Have You Heard About...? -- Archived Articles
Seniors and Antidepressant Medications
Seniors are often reluctant to seek help for a mental health problem. Many elements can contribute to this reluctance. Seniors often feel they should not complain, should persevere or “be stronger” in order to overcome difficulties. These attitudes can serve folks well in some situations in life, but can result in a delay receiving help for a mental health problem.
If your loved one has taken the step of talking to his or her doctor about a mental health issue, that is a great accomplishment. If the diagnosis is depression, the doctor may recommend a course of action aimed at treating the illness to restore a sense of well being. Antidepressant medications are often recommended to treat depression. Many seniors misunderstand antidepressant medications and their role in the treatment of depression. In general, these drugs work on the brain to restore balance to the brain chemistry resulting in the alleviation of symptoms. These drugs are not “happy pills” or stimulants, a common misconception. They do not result in a feeling of being “high”. When effective, these drugs can restore a sense of wellness. Doctors have many drugs available to treat depression. Modern antidepressant medications are not addicting and have fewer side effects than older drugs.
Finding the exact drug, or combination of drugs, that provides relief can be a process. Patience is the key; it can take time to sense if drugs are working. Sometimes the doctor needs to try several different drugs to arrive at the correct “recipe” that will provide the benefit needed with minimal side effects. Seniors and their families should work closely with the doctor to find the right approach and make sure the doctor is aware of any side effects that have been observed.
Effective treatment of depression can enable folks to re-engage and enjoy the richness of life.
All Problems With Memory Are Not Alzheimer’s
Older folks who have problems with memory are at risk of being labeled with Alzheimer’s disease without a thorough understanding of all the dementias. Dementia is a general term referring to a slow, progressive decline in mental abilities that interfere with daily life. This can include forgetfulness, confusion and impaired memory. Sometimes there are changes in behavior and personality. There are many illnesses and conditions that can cause symptoms easily confused with Alzheimer’s disease. Heart disease, diabetes, liver and kidney diseases, brain tumors, severe brain injury, and substance abuse are a few possibilities among many. It’s very important to have symptoms of concern evaluated by a qualified medical professional with experience in diagnosing brain disorders. There may be approaches to help treat the underlying condition and/or treat the symptoms directly. Until there is a clear picture don’t assume a memory problem is Alzheimer’s disease.
There are resources available to help you. An excellent place to start is your local Alzheimer’s Association. You can request written educational material, attend educational presentations or speak to an information specialist.
Cancer Research Directions: It’s an Exciting World Out There
- New therapies are being developed that will provide more precise matching between patients and appropriate treatment.
- Scientists are looking for new “markers” circulating in the body that indicate the presence of cancer. This could help with earlier diagnosis. Generally, the earlier cancer is diagnosed and treated the better the outcome.
- New agents are being tested for some cancers that are less debilitating than previous drugs without sacrificing effectiveness.
- Novel ways to combine and administer multiple drugs to treat some types of cancer.
- Therapies aimed at stopping cancer cells from dividing without injuring normal cells.
- Drug research aimed at trying to “starve” cancer cells by cutting off the supply of nutrients cancer needs to grow.
- Identify how our immune systems can be used to recognize cancer cells that are present and target them for destruction.
- Development of new imaging approaches that allow doctors to see the cancer when it is very, very small.
Some of this research has been put into testing phases in animal or human studies and trials; some of the research is still in the exploration stage.
Researchers lead the way in looking to further our understanding of cancer, identify cancers at an early stage, provide effective treatment and allow patients
to continue with their lives. You can explore the cancer research horizons at The National Cancer Institute. This site also provides general information about cancer, cancer treatment,
and Clinical Trials.
Medication Errors
Medication errors can lead to confusion, medication misuse and potential harm. The Food and Drug Administration is making an effort to address this problem through educating health care providers, recording and monitoring medication errors for trends, and working with the drug industry to improve labeling. Health care providers are advised about commonly confused drugs (is it Zantac or Zyrtec?, Serzone or Seroquel? ), inconsistent abbreviations, and poor hand writing. While the FDA works with health care providers, consumers can play a significant role in reducing errors.
- How many bottles of medication are in your cabinet?
- How many doctors do you see?
- How many pharmacies do you use?
- Have you ever looked for an expiration date?
- Do you use vitamins or supplements?
