Monday, August 7, 2017

The Obesity ~ Heart Disease ~ Early Morbidity Triad



Hi Readers,  as I shared in my previous blog posting, 90% of older adults DO NOT have Alzheimer’s Disease [AD], yet AD gets enormous media attention and older adults are overly concerned about it, sometimes ignoring other more pressing health matters.  The CDC (2016) has identified the leading causes of death in older adults in this order, indicating that heart disease and cancer are by far more prevalent than AD:

“Heart disease 507,138k

Malignant neoplasms [Cancer] 419.389k

Chronic lower respiratory diseases 131,804k

Cerebrovascular diseases 120,156k

Alzheimer’s disease 109,495k” (CDC, 2016, p. 133)

 

Hidden within these statistics is the issue of overweight and obesity among older adults.  Among adults, BMI of 18.5-24.9 is normal, 25-29.9 is overweight, and 30+ is obese (CDC, 2016). Obesity is defined as, “an unhealthy excess of body fat, which increases the risk of medical illness and premature mortality” (Amarya, Singh, & Sabharwal, 2014, p. 63).  According to the CDC (2016), there are three subcategories of obesity, as shown below:

·        “Class 1: BMI of 30 to 34.9

·        Class 2: BMI of 35 to 39.9

·        Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity” (para. 4).

While there have been some recent studies linking overweight and longer life among older adults, those findings are disputed.  What we DO know and agree on is that OBESITY among older adults may lead to declining health status, increased health care spending, chronic morbidities [hypertension and stroke, Type 2 diabetes, metabolic syndrome, arthritis, urinary incontinence, and cancer], leading to loss of mobility, dependence, institutionalization, and early death (Amarya et al., p. 63). About 35% of older adults are obese, making this a major health crisis far more prevalent than Alzheimer’s Disease.  Sadly, many of my clients who have sought advice on preventing and delaying Alzheimer’s Disease have been obese.  In counseling older clients, practitioners must sometimes tell them what they do not want to hear, that obesity is the problem and not Alzheimer’s Disease. 

A former client, age 75, laughed at me when at the end of our talk about retaining independence and healthy aging,  I spoke to her about obesity, as “Helen” was at least 100 pounds overweight [Class 3 Obesity BMI] and sedentary.  “I am the healthiest fat person you have ever known” was her response, and then she told me about participating in water aerobics three times per week.  I reminded Helen that she had recurring congestive heart failure, hypertension, and arthritis, and that she was at risk of having a major health event and loss of independence if she did not take steps to lose weight and make some lifestyle changes.  Because Helen was trying to decide on moving to assisted living or remain at home, I recommended finding a suitable assisted living soon and prepare her house for sale as proactive strategies.  Helen disagreed with my assessments and huffed out of the office.   

 

Sadly, Helen’s son phoned me about six months later and told me that his mother had a massive stroke and could not speak, suffered short-term memory loss, and she was moved to an assisted living facility with 24/7 supervision on the West Coast near her children.   He and his four siblings were disposing of her home and personal belongings, as the prognosis was bleak.  A year later, “Roger” phoned to tell me that Helen’s health status had declined and she died in a nursing home.    

 

Although I could not convince Helen to change her habits toward a healthier lifestyle, and she got angry with me, I did everything I could as a gerontologist to give her professional and honest advice toward maintaining her independence and optimum aging.  This is an example of always telling clients the truth, although it may not be accepted. 

 

References:

Amarya, S., Singh, K., & Sabharwal, M. (2014).  Health consequences of obesity in the elderly.  Journal of Clinical Gerontology and Geriatrics, 5(3), 63-67. doi:10.1016/j.jcgg.2014.01.004 

CDC (2016). Defining adult overweight and obesity.  Retrieved from https://www.cdc.gov/obesity/adult/defining.html 

CDC, National Center for Health Statistics [NCHS], (2015).  Prevalence of obesity among older adults in the United States, 2007-2010.  Retrieved from https://www.cdc.gov/nchs/products/databriefs/db106.htm 

 
CDC, National Center for Health Statistics.  Health, United States, 2016: With Chartbook on long-term trends in health.  Hyattsville, MD 2017 https://www.cdc.gov/nchs/data/hus/hus16.pdf#020

 

 

 

 
 

Alzheimer's Prevalence ~ Stay Away, Chicken Little


The United States Census (2017) indicates our population is 323,127,513. Of that, 15.2% are older adults, which means there are approximately 47m Americans age 65 and over. 

