet loved ones’ daily living needs. Design features such as multi-level countertops and pull-out drawers in the kitchen provide easy access to pots and pans. No-step entries to the home may cost more, but they can make homes safer and more comfortable for everyone.
AARP and the National Association of Home Builders (NAHB) have collaborated to help develop a certification program for remodelers, builders, and developers who focus on the connections between home design and the needs of aging people. The Certified Aging-in-Place Specialist (CAPS) program teaches building professionals about the changing needs of people as they age, as well as products and building techniques that can better support aging in place. While there are more than 1,700 certified professionals in the U.S., there is only one in Oklahoma.
Growing Consumer Interest
Realtors, interior designers, and architects have discovered that consumers are starting to show more interest in features and products that promote successful aging in place. People are also realizing that when homes are designed and constructed with these features, the homes’ value increases.
In Georgia, an “Easy Living Home” designation has been developed. It focuses on three key features of home design; all new homes constructed using the Easy Living Home approach have:
- Accommodations for first-floor living, with the master bedroom and full bath on the first floor
- At least one no-step entrance to the central living area of the home
- A maximum clearance (up to 36 inches across) in all doorways for easy movement throughout the home
Proponents contend that these homes are “easy to build, easy to visit, and easy to sell.” Across the country, builders, developers, and realtors are replicating elements of “universal design” – design informed by features that provide comfort, safety, and the ability to age in place. There is significant consumer interest in aging in place and the type of home required for it.
Home Safe Home
No home can be “sweet” if it isn’t “safe.” The types of home features and fix-its described in this column make homes easier to use, which increases the independence of residents and makes caregiving easier.
I hope that these ideas prompt you to evaluate your loved ones’ home and to make the kinds of changes that you deem necessary and beneficial.
Elinor Ginzler is a national expert on independent living and aging issues. She currently serves as AARP’s lead spokesperson on caregiving, housing, and mobility issues, including older drivers’ safety.
Getting the flu can be a nasty experience, no matter what your age or general health, and each year flu shots are a major public health initiative. But, because of the risks to the elderly, senior flu prevention is especially important.
According to the Centers for Disease Control (CDC), each year more than 200,000 people will be hospitalized because of the flu, and 36,000 of them will die.
"Disproportionately it's the elderly," explains Debra Beauchaine, MN, ARNP, and geriatric services director at Virginia Mason Medical Center in Seattle. Seniors in their seventies and eighties are at higher risk from the flu than seniors in their sixties, because of declining immunity to illnesses as they age.
HOW FLU SPREADS
Seasonal (or common) flu is one of the most highly contagious illnesses. It is spread by "respiratory drops"-coughing and sneezing. Someone may touch something with the flu virus on it-such as door knobs, telephones or shopping cart handles-then unwittingly touch their mouth or nose.
And it's not enough to simply stay away from other people who feel sick. "People may be contagious one day before they develop any symptoms, and for up to five days after becoming sick," Beauchaine says. "That's part of the problem; people don't realize they have the virus before they actually feel sick."
Flu symptoms include fever, chills, runny or stuffy nose, headache, sore throat, cough, extreme fatigue, and muscle aches. Nausea, vomiting and diarrhea are sometimes present, but rarely prominent.
Flu season typically runs from October through the end of February, but some years it runs into March and April as well. It is estimated that 10 to 20 percent of the U.S. population contracts influenza each year. Once someone gets the flu, the only real "cure" is to rest and drink plenty of fluids, although a doctor may prescribe Tamiflu® or Relenza®, both anti-viral medications which can keep the influenza virus from spreading inside the body and shorten the duration of symptoms. Both must be taken within 48 hours of the onset of flu symptoms, and neither is a substitute for a flu vaccination.
FLU & SENIOR HEALTH
While otherwise healthy adults can be laid low by the flu for a full week, senior citizens are at risk for becoming much sicker. "They are more vulnerable, once they get the flu, to develop complications," Beauchaine says. "Because the flu is really a pretty severe illness, they may not have as much of what we call 'physiological reserve' as a younger adult. So, seniors will feel very sick from a case of the flu and that puts them at greater risk for complications."
Dr. W. Paul McKinney, associate dean of the School of Public Health at the University of Louisville, explains that one of the more serious complications is primary viral pneumonia or a secondary bacterial pneumonia. Most hospitalizations and deaths from the flu are a consequence of pneumonia and other respiratory disorders. Also, if a senior has any chronic health conditions, such as congestive heart failure, chronic lung disease, even diabetes or renal failure, those could be exacerbated by the flu. And another common complication of the flu is dehydration, so drinking plenty of fluids is especially vital for the elderly.
