Archive for July, 2011

July 27, 2011

South Carolina: Grasping for Any Way to Prevent Alzheimer’s

Is there a way to prevent Alzheimer’s disease? Last week, a study presented at the Alzheimer’s Association International Conference in Paris suggested there might be, something that would give hope to millions who worry that one day they may be struggling with dementia.

The new study, by researchers at the University of California, San Francisco, estimated how many Alzheimer’s cases might be attributable to certain behaviors or conditions: physical inactivity, smoking, depression, low education, hypertension, obesity and diabetes.

The authors used a mathematical model to surmise that these behaviors and conditions, all of which can be modified, are responsible for about half of the roughly 5.3 million Alzheimer’s cases in the United States and 34 million cases worldwide.

And they calculated that if people addressed these risks — by exercising, quitting smoking, increasing their education or losing weight, for example — a significant number of Alzheimer’s cases could be prevented. Reducing the prevalence of these risk factors by 10 percent, the researchers estimated, could prevent 1.1 million cases worldwide; reducing these risk factors by 25 percent could prevent more than three million cases.

The operative word was “could.” As the researchers pointed out, there is not yet scientific proof that any of these risk factors in fact cause Alzheimer’s. Only if they are shown to do so could the new analysis be considered a practical recipe for preventing the disease.

“These things are not definitive,” said one author, Dr. Kristine Yaffe, a professor of psychiatry, neurology and epidemiology. “We’re assuming that these are sort of causally related to the risk of dementia and Alzheimer’s, but unless you have a great trial, you just don’t know.”

But while experts may have understood that distinction, not everyone else did. Some headlines made things sound more certain: “7 Things You Can Do to Fight Alzheimer’s” or “7 Steps to Prevent Alzheimer’s.”

In an editorial accompanying the study, both published in the journal Lancet Neurology, Dr. Laura Fratiglioni, director of the Aging Research Center at the Karolinska Institute in Sweden, suggested that the report was valuable, but said that the estimates “could be regarded as only theoretical” until more rigorous research is done.

“We have been able to identify some possible preventive factors,” Dr. Fratiglioni said, “but we do not have the final answer because we do not have the experimental studies.”

Indeed, research on prevention of Alzheimer’s is in its infancy. It has only been since the 1980s that dementia has not been considered a symptom of normal aging. And studies on preventing Alzheimer’s can be complicated and costly, especially the randomized controlled trials that provide the strongest evidence. Such trials have to follow people for years, and isolating individual risk factors — separating obesity from hypertension, diabetes, nutrition and physical inactivity, for instance — is challenging.

Last year, a National Institutes of Health panel of experts with no vested interest in Alzheimer’s research concluded that “no evidence of even moderate scientific quality exists to support the association of any modifiable factor (such as nutritional supplements, herbal preparations, dietary factors, prescription or nonprescription drugs, social or economic factors, medical conditions, toxins or environmental exposures) with reduced risk of Alzheimer’s disease.”

Most research, the panel found, involved observational studies, showing that people who did or did not get Alzheimer’s had certain characteristics beforehand, but not whether the characteristics were causal.

The panel found the strongest evidence for only one conclusion: that the herb gingko biloba does not prevent Alzheimer’s. There was moderate evidence that neither vitamin E nor drugs called cholinesterase inhibitors, used to treat dementia symptoms, decrease risk of Alzheimer’s. And there was moderate evidence that the gene ApoE4 significantly increases Alzheimer’s risk, as does menopause therapy with estrogens and progestins.

Evidence for or against any other causal factor was poor, often because studies were small, used vague or changing definitions, or did not rigorously monitor what subjects were doing.

“We debated for hours and hours and hours how to write the report, because certainly we didn’t want it to be the carrier of bad news,” said Dr. Martha Daviglus, the panel’s chairwoman and a preventive medicine expert at Northwestern University. But “we wanted the public to realize that at this point nothing that people can sell to them is proven to work.”

