Boom or BUST?

Caregivers may especially fall victim to depression over time. The worry and stress of taking care of a loved one, who used to perhaps take care of him/her, can add up. Seeking local support groups is a helpful start. People within these groups have been in similar situations and can share what may have been helpful and give resourceful information on the specific disease process. As the loved one’s illness or disease progresses, the levels of care may change from one caregiver to the need for some time outs. Perhaps another caregiver or at least a part-time relief worker may need to come into the picture. This leads to the need for information on what is available locally in adult daycare, respite care, or assistance through home health care agencies. Later, caregivers may have to look into assisted living (which can range from living in a home with the help of cleaning/meal mak-ing/ lawn maintenance and then progresses to skilled nursing and full-time care as the loved one’s condition requires) or nursing homes.

For adult children (or others) who are facing their loved ones’ aging issues, the Mayo Clinic has an excellent Web site. For example, the page for children with aging parents gives the top five clues that an aging parent may have health concerns, including: weight loss, clues that indicate the parent is having trouble maintaining the house, faltering appearance, low spirits or depression, and mobility problems (problems getting around because of joint problems or muscle wasting, etc.). The site goes on to help with what to do if any of these signs are detected and how to seek help within the parent’s community (eldercare locator). See www.mayoclinic.com for more information.

Making decisions about someone else’s health is not something we always think about or are made knowledgeable of when we are younger. The positive news in healthcare is that improvements in vaccines and preventive health measures have helped Americans to live longer life spans. However, diseases or simply not living healthy lifestyles can make the later years unable to manage without some sort of help. That help usually comes from loved ones, as long as we are lucky enough to have them.

Nearly 25% of Americans give care to a family member or friend. The average caregiver is a female with an average age of 46. With the increase of stress in the workforce over the generations, this puts additional challenge on Americans. Women are still often the primary child caretakers, housekeepers and cooks, plus they often work a full-time job that often requires after hours attention. Whether a male or female caregiver, however, add the duties of homework with kids and the care of an aging parent, and where is any time for a spouse? What about a social life? And how about caring for oneself when spending a full day (and often long nights) taking care of a loved one?

America is not going to get younger any time soon. The older baby boomers began turning 60 this year, which translates to aging of the United States’ largest demographic group of over 77 million people (born between the years 1946-1964). Therefore, our best option in helping prevent a burden on family or finances from poor health with aging is to prevent that decline in the first place. Chronic disease has come a long way in treatments and prevention. Though cures are not in place for some of the major causes of premature death and disability, healthy lifestyle choices are shown to help with a number of the main threats.

MAJOR OLDER ADULT HEALTH CONCERNS: Alzheimer’s Disease/Dementia:

Research shows that caring for a loved one with dementia often leads to a decreased quality of life for the caretaker, in terms of not going to a physician when necessary or engaging in activities that used to be a big part of life.

Research done on caretakers over approximately 18 years showed that caretakers who receive intervention in the form of counseling can delay having to send a loved one with Alzheimer’s disease to a nursing home by an average of 18 months (NY University School of Medicine). Folks in the intervention group were assigned to a counselor who provided individual sessions, without the patient attending. They were also given help in the way of financial planning, help from other sources as deemed necessary, informational resources and help in dealing with the patient’s behavioral problems.

Another big study, done by the National Institutes of Health (NIH) in five different regions of the US, showed improvement in caregiver quality of life. Specifically, the caregivers showed they had better social support, took better care of themselves, and were less depressed when they received intervention. Interventions meant the caregiver received support in the way of learning caretaker skills through instruction and role playing, social support groups, sharing of information and management of stress. The outcomes of the study were so positive that researchers suggest that the next step is to find ways to use the interventions throughout US networks involved in health services. If a caregiver has instruction and the support of someone in the same or similar situation, he or she is likely to feel less overwhelmed and alone. Until a set of clear guidelines does come into place, the NIH has developed a set of tips and resources that are helpful.

Visit:

www.nia.nih.gov/Alzheimers/Publications/caregiverguide.htm (National Institute on Aging)
www.alz.org (Alzheimer’s Association)
www.alz.org/aboutAD/Warning.asp for the 10 warning signs of Alzheimer’s Disease

Another great resource for caregivers of Alzheimer’s patients is: www.helpguide.org/elder/aging_challenges.htm
This site gives specific information that supports caregivers of Alzheimer’s Disease, from tips on how to keep the loved one with Alzheimer’s home longer, to finding respite care when some time off is necessary. It also gives excellent local information on respite care, help with daily money management, and all the way to nursing homes/assisted living centers and eventually end-of-life decisions and issues. Caregivers need support, and this is an excellent resource on how to stay connected with others in similar situations and those who can provide help.