SENIOR FLU PREVENTION
Staying away from work or crowded places while sick is important to prevent spreading the flu to others. But that's not an option for seniors living in nursing homes or assisted living facilities, making senior flu prevention that much harder at these communities. "When you congregate large numbers of people in close quarters, transmission is a lot easier," McKinney says.
However, Beauchaine points out that nursing homes usually require all employees to be vaccinated, which is the single most effective way to guard against getting the flu. And, it's important to get a flu shot every year, because the virus changes slightly from year to year. Getting a flu shot one year and not the next, will not protect someone from that year's particular strain.
"They should make every reasonable effort to get vaccinated early in flu season," McKinney says, but don't do it too early in the season, because occasionally the immunity will wear off before flu season ends, especially if the season lasts into March or April.
According to the U.S. Department of Health and Human Services, seniors covered by Medicare Part B pay no coinsurance or deductible for their flu shot, as long as they receive the shot from a Medicare provider.
What if a senior is otherwise healthy and doesn't feel they are "at risk?"
"There is no reason a healthy senior should defer a vaccine," McKinney says.
A University of Michigan study found that boosting elderly flu vaccinations could save as many as 6,500 lives over ten years. In fact, research from Johns Hopkins University shows that annual flu shots reduce the number of deaths among hospital patients by one half.
While vaccination is the most important senior flu prevention, it's only 70 to 90 percent effective, so some people who receive the vaccination will still get the flu.
So, for at-risk populations, it's especially important that everyone around them also gets vaccinated. That includes everyone involved in taking care of the elderly. And like nursing homes, some hospitals, such as Seattle's Virginia Mason, require all employees to be vaccinated.
The CDC's target groups for vaccination keep expanding, recently adding children aged 2-5, and lowering the seniors' age range from age 65+ to 50+. The CDC estimates 218 million Americans fall into the at-risk groups that should be vaccinated. "That's over two-thirds of this country," McKinney says. "This year we'll have 100 million doses of the vaccine, so we won't even be able to vaccinate 50 percent."
According to McKinney, the U.S. should not face a vaccine shortage this year. "Unless someone is in a very remote, isolated area, there shouldn't be a problem getting the vaccine," he says.
While it's not possible to get the flu from the standard injectable flu vaccine, which is made from a killed virus, some people will experience a sore arm for one to two days, and possibly a fever. (The newer nasal spray vaccine is made from a live attenuated virus and recommended only for healthy, non-pregnant people between the ages of five to forty-nine.)
Although some people believe certain foods or vitamins can ward off illness, Beauchaine says that while they may make you healthier in general, they aren't effective for senior flu prevention.
During flu season, practicing good hygiene can help people avoid catching or spreading the flu. Wash hands frequently, especially after touching door knobs and stair rails in public places. Always cover nose and mouth when coughing or sneezing, and immediately wash hands afterward. And, of course, stay away from people who are sick. People taking care of the elderly especially need to follow this type of common sense senior flu prevention.
Finally, don't confuse influenza with avian flu. While bird flu gets a lot of press these days, it is extremely rare, occurring when a human has direct contact with infected poultry or surfaces contaminated by secretions or excretions from infected birds. Vaccines to protect against bird flu are being developed, but are not yet available.
GEORGE F. FULLER, COL, MC, USA, White House Medical Clinic, Washington, D.C.
Am Fam Physician. 2000 Apr 1;61(7):2159-2168.
See related patient information handout on the causes of falls and tips for prevention, written by the author of this article.
Falls are the leading cause of injury-related visits to emergency departments in the United States and the primary etiology of accidental deaths in persons over the age of 65 years. The mortality rate for falls increases dramatically with age in both sexes and in all racial and ethnic groups, with falls accounting for 70 percent of accidental deaths in persons 75 years of age and older. Falls can be markers of poor health and declining function, and they are often associated with significant morbidity. More than 90 percent of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age. One third of community-dwelling elderly persons and 60 percent of nursing home residents fall each year. Risk factors for falls in the elderly include increasing age, medication use, cognitive impairment and sensory deficits. Outpatient evaluation of a patient who has fallen includes a focused history with an emphasis on medications, a directed physical examination and simple tests of postural control and overall physical function. Treatment is directed at the underlying cause of the fall and can return the patient to baseline function.