Many members of the Alzheimer’s community were stung, considering the panel’s conclusions a “glass half empty,” said William Thies, the Alzheimer’s Association’s chief medical and scientific officer. “We would agree that we haven’t proven any of these risk factors, but there’s data that are pretty good for some of them. And in a world where we have lots of Alzheimer’s disease and no definitive medical intervention, prevention strategies that are based on lifestyle changes are certainly attractive.”

Dr. Yaffe and her colleague Deborah Barnes excluded risk factors like nutrition or brain exercise because they believed research was not solid enough. They used a more elastic threshold to evaluate research than the N.I.H. panel because, Dr. Yaffe said, the panel “didn’t quite do the field justice.”

Their model weighed the strength of existing research and how widespread the risk factors were. In the United States, they estimated that 1.1 million Alzheimer’s cases, or 21 percent, may be linked to physical inactivity. Fifteen percent may owe to depression, 11 percent to smoking, 8 percent to midlife hypertension, 7 percent to obesity, 7 percent to low education and 3 percent to diabetes.

Their estimates for the risk factors worldwide differed because some behaviors and conditions are more common than in the United States. So low education accounted for 19 percent, or 6.5 million cases, worldwide, while physical inactivity accounted for 13 percent and obesity 2 percent.

Dr. John W. Williams Jr., a professor of medicine at Duke University who led an analysis of Alzheimer’s prevention research for the N.I.H. panel, said studies like Dr. Yaffe’s can be informative “when we don’t have other evidence” and can help shapers of public policy “make decisions about where to invest to reduce risk.”

But he said: “What should individuals do with it? Probably not much.”

Among the limitations, he said, was that some risk factors, like physical inactivity and obesity, “are darn hard to change.”

And does a risk factor like depression cause Alzheimer’s — or is it the other way around?

Still, everyone agrees these risks merit attention for other reasons: preventing cancer or heart disease, improving overall health.

“It’s good if you can do it, but not in the name of Alzheimer’s,” Dr. Daviglus said. “But maybe we will find out that by doing this for other diseases, we are also doing it for Alzheimer’s.”

By PAM BELLUCK

July 18, 2011

South Carolina:Missing Persons and Alzherimer’s

Did you know that there are 2300 people reported missing every day?

Every evening, as I scan the list of missing persons, I am amazed to see how many are senior citizens.

According to TruTV, “Among missing adults, about one-sixth have psychiatric problems. Young men, people with drug or alcohol addictions and elderly citizens suffering from dementia make up other significant subgroups of missing adults.”

Many don’t realize that senior citizens that suffer from dementia will go for a simple walk and become lost.  When they leave, they are feeling fine and know where they are going, but during their walk they will begin to forget what their mission was, they become confused and disoriented.  They loose track of time, and a hour turns into a day.

Some are found, but sadly, many are not found, until it is too late.  Sometimes, It is not until they become lost before anyone realizes that the senior is suffering from Alzheimer’s.

According to the Alzheimer’s Association report, “Generation Alzheimer’s,” it is expected that 10 million baby boomers will either die with or from Alzheimer’s, the only cause of death among the top 10 in America without a way to prevent, cure or even slow its progression.

With more than 10,000 baby boomers a day turning 65, baby boomers will spend their retirement years either with Alzheimer’s or caring for someone with Alzheimer’s.

If you suspect either you or your parent has Alzheimer’s, you might want to try contacting the Alzheimer’s Association as they are the world’s leading voluntary health organization in Alzheimer’s care, support and research, for help.

Written By Jerrie Dean, with the Examiner

July 12, 2011

New Jersey Senior Health: When ‘Take as Directed’ Poses a Challenge

If the label on one bottle of prescription drugs says, “Take one tablet twice daily,” and the label on another says, “Take one tablet every 12 hours,” would you realize that you could take both medications at the same time?