Arthritis:

Arthritis can definitely have genetic predisposition, though research is still trying to determine to what extent. However, staying active can help reduce symptoms and help keep range of motion in joints. Movement of the joint helps in its lubrication and freedom of movement. In pain, we tend to stop moving what hurts. However, this can lead to degeneration of that joint and the muscles that move it, which increases the likelihood of injury. Pool exercise may be one of the best choices for staying fit in arthritis-prone people, as it prevents weight burden on the joint involved. Aquatic group exercise ensures proper movements and can help add variety to movements. Plus, it adds a social perspective to exercise which can lead to motivation and increase adherence to a good habit.

Cardiovascular disease:

Cardiovascular disease may mean a heart attack, stroke, or discomfort related to lack of good blood flow and can debilitate people to various degrees. In the worst case scenario, a stroke or heart related incident may lead to sudden death. Otherwise, it may leave impaired function of the body or the heart, and can severely impact quality of life. Others are more fortunate and can lead relatively normal lives with medication, intervention from surgery or procedure, and lifestyle modification (such as exercise and healthy food choices). Thankfully, many risk factors that lead to cardiovascular disease are controllable with these same healthier lifestyles.

Often, people worry about heart disease (with very good reason), but forget about stroke. Many of the same risk factors that can lead to a heart attack are also risk factors for stroke, such as high blood pressure, smoking, diabetes, high cholesterol, being physically inactive or overweight, having abnormal heart rhythms or other heart problems, carotid artery disease, and family history of cardiovascular problems. Strokes affect over 700,000 people each year. Strokes can affect someone for a short period of time (such as with transient ischemic attacks or TIA’s) or can permanently disable one or even both sides of the body.

Signs of stroke:

• Sudden numbness/weakness of face, arm or leg – especially on one side
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, or balance
• Sudden, severe headache with no known cause

Do not ignore the signs or symptoms, especially if they do not resolve within a few minutes, even though denial or mistakes in recognizing symptoms can be common. CHECK THE TIME – if someone has symptoms that sound like a stroke, note what time it is so you can report that to the medical team or physician. Unless you are extremely close to the emergency room (ER) of a hospital, you should call 911 to activate an emergency response team. Healthcare teams can begin care right away while the loved one or neighbor who drives a stroke victim spends that time getting the person to the ER. Time lost equals brain function lost!

Cancer:

With early detection and newer treatments targeted specifically at the type of cancer cell and DNA of the patient, cancer has become somewhat less of a death sentence upon diagnosis. It is usually when a tumor or growth has gone on for far too long that detrimental diagnoses are given. That is why it becomes more important to follow guidelines for checkups and make sure to pay attention to what you can do to prevent cancer.

Exercise and diet seem to be important, though research continues to find inconclusive results when studying various kinds of foods and their prevention against cancer. However, we do know that eating nutritious, higher fiber and lower simple sugar diets help ward off obesity and various other metabolic disorders which in turn can add up to trouble for heart disease and other chronic disease. Exercise has proven helpful in prevention of breast cancer and certainly proves helpful in recovery from many types of cancer.

Diabetes:

Type 2 Diabetes has become nearly epidemic in nature, affecting over 17 million adults and children. Not exercising and being above ideal body weight takes its toll on the body’s ability to use glucose, our body’s form of food energy, properly. Also, insulin’s job to clear glucose from the bloodstream and store it in muscle and liver tissue becomes harder and harder. Eventually tissues become less sensitive to insulin when the pancreas has produced so much insulin to try to remove excess glucose from the bloodstream.

For adults age 65 and above, one in five has diabetes. The problem with diabetes in older adults is the same thing that can help keep it in control. Not staying active and gaining excess body fat lead to the disease – but if this has been a lifestyle choice for many years, it is often harder to make the changes in activity and eating necessary to help bring glucose levels into ideal ranges. Also, when diabetes occurs in older adults, it is often accompanied by other health problems, such as high blood pressure and high cholesterol, making a need for more medication and more need for healthy habits.