Of that 47m,  5.1m  or approximately 11% have been diagnosed with AD (Alzheimer’s Foundation of America, 2017). Of that 5.1m, 5% or 255k have been misdiagnosed with Normal Pressure Hydrocephalus (National Hydrocephalus Foundation, 2014), a treatable and reversible condition that has symptoms similar to AD including dementia, gait changes, balance difficulties, and urinary incontinence.   This means that about 90% of older adults do NOT have AD.   

Further, the CDC (2016) has identified the leading causes of death in older adults in this order, indicating that heart disease and cancer are by far more prevalent than AD.  Any headline with "Alzheimer's" gets attention and yet, these are scare tactics and sensationalism.  Almost FIVE TIMES more older adults die every year from heart disease, yet "Heart Disease" in a headline gets few readers.  Please do not adopt the "Chicken Little" approach to Alzheimer's.  Here are the FACTS.  Leading causes of death in 2016 were:

“Heart disease 507,138k

Malignant neoplasms [Cancer] 419.389k

Chronic lower respiratory diseases 131,804k

Cerebrovascular diseases 120,156k

Alzheimer’s disease 109,495k” (CDC, 2016, p. 133).




References:
Amarya, S., Singh, K., & Sabharwal, M. (2014).  Health consequences of obesity in the elderly.  Journal of Clinical Gerontology and Geriatrics, 5(3), 63-67. doi:10.1016/j.jcgg.2014.01.004
 
 
CDC (2016). Defining adult overweight and obesity.  Retrieved from https://www.cdc.gov/obesity/adult/defining.html 
 
CDC, National Center for Health Statistics [NCHS], (2015).  Prevalence of obesity among older adults in the United States, 2007-2010.  Retrieved from https://www.cdc.gov/nchs/products/databriefs/db106.htm


National Hydrocephalus Foundation (2014).  Normal pressure hydrocephalus.  Retrieved fromhttp://nhfonline.org/normal-pressure-hydrocephalus.htm
 

U.S. Census Bureau (2017).  Population estimates, July 1, 2016, (V2016). Retrieved fromhttps://www.census.gov/quickfacts/fact/table/US/PST045216
 

 

Friday, June 30, 2017

Alcohol Consumption ~ Good or Bad for Aging?


On 7 June 2017, USA Today featured on page one the headline, “Even moderate drinking is bad for the brain.”  On 23 June, The Week magazine had an article in the section, “Health Scare of the Week,” titled, “Drinking Speeds Mental Decline.”  Both headlines were not truthful, although the content within the articles was accurate, as I found when I accessed the actual journal article.  As my readers know, I dislike newspapers practicing this tactic, as it sensationalizes and cheapens the story. 

First, what is “moderate drinking?”  It depends on where you live, as the guidelines vary by country and the UK recommends lower amount for women than in the USA (IARD, 2017). In the USA, both the NIH (n.d.)  and CDC (2016)  define moderate drinking it as one drink per day for women/two per day for men. Portion sizes are 5 oz. Wine, 1.5 oz distilled liquor, or 12 oz regular beer [not malt liquor].