Elderly patients who have fallen should undergo a thorough evaluation. Determining and treating the underlying cause of a fall can return patients to baseline function and reduce the risk of recurrent falls. These measures can have a substantial impact on the morbidity and mortality of falls. The resultant gains in quality of life for patients and their caregivers are significant.
Epidemiology of Falls in the Elderly
From 1992 through 1995, 147 million injury-related visits were made to emergency departments in the United States.1 Falls were the leading cause of external injury, accounting for 24 percent of these visits.1 Emergency department visits related to falls are more common in children less than five years of age and adults 65 years of age and older. Compared with children, elderly persons who fall are 10 times more likely to be hospitalized and eight times more likely to die as the result of a fall.2
Trauma is the fifth leading cause of death in persons more than 65 years of age,3 and falls are responsible for 70 percent of accidental deaths in persons 75 years of age and older. The elderly, who represent 12 percent of the population, account for 75 percent of deaths from falls.4 The number of falls increases progressively with age in both sexes and all racial and ethnic groups.5 The injury rate for falls is highest among persons 85 years of age and older (e.g., 171 deaths per 100,000 white men in this age group).6
Elderly persons who survive a fall experience significant morbidity. Hospital stays are almost twice as long in elderly patients who are hospitalized after a fall than in elderly patients who are admitted for another reason.9 Compared with elderly persons who do not fall, those who fall experience greater functional decline in activities of daily living (ADLs) and in physical and social activities,10 and they are at greater risk for subsequent institutionalization.11
Falls and concomitant instability can be markers of poor health and declining function.12 In older patients, a fall may be a non-specific presenting sign of many acute illnesses, such as pneumonia, urinary tract infection or myocardial infarction, or it may be the sign of acute exacerbation of a chronic disease.13 About one third (range: 15 to 44.9 percent) of community-dwelling elderly persons and up to 60 percent of nursing home residents fall each year; one half of these “fallers” have multiple episodes.14 Major injuries, including head trauma, soft tissue injuries, fractures and dislocations, occur in 5 to 15 percent of falls in any given year.15 Fractures account for 75 percent of serious injuries, with hip fractures occurring in 1 to 2 percent of falls.15
In 1996, more than 250,000 older Americans suffered fractured hips, at a cost in excess of $10 billion. More than 90 percent of hip fractures are associated with falls, and most of these fractures occur in persons more than 70 years of age.8 Hip fracture is the leading fall-related injury that results in hospitalization, with these hospital stays being significantly prolonged and costly.16 It is projected that more than 340,000 hip fractures will occur in the year 2000, and this incidence is expected to double by the middle of the 21st century.17
One fourth of elderly persons who sustain a hip fracture die within six months of the injury. More than 50 percent of older patients who survive hip fractures are discharged to a nursing home, and nearly one half of these patients are still in a nursing home one year later.18 Hip fracture survivors experience a 10 to 15 percent decrease in life expectancy and a meaningful decline in overall quality of life.
Most falls do not end in death or result in significant physical injury. However, the psychologic impact of a fall or near fall often results in a fear of falling and increasing self-restriction of activities. The fear of future falls and subsequent institutionalization often leads to dependence and increasing immobility, followed by functional deficits and a greater risk of falling
We are all probably aware that exercise is good for us. It improves our overall functioning, both physically and mentally. It not only helps us live longer, healthier lives, but it also goes a long way in keeping us more independent as we age and allowing us to continue to participate in many of the activities that we enjoy. It improves our mood, and it feels good for our body. Exercise has found to be an effective treatment for many health concerns such as depression, diabetes, arthritis, and high blood pressure. It can prevent or delay the onset of other health conditions as well. And on the opposite end of the spectrum, those who are inactive are twice as likely to suffer from heart disease. They also have a higher risk of hospitalization and are dependent upon more medications than those who remain active throughout their lives.
It is easy for anyone to make excuses about exercising. We are too busy, too tired, unmotivated at times. As we age we have even more excuses at our fingertips. Aches and pains, lack of stamina, feeling the need to “take it easy”. These things add up and over time a lot of older adults become more inactive as they age, when it is actually a time in our lives that it is more important than ever to stay fit. There are many moderate endurance activities that are recommended for older adults such as walking, swimming, dancing, tennis, golf, and bicycling. Make your exercise program a priority, and to help with this try to keep it interesting and fun. Make it a social activity if possible.