Suggestions for consumers to help reduce errors and drug interactions include:
- At least YEARLY, gather your medications in a bag and bring the bag to your doctor on a visit. Do you still need all these drugs? Have many doctors prescribed medication? Does any ONE doctor know ALL your drug treatments? Review everything!
- If you take Over-the-Counter drugs make sure your doctor knows, some OTCs and supplements can interact with prescription medications.
- Carry a list with you: drug name, purpose, dosage, frequency.
- If you get a new prescription from your doctor, make sure you understand why and how it should be used. Ask questions.
- If a doctor writes a new prescription: request that the drug name and purpose be included on the label. Have you ever forgotten what that red pill was for??
- Consider using one pharmacy for all your prescriptions. Many pharmacies use a system that will produce an alert if there are potential interactions between drugs you are prescribed. Many folks use multiple pharmacies to save money; this can defeat the alert systems if the pharmacy does not know all your drugs.
- Is the print on your prescription bottle big enough to read? If not, ask your pharmacist if there is an option to help you. Some pharmacies dispense drugs with different color caps for different people in the family, this can help avoid “his and hers” mistakes when you take someone else’s medication by mistake.
- Pharmacists are great resources for drug information, get to know yours.
Do your part to protect your health, reduce errors and the serious health risks associated with medication errors.
Breaking Free: My Life with Dissociative Identity Disorder, by Herschel Walker and Dr. Jerry Mungadze
Book Review by Kathryn McCormack-Chen, LCSW
As a trauma psychotherapist, I read this book with great interest. When a well respected celebrity describes his experience with a medical or mental health condition it can present an opportunity for others to learn about the condition described. Public awareness can increase, stigma can be reduced and hope can be provided for others who share the same condition.
The diagnostic criteria for Dissociative Identity Disorder, as described in The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorder, 4th edition, are as follows:
- the presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
- at least two of these identities or personality states recurrently take control of the person’s behavior.
- inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
- the disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (e.g., complex partial seizures).
I read and I read and I read some more, looking for the real diagnostic evidence that Mr. Walker’s described condition meets the above diagnostic criteria. I could only find one reference to any symptom that was perhaps related to any form of dissociative disorder. Mr. Walker stated that he would drive home from college on occasion and not remember the trip. In psychiatric terms this could be called dissociative amnesia, but the essential component that is missing, is that it did not cause him significant distress. Mr. Walker described the excessive bullying that he received as a child as well as being subjected to racist events in which mock hangings took place, both of which are certainly situations in which a child could be traumatized. He said that he grew up in a very close and loving family, but felt that his family’s way of handling things was to not talk about problems. So he did the best he could to manage by himself. I mention this about his family because in many cases family members will ignore or discourage a child’s expression of any kind of distress, but I suspect that his family would have comforted him. This is important because it is often the case with children who experience traumas that they do not feel support at home. So when Mr. Walker was able to go on in life and achieve great things, this overall environment of love and support contributed greatly to his ability to be successful. Put another way, we could say that the “good” in his life outweighed the “bad.”
Mr. Walker states that he believed he had “alters” (the name for these different personalities mentioned in the diagnostic criteria above). When he described the alters he had they never did take over his thoughts and behaviors to the point of severe distress. I believe that these “alters” were actually errors in thinking, the survival mechanisms used by trauma survivors often referred to as “codependent’” characteristics. In times of stress the person’s thinking patterns become more focused on outside influences than on one’s own internal judgment. The fact that Mr. Walker was always aware of these times when the proposed alters took over provides the ultimate contradiction for a diagnosis of dissociative identity disorder.
Finally, a word of caution to those who read a book about a famous person’s illness: do your research and check it out with knowledgeable professionals before you decide that you have the same disorder.
Kathryn McCormack-Chen, LCSW
What are the benefits that occur when a person stops smoking cigarettes?
I was recently reading the September 2008 edition of the AARP Bulletin and came across an article written by former Surgeon General Dr. C. Everett Koop. This article highlighted some meaningful statistics relating to smoking cessation.
Dr. Koop contends that it is “never too late to stop smoking” because the body begins to immediately heal some of the damage done by long-term tobacco use.