Both articles featured a recent study published in the British Medical Journal [BMJ] regarding alcohol and older adults.  Anya Topiwals, who was the primary investigator, wanted to know if moderate alcohol consumption was beneficial to brain health or detrimental.  They examined 30 years of records of 527 British civil servants starting at age 43.  The moderate drinkers, defined as consuming 8-12 glasses of wine, beer, or liquor weekly, showed brain structure changes in their MRIs.  Topiwala et al. (2017) found that higher alcohol use was associated with reduced gray matter density, hippocampal atrophy, and reduced white matter microstructural integrity.  The researchers found that drinking alcohol, even in small amounts, may not be beneficial to good brain health as reported in previous studies.   The study was an observational design, and therefore, no cause/effect can be proven.  So the claim cannot be made that moderate drinking destroys the brain.  There were many other confounding variables that could explain the brain shrinkage beyond alcohol consumption.  The researchers recommended that people NOT take up drinking for healthy aging.  They also cautioned that other factors unrelated to alcohol may explain the brain changes.

Conversely, some studies have shown a positive connection between light and moderate alcohol consumption and healthy aging.  In 2014, scientists from the Department of Neuroscience at Uppsala University in Sweden, led by primary investigator P. S. Hogenkamp, examined whether alcohol intake at age 70 is linked to cognitive [brain] functioning.  The participants were 652 men who were assessed at age 70 and 77 and tested to see if drinking impacted performance on assessments of executive functioning.  They found that moderate drinking among the older Swedish men did impact cognitive performance on the brain performance assessments:  They performed better than the abstainers and the heavy drinkers!  They also cautioned that although these findings do not show cause and effect,  Hogenkamp et al. (2013) do not support the view that people should consume moderate amounts of alcohol to slow cognitive decline because other factors may explain their findings. 

Another study conducted in 2017 found light alcohol consumption may be beneficial for heart health.  In a recent research study carried out in Sweden, scientists Susanna C. Larsson, Alice Wallin, and Alicia Wolk wanted to review the scholarly literature to determine if there is an association between alcohol consumption and risk of heart failure.  They carefully analyzed previous scientific studies to learn more about the impact of alcohol on aging.  Larsson et al. (2017)  reviewed 13 different studies that included almost 14,000 cases and 356,000 participants, one of the most comprehensive meta-analysis on the topic to date.  After analyzing the literature and findings, Larsson et al. (2017) determined that light alcohol drinking [up to one drink per day] was associated with a lower risk of heart failure.  The Larsson et al. (2017) has a high rate of validity due to the large volume of previous research evaluated by the team. 

Is light or moderate drinking acceptable for optimum aging?  Should it be avoided altogether, or are there benefits and protective factors?  The experts cannot decide.

References:


Hogenkamp, P. S., Benedict, C., Sjögren, P., Kilander, L., Lind, L., & Schiöth, H. B. (2014). Late-life alcohol consumption and cognitive function in elderly men. Age (Dordrecht, Netherlands), 36(1), 243-249. doi:10.1007/s11357-013-9538-7

International Alliance for Responsible Drinking [IARD], (2017). Drinking Guidelines: General Population.  http://www.iard.org/policy-tables/drinking-guidelines-general-population/

International Alliance for Responsible Drinking [IARD], (2017). National Drinking Guidelines. http://www.iard.org/wp-content/uploads/2016/04/Policy-Review-National-Drinking-Guidelines.pdf

Larsson, S. C., Wallin, A., & Wolk, A. (2017). Alcohol consumption and risk of heart failure: Meta-analysis of 13 prospective studies. Clinical Nutrition (Edinburgh, Scotland), doi:10.1016/j.clnu.2017.05.007

NIH Drinking Levels Defined (n.d.) Appendix 9. Alcohol.    https://www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking

Topiwala, A., Allan, C.L., Valkanova, V., Zsoldos, E., Filippini, N., Sexton, C., Mahmood, A., Fooks, P., Singh-Manoux, A., Mackay, C.E., Kivimaki, M., & Ebmeier, K.P. (2017).  Moderate alcohol consumption as risk factor for adverse brain outcomes and cognitive decline: longitudinal cohort study. BMJ 2017357 doi: https://doi.org/10.1136/bmj.j2353 (Published 06 June 2017)Cite this as: BMJ 2017;357:j2353

 

 

 





 

 


 



 

Saturday, June 17, 2017

Brain Games ~ The Facts


Hi Readers,

Puzzles and games do not make people smarter, maintain cognitive functioning, or prevent Alzheimer’s Disease.  It is a myth perpetuated by companies trying to sell false hope and make money prying on vulnerable people.  Research trumps scare tactics.  See the facts below.  AgeDoc

 

Story Source:

Materials provided by Florida State University. Original written by Dave Heller. Note: Content may be edited for style and length.