What if one bottle says, “Take with food and water,” but the second doesn’t?

Given that the average adult over age 55 juggles six to eight medications daily, the ability to consolidate pill-popping is no minor matter. “I’m more likely to be able to sustain a medication regimen if I only have to take it three or four times a day,” said Michael Wolf, an associate professor of medicine at Northwestern University who studies drug safety. “Seven or eight times a day is complicated to fit into your daily schedule.”

His sister, who has lupus, sometimes takes up to 16 different drugs, he noted. “Why can’t we standardize prescriptions?’

Why indeed? The idea has been kicked around for years. Nearly three years ago, the Institute of Medicine proposed that pharmaceutical manufacturers adopt a universal dosing schedule that would make it possible for people to take medications at just four times of day: morning, noon, evening and bedtime.

Virtually all drugs could be formulated to fit into this framework, Dr. Wolf said: “It’s ridiculously simple, an incredibly basic idea.”

As it stands now, however, patients must fight their way through a thicket of often conflicting instructions when taking more than one drug. Many studies suggest that most of them don’t do it very well, even when relatively few medications are involved.

Recently Dr. Wolf and his team interviewed 464 adults ages 55 to 74 who were patients at several Chicago medical practices and clinics. The researchers presented each patient with seven typical amber pill bottles with dosing instructions on the labels and a slotted tray marked with times of day. “Show us how you’d take these medications over 24 hours,” the interviewers instructed the patients.

“There was no reason to take these medications more than four times a day,” Dr. Wolf said. In fact, he pointed out, 90 percent of all prescription medications can be taken no more than four times a day.

Yet the patients struggled to consolidate their doses in the experimental tray. About a third didn’t think to take two of the drugs together, even though the instructions on their labels were identical. When one drug was supposed to be taken with food and water and another carried no such instructions, half the study participants didn’t plan to take them at the same time, though they could have.

Two-thirds of the subjects wouldn’t take pills together if one label specified “twice daily” and the other said “every 12 hours,” though those phrases mean the same thing.

“Less than 15 percent succeeded in dosing in the most efficient way,” Dr. Wolf said. Instead, the participants indicated they’d take pills an average of six times a day, with some setting up as many as 14 doses a day.

The more cumbersome and harder to remember a medication schedule becomes, the greater the likelihood that people will misunderstand instructions, skip doses or abandon their drug regimen altogether. “This could be a major risk factor for adherence,” Dr. Wolf said.

The need for more simplified dosing instructions has been demonstrated in several such studies, but change has been slow to come, partly because pharmacists in each state are regulated by a different board of pharmacy. But a bill requiring a universal medication schedule has been introduced in New York State, and a similar measure has already become law in California.

For now, Dr. Wolf advises patients to regularly review the medications they take with a physician and to ask for help in simplifying the dosing. His suggested script: “Help me reduce the number of times I have to take these medications, so that over months and years, it doesn’t become a drag.”

By Paula Span, New York Times

July 5, 2011

South Carolina Senior health: How to detect and prevent malnutrition

Malnutrition is a serious senior health issue. Know the warning signs and how to help an older loved one avoid poor nutrition.

By Mayo Clinic staff

Good nutrition is critical to senior health — yet many older adults are at risk of inadequate nutrition. Know the causes and signs of nutrition problems in older adults, as well as steps you can take to ensure a nutrient-rich diet for an older loved one.

Problems caused by malnutrition

Malnutrition in older adults can lead to various health problems, including:

  • Fatigue
  • Depression
  • Weak immune system, which increases the risk of infections
  • Low red blood cell count (anemia)
  • Muscle weakness, which can lead to falls and fractures
  • Digestive, lung and heart problems
  • Poor skin integrity

Good nutrition is especially important for older adults who are seriously ill and those who have dementia or have lost weight. These older adults are more likely to be admitted to a hospital or long term care facility and are vulnerable to post-surgical complications and other problems linked to poor nutrition.