First of all, did you know that nicotine is more addictive than cocaine and heroin? Think about that if you have been trying to stop smoking without success. An old adage in addiction treatment that uninformed people often quote is “just say no to cigarettes.” Those of us who have worked in addiction treatment centers know that just saying no to any mood-altering chemical is not the answer. Nicotine addiction, like any other, has biological, psychological, and social components. Any kind of treatment aimed at smoking cessation needs to incorporate all of these components to enhance recovery rates. Another component of addiction treatment is what I call “deluge the clients with data.” This is important to help the person understand that any entity that meets the criteria for addiction has several components in common: addiction is a primary condition; it has a predictable course, and causes major harm to vital organs in the body. Sometimes just having more information helps the client to realize that nicotine does not calm her down; it just raises the level of nicotine in the blood so the craving for nicotine is temporarily lowered.
So today the data I want to deluge you with some positive statistics that Dr. Koop quoted about smoking cessation:
- After quitting your heart rate drops after 20 minutes.
- Carbon monoxide levels normalize after 12 hours.
- Heart attack risk drops, and lungs begin to reheal during the following 2 weeks to twelve months.
- Shortness of breath noticeably improves in one to nine months.
- Stroke risk equals non-smoker’s within five years.
There are several approaches available for people who are thinking about smoking cessation. There are over the counter products and/or prescription medications to curb nicotine cravings*, on-line support groups, hypnotism, and cognitive-behavioral therapy. But you must always consider the chances of medication interactions and the possibility of side effects that can occur when taking any new medications.…. Always check with your physician before trying any of these products.
(*Even using one of these products instead of cigarettes will eliminate your body’s exposure to tar, the reported cancer-causing agent in cigarettes).
A New Tool for Narcotic Dependence
The FDA has approved two new drugs which can be used to manage narcotic withdrawal. Narcotic drugs are also called opiates. There are many types of narcotic drugs, examples include heroin, morphine, Percoset, Vicodin, and oxycodone. The new drugs used in narcotic detoxification are called buprenorphine and buprenorphine/naloxone (brand names Subutex and Suboxone). These drugs can now be used by selected treatment programs and individual physicians to manage narcotic withdrawal. Traditional narcotic detoxification has used methadone, in a tapered dose, to help alleviate withdrawal symptoms over a short period of time until the addict is clean. Only specially licensed facilities could dispense methadone for this use. However, the stigma associated with narcotic addiction prevented some folks from availing themselves of programs offering narcotic detoxification and treatment.
The approval of these two new drugs was accompanied by new regulations that allow private physicians to treat withdrawal symptoms that accompany narcotic detoxification. Specially licensed private doctors can use these two new drugs in their office settings. The hope is the more comfortable and private setting of a doctor’s office will provide greater opportunities for addicts to get help. These new drugs are not for everyone, only your physician can determine if this is the right approach for you.
As with choosing any doctor, you should check the credentials, training, certifications and professional expertise before you decide on a particular physician.
Keep in mind that the introduction of these drugs does not replace the need for counseling services. Counseling approaches can assist addicts in repairing the damage to their lives caused by the narcotic addiction and prevent relapse. Physicians are required to provide information to their Suboxone patients about these supportive services and programs.
If you have decided to take the first step and want to contact a private doctor about narcotic detoxification, remember, the detoxification process is only the first step in getting well. The medication is not a short cut or a miracle end to dependence. Give yourself the best chance of recovering from narcotic addiction by using additional counseling services that are available to you.
We are familiar with many doctors in the area and we can help you select a qualified private physician to provide your narcotic detoxification services. If you are already in contact with a doctor, we can also assist you and your doctor in finding the best match of counseling services to meet your individual circumstances and needs. We have extensive knowledge of available treatment resources in the local area and we link with both nationally known and internationally known treatment programs. Your contact with us will be kept confidential
There is a lot of medical information on the web but, is it accurate?
Many people use the web as a resource for medical information. Have you noticed that some “health” sites look more like infomercials; they’re only missing the familiar face and voice from late night television…
National Institutes of Health has excellent suggestions for finding accurate medical information online. Before you rely on what you see, please consider the following questions.
- Who sponsors and pays for the site? This information should be readily available so you can judge the information accordingly.
- What is the purpose of the site? Is it informational or are they selling something?
- Where does the information come from? Does the site specify sources and provide citations? Are the contributors qualified in the field? Are recognized medical authorities and/or journals referenced?
- How is the information on the site selected? Is there an editorial board? Is the material reviewed by qualified scientists?
- Is the content current? This is especially important if you are looking for treatment options for some illnesses. Medicine can change fast, what was once considered the “standard of care” can change as a result of new research.