In addition to the 17 million people already diagnosed with diabetes in the United States, there are another 16.5 million or more who have impaired fasting glucose, or glucose that is not yet indicative of diabetes, but shows the likelihood that it is heading that way. Normal fasting glucose levels should be 65-99 mg/dL. Fasting glucose is considered impaired if it is between 100-125 mg/dL, and diabetes is present if two fasting glucose readings show over 126 mg/dL. The “impaired” reading should be a warning sign to make some changes to diet: do not take in as many simple sugars (such as with soft drinks, juices, candy and sweets, and other carbohydrates that do not contain much fiber or other nutritious materials) and alcohol. To o much of any kind of food leads to excess weight, and excess weight means the body has to work harder to control glucose.

Exercise on a consistent basis and wise food choices become imperative for the diabetic or person with impaired glucose readings. Often, a person who achieves good control over glucose can avoid medication; or if already on medication, can either lower the amount or eventually wean off of it. However, going too long with high glucose readings, called hyperglycemia, and ignoring the signs of diabetes can lead to major complications, even amputations of limbs and loss of kidneys. Know what your fasting glucose values are and if you are diabetic, make sure you know what ideal levels are (see the American Diabetes Association (ADA) Web site for more information at www.diabetes.org.

PREVENTION TIPS:

To prevent health problems or detect them as early as possible, it is recommended that you take charge of your health by investing some time with a physician you trust. It is important to find someone that you feel comfortable with and that you really think listens to you. Otherwise, you may not confide in him or her as well. Bring a list of questions or concerns with you when you go to the physician, and remember to read over them as you go through a check up to make sure you don’t forget something important. People rely on themselves to remember, but a lot of times, the focus gets centered on one concern and then may forget what other issues need to be addressed. When it takes a lot to get in to see a physician (time to get the appointment, time off work or arranged to be away from children, etc.) it is important to cover all the bases.

CHECK-UP GUIDELINES:

For men ages 18-39:

• Testicular self exams each month
• Dental checkups (usually 2 per year)
• Blood pressure check , at least once every 2 years (start getting familiar with your values now)
• Baseline cholesterol check and re-check every 5 years
• Baseline physical exams at least every 3-5 years (sometimes annually, but often based on insurance coverage).
• Eye exams every five years but of course yearly if you wear contacts/glasses
• Tetanus-diptheria boosters
• May need to get updates on Measles/mumps/rubella vaccines, chickenpox vaccine

Men ages 40-64:

In addition to above age 18-39 exams:

• American Diabetes Association suggests testing blood glucose at age 45 (sooner if there are many diabetes risk factors such as family history, overweight, sedentary) – check each year
• Age 50 – colorectal screening (series of tests varies based on risk factors)
• Age 50 – PSA testing and digital rectal exams
• Age 50 – yearly flu shot
• Age 55 – baseline hearing exam

Men ages 65 and older:

• All of the above and pneumonia vaccine starting at age 65
• Complete vision/hearing screenings every 1-2 years

Women ages 18-39:

• Monthly breast self-exams
• Dental checkups (2 per year)
• Gynecology issues: Chlamydia exam, pelvic exam, pap test every year
• Breast exam in clinic
• Blood pressure check at least once every 2 years
• Baseline cholesterol check, re-check every 5 years
• Overall physical exams – every 3-5 years (same as men; women sometimes fail to secure a general practitioner or internal medicine doctor and then need one when they get illnesses that a gynecologist/obstetrician cannot address)
• Eye exams every five years but of course yearly if you wear contacts/glasses
• Tetanus-diptheria boosters
• May need to get updates on Measles/mumps/rubella vaccines, chickenpox vaccine

Women ages 40-64:

• In addition to above age 18-39 exams:
• Yearly mammograms begin at age 40, sooner if strong family history
• Age 45 – blood glucose for diabetes (same as above for men – sooner if risk factors for diabetes) – yearly
• Age 50 – flu vaccine every year
• Age 50 – colorectal screening (variety of tests from sigmoidoscopy to colonoscopy)

Women ages 65 and above:

• All of the above plus pneumonia vaccine starting at age 65
• Age 65 – bone mineral density test (sooner if strong family history of osteoporosis or on medications that could increase likelihood)
• Complete vision/hearing screenings every 1-2 years

Sources:
www.healthyupdates.com, referenced CDC, American Cancer Society, AHA, ADA, and American Academy of Ophthalmology, and National Osteoporosis Foundation.