How malnutrition begins

The causes of malnutrition may seem straightforward: too little food, a diet lacking in nutrients, digestion problems related to getting older. But malnutrition is often caused by a combination of physical, social and psychological issues. For example:

  • Health problems. Older adults often have health problems that can lead to decreased appetite or trouble eating, such as chronic illness, use of certain medications, trouble chewing due to dental issues, problems swallowing or difficulty absorbing nutrients. A recent hospitalization may be accompanied by loss of appetite or other nutrition problems. In other cases, a diminished sense of taste and smell decreases appetite.
  • Limited income and reduced social contact. Some older adults may have trouble affording groceries, especially if they’re taking expensive medications. Those who eat alone may not enjoy meals, causing them to lose interest in cooking and eating.
  • Depression. Grief, loneliness, failing health, lack of mobility and other factors may contribute to depression — causing loss of appetite among older adults.
  • Alcoholism. Alcoholism is a leading contributor to malnutrition — decreasing appetite and vital nutrients and frequently serving as a substitute for meals.
  • Restricted diets. Older adults often have dietary restrictions, including limits on salt, fat, protein and sugar. Although such diets can help manage many medical conditions, they can also be bland and unappealing.

How to spot malnutrition

The signs of malnutrition in older adults may be hard to spot, especially in people who don’t seem at risk. To uncover problems before they become more serious:

  • Observe your loved one’s eating habits. Spend time with an older loved one during meals at home, not just on special occasions. If your loved one lives alone, find out who buys his or her food. If your loved one is in a hospital or long term care facility, visit during mealtimes.
  • Look for physical problems. Red flags for malnutrition might include poor wound healing, easy bruising, dental difficulties and weight loss. Watch for signs of weight loss, such as changes in how clothing fits.
  • Know your loved one’s medications. Many drugs affect appetite, digestion and nutrient absorption.

What you can do about malnutrition

Even small dietary changes can make a big difference in an older person’s health and well-being. For example:

  • Encourage your loved one to eat foods packed with nutrients. Spread peanut or other nut butters on toast and crackers, fresh fruits and raw vegetables. Sprinkle finely chopped nuts or wheat germ on yogurt, fruit and cereal. Add extra egg whites to scrambled eggs and omelets. Add cheese to sandwiches, vegetables, soups, rice and noodles.
  • Restore life to bland food. Make a restricted diet more appealing by using lemon juice, herbs and spices. If loss of taste and smell is a problem, experiment with seasonings and recipes. A dietitian also can help.
  • Plan between-meal snacks. This can be helpful for older adults who get full quickly. A piece of fruit or cheese, a spoonful of peanut butter and even a milkshake can provide nutrients and calories.
  • Make meals social events. Drop by during mealtime or invite your loved one to your home for occasional meals. Encourage your loved one to join programs where he or she can eat with others.
  • Encourage regular physical activity. Daily exercise — even if it’s light — can stimulate appetite and strengthen bones and muscles.
  • Provide food savings tips. If your loved one shops for groceries, encourage him or her to take a shopping list to the grocery store, check store fliers for sales and choose less expensive generic brands. Suggest splitting the cost of bulk goods or meals with a friend or neighbor, or frequenting restaurants that offer senior discounts.
  • Engage doctors. Talk to your loved one’s doctors about changing medications that affect appetite or the need for a restricted diet. Request screenings for nutrition problems during routine office visits. Ask about nutritional supplements, including drinks and pudding. Inform doctors if you notice weight loss or suspect depression. Consult a dentist about oral pain or chewing problems.
  • Consider outside help. If necessary, hire a home health aide to shop for groceries or prepare meals. Also consider Meals On Wheels and other community services, including home visits from registered dietitians.

Remember, identifying and treating nutrition problems early can promote good health, independence and increased longevity. Take steps now to ensure your loved one’s nutrition.