If you have not been active in a long time, start slowly and build up your endurance over time. Talk to your doctor before beginning any new exercise program and ask what is safe for you given any medical conditions, or to learn how to modify certain activities to avoid any problems. If you smoke, are obese, or diagnosed with any chronic health problems such as heart disease or diabetes, your doctor can give you the best advice on which activities will be the most beneficial to you. Time is precious and we only get one chance at life, make yours the best that it can be!
Our elderly loved ones need a little extra TLC during the hot summer months. Find out why dehydration increases with age and get valuable tips on keeping your favorite senior hydrated.
Senior dehydration is a common health issue that can lead to bigger problems if proper hydration is not made a priority, such as urinary tract infections and low blood pressure. Proper hydration helps to keep the body and vitals regulated. The University of Chicago Medical Center found that 40% of heat-related fatalities in the U.S. were among people over 65.
What Can Cause Dehydration?
There are a number of reasons the elderly are so prone to dehydration:
- The ability to notice changes in body temperature typically decreases with age.
- As people get older, body water content decreases.
- Many medications the elderly take make them more susceptible to dehydration.
- The elderly often experience diminished thirst; which leads to a reduced fluid consumption.
- With aging, the kidneys have a reduced ability to concentrate urine and retain water during water deprivation.
- Specific conditions, such as reduced swallowing capacity, decreased mobility, comprehension and communication disorders, as well as, decreased mobility and/orincontinence can contribute to dehydration.
- Many seniors have underlying health conditions that make them less able to adapt to heat.
What Health Issues Can Dehydration Create?
There are some staggering statistics, compiled from The Department of Health, The Hydration for Health Initiative, The Adult & Geriatric Institute, European Review of Aging and Physical Activity, and the Department on Aging, about dehydration in seniors.
Things you should know about dehydration:
- Dehydration has been associated with increased mortality rates among older adults
- Dehydration can accelerate or bring about emergency hospitalization and/or increase the risk of hospital stays
- Dehydration is a frequent cause of hospitalization of older adults and one of the ten most frequent diagnoses responsible for hospitalization in the U.S.
- Dehydration has been associated with many elderly health issues, including elderly confusion, impaired cognition, falling and constipation
- It is estimated that avoidable costs of hospitalizations resulting from dehydration is $1.14 billion, annually
What Steps Can Be Taken To Prevent Dehydration?
Fluid intake is key. Families and caregivers need to be cognizant about risks and plan ahead to make sure aging loved ones are properly hydrated. Here are some tips to help encourage fluid consumption and reduce the risk of elderly dehydration:
- Offer fluids on a regular basis throughout the day.
- Encourage 8 oz. of fluid intake every time the senior takes medication.
- Keep water bottles and/or a water cooler available throughout the day wherever the senior is (for example, in bed, on the patio, throughout the house or at the senior living community).
- Provide favorite “mocktail” concoctions (see below for some great recipes) or your senior’s favorite beverages (make sure they’re not caffeinated or alcoholic).
Tasty Recipes To Keep Your Elderly Loved Ones Hydrated
Strawberries and Coconut Water
To make 2 Strawberry Mocktails combine:
- 1 cup (250ml) of fresh coconut water
- 1 cup (250 ml) strawberries hulled and sliced
- 3 T of sugar syrup or agave nectar
- To make the sugar syrup, boil sugar and water together in a ratio of 1:3 sugar to water until it thickens to a runny syrup consistency. Store in a jar for all future cocktail making.
- Measure 1 cup of coconut water, either directly from a cut-open coconut or from a store-bought container (if you are lucky enough to live in an area that sells fresh coconut water in a bottle).
- Combine the strawberries and sugar syrup and blend with a blender to desired consistency.
- Serve with ice.
Get more information on making this delicious
Cucumber Lemonade with Basil
To make 3 to 4 Cucumber Lemonade treats combine:
- 1 English cucumber
- 3 C water
- 3 lemons
- 2 T sugar
- 1 small bunch basil
- 1 C soda water
- Start by cutting your cucumber in half. Peel one half and cut it lengthwise (you can cut it in half again first if need be).
- Scoop the seeds out and chop it into pieces.
- Put the cucumber pieces in a food processor and puree until smooth.
- Put puree in a fine mesh sieve over a container and push with a wooden spoon or spatula, extracting as much liquid as you can from the cucumber puree.
- Fill a separate bowl or container with 3 cups water. Squeeze 2 lemons into the water and mix in the sugar.
- Pour lemonade and cucumber juice into a pitcher or serving container. Slice remaining cucumber half (unpeeled) and remaining lemon and add to pitcher. Add basil, too. Refrigerate until chilled.
- Serve with ice.