- Are there links to other sites? Are links simply driven by paid advertising or do the other sites have to meet certain criteria?
- Does the site collect any information about YOU, the visitor? There should be clearly written privacy policies for you to review describing what data, if any, is collected about you and how it will be used.
- Is the information presented in a way you can understand? Maybe the latest information from a clinical journal is too complex, perhaps a site oriented to the layman would be a better choice.
Consider asking your doctor for suggestions for web sites with accurate information. An often overlooked source of information is your local public library’s web portal. Many libraries have lists of recommended web sites by subject, including health and fitness. Some even have subscriptions to data bases that allow patrons to search medical journals with no cost!
Be cautious; examine the source carefully before you trust the information.
We can help you navigate the maze of information, guide you towards reputable sources and help you decipher the information.
Falling down can be more serious than “OOPS”
Do you realize how dangerous falls can be to our seniors? The end result of a fall can be lost independence!
The Centers for Disease Control and Prevention reports one in three people over the age of 65 has suffered a fall. Each year about 1.6 million adults visit Emergency Departments due to fall related injuries. That’s a lot of injuries.
The injuries can range from bumps and bruises to concussions or broken bones. Fractures of the hip, in particular, can precipitate a cascade of problems that can result in incapacitation, admission to a nursing home and/or loss of independence.
Fall prevention can be an important step if you are caring for an older loved one.
There can be many factors that increase the risk of falls, the following list contains a few points for your consideration:
- The environment: rugs, clutter, electric cords can create obstacles and increase the risk of tripping.
- Medications: some medications make folks dizzy, some medications may contribute to “orthostatic hypotension”. This is when the blood pressure drops when you stand up. This can cause disorientation and dizziness.
- Strength and balance: lack of physical activity or illness can result in a lack of strength to support motion and loss of flexibility and coordination.
- Eyesight: poor vision can impair the field of vision resulting in failure to see obstacles. Poor lighting can compound the problem.
- Medical conditions: Some chronic illnesses cause weakness which could lead someone to be unsteady on their feet. Osteoporosis can thin the bones and increase the risk of serious injury from a fall.
Small steps can lead to big benefits in safety and help preserve quality of life and independence.
We can provide a Comprehensive Home Safety Assessment and recommend improvements to reduce fall risks and increase safety and comfort in the home. Contact us to discuss how we can help you.
How do I know which joint condition I have?
You know that some or all of your joints are painful and swollen, but aren’t sure what is going on….here is a simple way to figure out which condition you may have:
- Arthritis is a collective term for “inflammation” of the joints.
- Rheumatoid arthritis is a condition in which the lubricating fluid in the joints becomes inflamed and can lead to deformity of any joints and can occur at any age.
- Osteoarthritis occurs when the cartilage and connective tissue of the joints are affected; this leads to “bone on bone” friction and causes steady pain, especially in the hips, spine or knees, and mostly occurs in those aged 65 or older.
- Bursitis occurs when there is inflammation of the pad between the muscles and tendons, and usually occurs in the elbows or shoulders.
- Osteoporosis, on the other hand is a condition that can occur in both men and women, but is most frequently diagnosed in women who are post-menopausal. (Most bone loss occurs in the first 5-7 years after menopause.) This is a condition in which the bones become porous because there is an imbalance between bone formation and bone reabsorption. It is especially dangerous, if untreated, because bone fractures can occur with even the slightest movement. All women of menopausal age should have a baseline DEXA scan which can be prescribed by your family doctor or gynecologist.
You should visit your doctor if you suspect that you have one or more of these conditions. But, as always, do your homework, and know about what treatments may suit you. That will be the focus of our next article.
Checklist for calling your doctor
If you need to call your doctor it pays to sit down for a minute and compose your questions in advance. A little forethought can help you get to the point quickly, communicate your concerns effectively, and get the advice you need. Prepare all your information on a piece of paper so it’s at hand when you speak to the doctor.
Before you make the call to the doctor you should be prepared to:
- Describe your symptoms or problems….why are you calling? Be specific, for example: “I have had a temperature of 101 for two days”.
- Report the results of anything the doctor has asked you to track like blood pressure, glucose levels, and temperature.
- Provide your current medication information: drug name, dosage, frequency, purpose. Remember, if you are calling after-hours the doctor may not have this information readily available.
- Have your pharmacy phone number handy in case the doctor needs to call in medication.
- Ask the doctor what you should do, write down this information.