 

Think brain games make you smarter? Think again, researchers say

New study finds no evidence games increase overall cognitive abilities

 

Date:            April 17, 2017
 

Source:         Florida State University

 

Summary:     Brain games marketed by the billion-dollar brain-training industry don't improve cognition or help prevent age-related brain decline, new research finds.

Be skeptical of ads declaring you can rev up your brain's performance by challenging it with products from the growing brain-training industry.

Science does not support many of the claims.

That's according to a new study published in the science journal Frontiers in Aging Neuroscience from a team of Florida State University researchers.

Neil Charness, professor of psychology and a leading authority on aging and cognition, teamed up with Wally Boot, associate professor of psychology, and graduate student Dustin Souders to test the theory that brain games help preserve cognitive function.

"Our findings and previous studies confirm there's very little evidence these types of games can improve your life in a meaningful way," said Boot, an expert on age-related cognitive decline.

Charness, who's also the director of FSU's Institute for Successful Longevity, said an increasing number of people believe brain training helps protect them against memory loss or cognitive disorders.

"Brain challenges like crossword games are a popular approach, especially among baby boomers, as a way to try to protect cognition," Charness said.

That popularity has turned the brain-training industry into a billion-dollar business. Brain games are available online and through mobile apps that typically sell for about $15 a month or $300 for lifetime memberships. But advertising for this rapidly growing business sector has sometimes used inflated claims. The Federal Trade Commission fined one brain-training company $50 million for false advertising, which was later lowered to $2 million.

"More companies are beginning to be fined for these types of inflated claims and that's a good thing," Boot said. "These exaggerated claims are not consistent with the conclusions of our latest study."

The FSU team's study focused on whether brain games could boost the "working memory" needed for a variety of tasks. In their study, they set up one group of people to play a specially designed brain-training video game called "Mind Frontiers," while another group of players performed crossword games or number puzzles.

All players were given lots of information they needed to juggle to solve problems. Researchers tested whether the games enhanced players' working memory and consequently improved other mental abilities, such as reasoning, memory and processing speed.

That's the theory behind many brain games: If you improve overall working memory, which is fundamental to so much of what we do every day, then you can enhance performance in many areas of your life.

The team examined whether improving working memory would translate to better performance on other tasks or as the researchers called it: "far transfer."

In short, no.

"It's possible to train people to become very good at tasks that you would normally consider general working memory tasks: memorizing 70, 80, even 100 digits," Charness said. "But these skills tend to be very specific and not show a lot of transfer. The thing that seniors in particular should be concerned about is, if I can get very good at crossword puzzles, is that going to help me remember where my keys are? And the answer is probably no."

Charness has spent much of his career the past 45 years trying to wrap his brain around the way the mind functions and how it ages. With the senior population continuing to grow -- 45 million Americans are 65 or older -- Charness understands their concerns about preserving brain function and remaining independent.

"People have real concerns about loss of cognition and loss of memory as they age, so they do all kinds of things to try to stave off cognitive decline," Charness said.

Charness noted that other research finds aerobic exercise, rather than mental exercise, is great for your brain. Physical exercise can actually cause beneficial structural changes in the brain and boost its function. He predicts "exer-gaming," which combines exercise with brain games, will increase in popularity in the 21st century.

"I wouldn't come away from our article totally discouraged," Charness said. "It's another piece of the puzzle that we're all trying to assemble. It's discouraging in the sense that we can't find far transfer and that seems to be a fairly consistent finding in research. But if your real goal is to improve cognitive function and brain games are not helping, then maybe you are better off getting aerobic exercise rather than sitting in front of the computer playing these games."

