Geriatric Health Related Issues

(Please note: The following health related articles are not intended to replace the sound medical advice that can only be obtained by consulting with your family physician.)

The Spiraling Effects Of Poor Nutrition In The Elderly

It is fairly common to see a hospital admission of a frail older person who has fallen at home, and they are also diagnosed with 'dehydration' and ‘malnutrition’. The electrolytes, like sodium and potassium, may be out of the normal range and their blood glucose level may be too high or too low. This is often due to poor nutrition at home. It can be a spiraling affect when someone stops eating adequate meals and is not drinking enough fluids throughout the day.

This scenario more often occurs when a person lives alone and has no one to look after their well being. They may be too weak to cook a meal or they may be suffering from depression and so they stay in bed too long each day. Their sleep-wake cycle may be off, and they may not be taking their daily medication. Their nutritional intake is often poor for a long period of time before they end up being seen by a health care professional, and then it is usually in the emergency room.

One solution that may be helpful is a daily meal delivered to the home by a local agency, such as "Meals On Wheels". Unfortunately, some seniors are not aware of this service or they may feel they cannot afford it. Sometimes a local religious or senior organization will help pay for this service! There are health shakes, such as Ensure, that can help provide adequate nutrition, including vitamins and protein. They come in various flavors, and may be given daily. If diabetic, always check with the person’s physician before giving supplements. If dementia is suspected, someone should be responsible for checking on them daily to make sure they are eating and drinking sufficiently.

Anti-Cholinergic Medication And The Elderly

The Journal of the American Geriatrics Society recently reported findings from a recent Wake Forest Medical Center research study, which showed that when seniors were prescribed anti-cholinergic medications, it 'adversely affected' their level of independence and self care abilities. Another research study documented that when older nursing home residents took drugs for dementia and anti-cholinergics for incontinence at the same time, they had a 50 percent faster decline in mental abilities than those treated only for dementia.

Many medications have anticholinergic properties including some for high blood pressure, some antidepressants, most allergy medicines and incontinence medicines. Some of the most common anticholinergics in the participants include the blood pressure medication nifedipine (Adalat® or Procardia®), which has mild anticholinergic properties, the stomach antacid ranitidine (Zantac®), which has moderate anticholinergic properties, and the incontinence medication tolterodine (Detrol®), which is highly anticholinergic.

Arthritis Complications and Diabetes

People with diagnosed diabetes are nearly twice as likely to have arthritis, and the inactivity caused by arthritis hinders the successful management of both diseases, according to a new Morbidity and Mortality Weekly Report (MMWR) study released May 8 by the Centers for Disease Control and Prevention (CDC). This is one of the first studies of its kind to look at the relationship between arthritis and diabetes and the outcomes associated with physical activity.

"Arthritis is a frequent co morbid condition for adults with diabetes," said John H. Klippel, M.D., president and CEO, Arthritis Foundation. "But for both diseases, physical activity is key to effective management. A lack of physical activity actually results in undesirable consequences including increased pain, stiffness, inflammation, physical limitation and potential disability." And physical activity is important for helping to keep blood glucose levels under control.

CDC Recommends Shingles Vaccine For People Over 60

The new recommendation was published in the May 15 online edition of the Mortality and Morbidity Weekly Report. "The publication of these guidelines will give an impetus to the use of shingles vaccine," said Dr. William Schaffner, chairman of the Department of Preventive Medicine and a professor in the Division of Infectious Diseases at Vanderbilt University School of Medicine and vice president of the National Foundation for Infectious Diseases.

Schaffner thinks getting vaccinated is very important. "There are about 1 million cases of shingles that occur each year in the United States," he said. "Half of these occur in people aged 60 and older." Moreover, 50 percent of those who live to 85 will have shingles, Schaffner said. "Shingles is very common and ranges from mild to very severe and disabling," he said.

"The vaccine is about two-thirds effective," Schaffner said. "It will prevent about two-thirds of the cases of shingles and its consequent pain syndrome. Like most vaccines, it's not perfect, but it offers the promise of reducing the risk and occurrence of shingles by two-thirds, and that's not bad." One drawback to the vaccine is its cost, which is about $150, Schaffner noted. In addition, the vaccine may not be covered by private insurance. For Medicare patients, it is currently covered under the Part D drug benefit, so its cost will vary by provider.

Some Antibiotics Increase The Risk For Tendonitis In The Elderly

Certain antibiotics, such as Cipro, are shown to produce a higher risk for tendonitis and even tendon tears. "The FDA continues to receive a considerable number of reports of tendon-related adverse events," Edward Cox, director of the agency's antimicrobial products office, told reporters.

The risk is greater in patients ages 60 and older, those who have had certain organ transplants and those using steroid therapy, the agency said. It added that doctors should restrict use of the drugs to conditions clearly caused by bacteria. Patients with tendon pain should immediately stop taking the drug, halt any exercise and call a doctor, the FDA said. The estimated risk of tendon ruptures is about three to four times higher with fluoroquinolones, said Dr. Renata Albrecht, head of the FDA's division of special pathogen and transplant products. Most cases involve the Achilles tendon, which attaches the calf muscle to the heel. Less frequent ruptures affected tendons in the shoulders, biceps, hands and elsewhere.

An Anti-Histamine To Improve Cognition In Alzheimers?

A study that tracked 120 mild to moderate Alzheimer's patients for a year, found that at six months those taking Dimebon three times a day showed significant improvement in mental tests and cognitive functioning, while those placed on the placebo kept deteriorating. A year into the study, the Dimebon group was still improving, while those without the drug were declining rapidly. Dimebon appears to stop and perhaps even reverse the symptoms of the cruel and degenerative disease, according to a new study recently published in the journal Lancet.

Dimebon, an anti-histamine, has been shown to improve patient memory and skills, and to help on daily tasks like using the telephone, shopping and remembering the grocery list. "I was pleasantly surprised to see the effect on cognitive function, on memory, on activities of daily living that not only were clearly significant but seemed to increase over time," said Dr. Sam Gandy, former chairman of the Alzheimer's Association Medical and Scientific Advisory Council. It is estimated that the drug is about 2 years away from FDA approval, pending further studies.