- Ask the doctor if you should call back to report how you feel.
- Ask the doctor if he/she wants to see you in the office.
- Ask if you should go to the Emergency Room. The doctor may tell you to go to the Emergency Room only if you get other symptoms or if your symptoms get worse. Write down all this information.
- Thank the doctor for talking to you.
Take time to plan before you call your doctor so you can convey the important information and get the help you need.
Why is the FDA reviewing Acetaminophen?
June 2009- The Food and Drug Administration (FDA) is currently reviewing the drug acetaminophen. This is the active ingredient in Tylenol and many other products. The FDA has noted an increase in the number of accidental overdoses (with some deaths) related to use of acetaminophen. They are trying to arrive at a strategy to reduce the overdoses and health complications that can result from the use of too much of this drug.
The concern is that the public may not realize when they are taking numerous products which all contain acetaminophen and could, unknowingly, take too much. Too much acetaminophen can be harmful to your liver.
It is easy to accidentally take too much acetaminophen. Prescription pain medications like Vicodin and Percoset already contain acetaminophen so if folks add a couple of Tylenol to their medication they could easily exceed the maximum recommended dosage. Many over-the-counter preparations for coughs, colds, allergies, muscular pain, arthritis, and headaches contain acetaminophen. This includes products with the name Tylenol as well as generic store brands. If you had a cold and used an over the counter product with acetaminophen and also took a headache preparation containing acetaminophen you could exceed the safe dosage.
The FDA is considering a variety of approaches: reducing the maximum recommended dosage, limiting over-the-counter availability of high dose acetaminophen, adding additional warnings to packages, programs to educate the public.
Please read your labels carefully. Any drug, prescription or non-prescription, has the potential to cause problems. Check your ingredient labels for the presence of acetaminophen. Know what you’re taking and how much you are taking. It is prudent to review all your medications periodically with your physician. Be sure to include your non-prescription drugs and supplements. Your local pharmacist can be a resource to assist you in identifying products which contain acetaminophen.
We can facilitate a medication review as part of our Case Management service. We can accompany you, or your loved one, to your doctor to review your medications for safety and effectiveness. Contact us if we can be of service.
Reclast®, a once yearly treatment for osteoporosis
Osteoporosis is a serious problem and there are many treatment approaches: diet, weight bearing exercise, calcium/Vitamin D, supplements, and prescription medications. Many of the oral prescription medications have complex directions for use. Pharmaceutical manufacturers have been seeking treatment approaches that are less complex and more convenient.
Reclast® is a new drug used to treat osteoporosis. It received FDA approval in August 2007 for treatment of osteoporosis. Reclast® is a once a year formulation. It is a liquid given in a doctor’s office by IV infusion (in your arm vein) over a 15 minute period of time. The TV and print ads stress the ease and convenience of this drug. While all decisions about medications should be made with your physician, there are some specific factors you might consider for your discussion about Reclast®.
Warnings and precautions about Reclast® are similar to other drugs in the same class. Side effects run the gamut from mild to severe. If you experience side effects with drugs you should discuss them with your doctor. Sometimes the “solution” to the side effects is to stop taking the drug and see if the bothersome side effects go away. Reclast® is designed to work for one year in your body. If you experience any of the side effects, you do not have the option to stop taking the drug. This could be a concern for you and your physician.
Since Reclast® is new, it has only been used in general population since August 2007 at the earliest. Some data is starting to emerge with some particular concerns. FDA has asked doctors to be aware of risks for dehydration and kidney problems in women that use Reclast®. Doctors should screen carefully and monitor women on Reclast® to avoid these risks and potential complications. There may be additional concerns as the drug is used by more women and data is collected.
Sometimes a good case can be made to wait on the sidelines for more comprehensive information to be developed for a new drug.
We can help you sort through complex information to help guide you in your medical decisions. In our role as Medical Advocates, we believe everyone should have an understanding of medical information in order to make an informed choice. Accurate information helps you have more effective conversations with your doctors and make an informed decision about your health. Contact us if we can help you in any way.
Time to take your medicine…..it could make a difference
When the doctor prescribes medication for you, be sure to ask if there is a specific time that you should take the medication. Some drugs should be taken at specific times of the day or with specific circumstances like with or without food. There is more study on timing medications to work with our circadian rhythms so the medication is more effective. Circadian rhythms are the cycles our bodies go through during a 24 hour period related to digestion, absorption, excretion, and metabolism.