Reference:

Florida State University. (2017, April 17). Think brain games make you smarter? Think again, researchers say: New study finds no evidence games increase overall cognitive abilities. ScienceDaily. Retrieved June 17, 2017 from www.sciencedaily.com/releases/2017/04/170417095528.htm

 

 

Thursday, June 15, 2017

June 15 World Elder Abuse Awareness Day


World Elder Abuse Awareness Day
June 15

Today represents the one day of the year when the whole world voices its opposition to the abuse and suffering of older adults.

Elder abuse is a global social issue which affects the health and human rights of millions of older persons around the world, and an issue which deserves the attention of the international community.

Facts About Elder Abuse From The World Health Organization

· 1 in 6 older adults worldwide have been abused in the past year.

· As many as 2 out of 3 people with dementia have been abused.

· Victims of elder abuse were twice as likely to die compared to older people who did not report abuse.

· The United States spends $5.3 billion each year in medical costs from violent injuries to older people.

 
Click here to view the complete Elder Abuse pamphlet from the World Health Organization:

 

Tuesday, June 6, 2017

Caregiving Resource ~ Dr. Warren Hebert



Hi readers, today I had the pleasure of meeting caregiving expert Dr. Warren Hebert.  Hebert, who is an assistant professor in the School of Nursing at Loyola University New Orleans, is a compassionate and knowledgeable authority on caregiving.  From our conversation, I was impressed with his passion and understanding of the challenges faced by caregivers.  We also discussed caregiving attitudes and expectations cross-culturally and how caregiving is approached in various global cultures and within ethnic groups in America.  We also talked about caregiver burnout and exhaustion.  Of course, we also examined the benefits, advantages, and joys of caring for loved ones. 
With a focus on general audiences, Dr. Hebert's radio program is a must for caregivers, scholars, clergy, counselors, and anyone interested in how families care for loved ones when they need help.  Below is the link to his radio show at Radio Maria.  It is live every Wednesday from 4-5 pm Central Time.  Not available at that time?  No problem.  By clicking this link, achieves of past shows are also available. I believe anyone interested in caregiving will benefit from Dr. Hebert’s pearls of wisdom.  I hope you find this resource valuable!  AgeDoc


Thursday, January 5, 2017

Updated BEERS List

Hi readers, a serious issue is overmedication of older adults and/or taking medications that cannot be adequately metabolized by the older body.  Never assume that medical professionals know appropriate dosage or if the prescribed medication is appropriate for you.  Be proactive and ASK, “Is this aligned with the Beers list?”  Some medications on this list are over-the-counter medications, so pay attention to what you take and how much.  Below is a blurb about the Beers list and I have also attached the link for the updated list here.  http://www.americangeriatrics.org/files/documents/beers/BeersCriteriaPublicTranslation.pdf

What is the Beers List and Why Do I Need it?
“For more than 20 years, the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults has been the leading source of information about the safety of prescribing drugs for older people. To help prevent medication side effects and other drug-related problems in older adults, the American Geriatrics Society (AGS) has updated and expanded this important resource. The expanded AGS Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults identifies medications with risks that may be greater than their benefits for people 65 and older. “
Why Experts Developed the Beers Criteria

“As you get older, your body changes. These changes can increase the chances that you’ll have side effects when you take medications. Older people usually have more health problems and take more medications than younger people. Because of this, they are also more likely to experience dangerous drug-drug interactions. Every year, one in three adults 65 or older has one or more adverse (harmful) reactions to a medication or medications. This is why it’s important for researchers to identify and help reduce use of drugs that are associated with more risks than benefits in older people. The Beers Criteria was last updated in 2003. The criteria need to be updated regularly because new drugs continue to be marketed and new studies continue to provide information on the safety of existing medications. In 2011, the criteria was updated by the American Geriatrics Society using a panel of healthcare and pharmacy experts. The AGS will continue to update the criteria on a regular basis.”

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