April 2004 When
we talk about aging we know that many people age in very different ways.
In this congregation alone we have the gamete of people who have chronic
diseases in their 70’s to one 97-year-old member who just gave up
her mustang classic stick shift for an automatic car she is still driving.
So aging and the ability to function is really individual.
There are many factors
related to this. Genetics is a big one, and then there is life style and
the ability to change with the times. Many of the people who are functioning
well into their 90’s have been moderate in their life style, making
healthy food choices and exercise much a part of their daily routines.
Also it has been noted that a spiritual connection such as church activities
and other community organizations have contributed to the health of our
aging citizens.
According to Beck
and Chumler in the Journal of Gerontological Nursing, many baby boomers
who have received better medical care and had better work environments
than their predecessors will enter old age healthier than previous generations.
They will also strive for wellness and expect a health care system to
assist them in healthy aging, not just providing care when they become
ill. Many health promotion and disease prevention measures that have been
identified as decreasing mortality and morbidity, are actually lifestyle
changes rather than the direct result of medical care. And the lifestyle
patterns that are recommended need to begin long before a person enters
the geriatric category. So we can consider that being concerned with the
health of older people is to address the issue of healthful and preventive
lifestyles for younger people as well.
So what are these
preventive measures?
PRIMARY PREVENTION:
- Smoking:
within 1-5 years older people can expect a reduction of risk of CAD
(Coronary Artery Disease)
- Alcohol Limitation:
alcohol abuse is estimated anywhere between 5-25% of older persons.
Besides liver disease and esophageal varices it is also implicated in
malnutrition, increased smoking, accidental falls and adverse drug reactions.
- Adequate
Nutrition: This is a big issue with older adults. Although caloric
needs may diminish with decreasing activity levels, protein, vitamins
and minerals are needed for the body to resist or recover from injury
or infection. Adequate fiber and fluid are essential components to prevent
constipation, which contributes to bowel impaction and sometimes obstruction
and can be linked to cancer of the bowel. In general fats should make
up only 30% of the diet, but it important to be willing to compromise
on that measure when an older person is underweight. (EG a heart patient
who is very malnourished and will not eat anything high in cholesterol).
On the other hand if an older person is overweight or obese.. it increases
their risk of diabetes, heart disease, kidney disease, osteoarthritis,
and some forms of cancer. Also the more overweight, the more difficult
it is to exercise which decreases the risk of all these diseases thus
a vicious cycle ensues. A heavier person will have a harder time with
exercising thus will gain more weight because they are not using the
calories they are taking in.
- Immunizations:
Although not a lifestyle measure immunizations are a part of primary
prevention. Pneumonia immunizations are recommended for adults over
65 and are better given at age 55 when the immune system is more effective
than in later years. It lasts for 10 years. Flu vaccine will reduce
the prevalence of flu about 70% with very little risk. Tetanus should
be repeated every 10 years. (not common but can be fatal in older people)
- Exercise:
Start slow and use low impact and progressing gradually with such activities
as walking, swimming and stationary bicycling. Also stretching increases
flexibility and range of motion. Seniors should consult their physician
before starting an exercise program and get help from community activities
that have senior programs like yoga that stress safety. Doing an activity
that is enjoyable will help to sustain it and also doing it with someone
(like a walking partner or a class) will be social as well and keep
the interest in the activity.
SECONDARY PREVENTION
- Cancer screening:
early detection of many types of cancer, leads to dramatically improved
survival rates. Mammogram, pap smears, colonoscopy, prostate screenings
are the routine tests and are paid for by most insurances. Blood tests
for sugar, cholesterol, iron, and thyroid are all easily assessed. Other
newer scans for heart and other organs can detect problems if there
is a risk or a worry that one will develop certain disease. Research
is now being done on recognizing the signs of impending Alzheimer’s,
hoping to arrest it before symptoms occur.
TERTIARY PREVENTION
- Appropriate
medication use: Older adults use more medication and increases
their risks of adverse drug reaction, side effects, influences on their
lifestyle, taste for food, and ability to drive. If possible seniors
should know what it is for and when and how to take it. Review with
them the insert on the medicine label and if the doctor did not make
it clear, ask the pharmacist to answer any questions you may have. Also
a good web site is www.medlineplus.gov.
What to do with a
parent who has a debilitating chronic disease and can no longer live alone?
First of all establish
that fact. There are many people living alone in their 80’s and
90’s who prefer to live alone to maintain independence. Even those
people who have been diagnosed with Alzheimer’s can stay in their
own home provided they are safe.
Organizations
to help with that are:
- Center for the
Healthy Aging
- Wise
- Westside Center
for Independent Living
Meals on Wheels are
a good solution for a senior who is unable or unwilling to cook. If affordable,
help with housework, shopping and laundry a few times a week may be all
they need. Many of our seniors are in rent control apartments and cannot
afford help. If that is the case there are case worker available through
Wise and other case worker organizations who will go out to the house
and make a needs assessment and secure low cost help and or free services
from agencies like WCIL (assistive technology).
If and when it is
no longer an option for your parent to live alone then the choice of either
having them come to live with you another family member, or an assisted
living or nursing home has to be explored. There are many considerations
to be made when choosing these options. They are listed in the brochure
(Senior resource book).
Memory Loss?
What does this mean? If mom forgets to serve the apple pie she baked,
that’s forgetfulness. If she forgets she already baked the pie she
may have a serious problem. Forgetting where one puts one’s keys
is normal but patterns of forgetting where keys or other things are kept
are to be looked at as abnormal. Usually when there is some dementia present
it is apparent if you live with that person. If a person lives alone they
can learn to hide some of the symptoms so that when you visit it is not
apparent. If you suspect there is some decline in functioning I would
advise you to check closely how she or he is functioning in relation to
cleanliness, food habits, organization of daily activities and finances.
Often times a crisis promotes action such as getting lost in familiar
routes, loss of caring about appearances, or financial confusion. However
some of these can be gradual and not noticed until the problem is at crisis
levels.
Dementia can be present
as Alzheimer’s or other forms of dementia such as strokes, infections,
medications, brain injuries and hormone imbalance. Some of these are reversible,
such as medications and hormone imbalance and once a correction is made
the symptoms subside.
Difficult behavior
of older people can be a result of dementia. Many people are upset when
a parent or other older adult who was vibrant and sharp at one time, now
is forgetful, and unable to track …which can be very frustrating
to one living with that person. For example if that person is diagnosed
then there are things that can be done such as medications and establishing
routines.
When routine is upset,
they may get resistant or fearful. They may not want to be out in crowds.
If they are prone to anger it is usually directed at the spouse if still
living or the children (you). They resist help and try to hold on to what
little independence they have left. Many times they behave much better
with a stranger or someone they don’t know because they are not
comfortable to resist as they are with a family member.
Early diagnosis is
important. Medications can slow the progression of disease, arrangements
can be made to enhance life style and prevent unsafe situations.
What can we do?
Tips for enhancing communication:
- Keep them involved
(regular scheduled outings, church activities)
- Reassign household
chores: You may reassign the banking duties to yourself or some one
else and have them focus on gardening if that is something they like.
- Talk to others
who are going through this to get ideas what works for them
- Give yourself
a break (respite care)
- Keep some of your
favorite hobbies (you may have to give up some activities)
Housing Options:
- Live alone (best
idea for most) - resources listed above
- Live with children
- refer to above
- Assisted living
- Nursing homes
- Alzheimer’s
homes
For more information
on referrals for housing options, call Mary
Jo Dalton in the church office.
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