Some medications seem to be more effective if given with these normal rhythms in mind. This is particularly important with drugs that are taken once-a-day. Pharmaceutical companies are actively creating many new drugs in once-a-day formulations since it is easier to remember to take medicine once daily. Some of our older drugs are getting similar attention from pharmaceutical companies, reworking the drugs into once-a-day formulations. The time you take your drug can help it to work as best as possible, minimize side effects or interactions and more effectively treat your symptoms.
For example: There are many once-a-day drugs used to treat excess stomach acid. If your excess acid wakes you in the night your doctor may recommend you take the medication before dinner. Other folks may experience the excess acid after physical activity, so the doctor may recommend it be taken in the morning.
Drugs for high blood pressure can work best when taken at exact times depending on the specifics of your blood pressure problem and the particular class of drug. This is particularly important if you take two or more medications for high blood pressure. Aspirin for cardiovascular protection can work better when taken at night by some individuals.
If you take medication(s) for any of the following conditions, ask your doctor if there is a specific time of the day you should take your medicine.
- High blood pressure
- Heart disease
- High cholesterol
- Excess stomach acid
- Diabetes
- Thyroid disorders
- Depression
- Environmental/seasonal allergies
Keep in mind that some drugs are recommended for a particular time of the day simply so it will become a habit and make it easier to remember to take it routinely. As always, ask your doctor specific questions about any medications that are prescribed, provide a list of all your current medications for review and read your medications labels and inserts.
We can accompany you, or your loved one, to your doctor appointment to make sure a thorough medication review is completed and all your questions are addressed.
Health Considerations When Traveling Abroad
We are fortunate here in the US that our health care is portable when we travel within our own borders. That includes private insurance and Medicare. But that same portability does not apply for Medicare when traveling abroad. Here are some ideas you can implement to make your travel experience less stressful.
- Always bring your private insurance card with you, in a safe place, when you travel, as most companies will cover you in Europe if you get ill. In England if a person needs an Emergency Room visit, that is a free service, but if one needs to be hospitalized and is insured by Medicare, then the burden of the cost will fall on you, the patient. Check with your private insurance before you depart to see if any restrictions apply according to your policy.
- Always carry a list of your medications, as well as over-the-counter supplements, also in a safe place, so you can show them to medical professionals if you need their services. This applies to both Medicare and non-Medicare enrollees. This should also contain a list of any medication allergies.
- Carry a list of your medical conditions with you, to be kept with you at all times on your trip. Also, if you are traveling alone, have a contact person back home who has both a list of your medications and medical conditions in case you cannot speak for yourself.
- Always be sure you have enough of your prescription medication to cover your entire trip. Most pharmacies will gladly give you a bit extra medication under these circumstances, however, in some cases you may need to contact your doctor to be sure you can get enough to last throughout your trip. I recommend that you carry your medications with you en route to your destination, because if you send them ahead with your luggage they may get lost.
- If you are a Medicare enrollee you can purchase an insurance policy for your trip through your travel agent or company through which you booked your reservations. This can often be done on-line. Be sure the amount is adequate enough to airlift you back home in case of a severe emergency.
- There may be other potential insurance/health coverage difficulties when traveling to Asia, or other countries. Be sure you are aware of them before you leave, and make adequate preparations.
Holiday Blues Got You Down?
It’s that time of the year again. We constantly see our televisions portraying their Happy Holidays array of old movies and commercials for gifts perfect for those we love. Then we turn on the radio and here comes all the happy songs of the holiday season. And everywhere we go we see holiday decorations-and don’t forget the music at the Mall…
For some of us that can just be too much. As we age we lose more and more family members, friends, and the loss of a beloved pet can be devastating. So it is hard not to think of the happy times we had with those we have lost, but it is also hard not to think of how much we miss them. So in the midst of the “be happy”, stress-filled holiday atmosphere we try to live up to our own expectations, and others’ expectations to be jolly and care-free. But along with the happy memories we have of past holidays with loved ones we also feel the sadness more at this time of year than perhaps any other time.
So, what can we do to make it easier?
- Make a conscious decision to be positive instead of negative.
- Allow time alone for ourselves to reminisce, or set aside a time for the whole family to reminisce. Make it a joyful time of story-telling or special moments shared. Include children when appropriate so they can learn new things.
- Take good physical care of ourselves: eat well, sleep enough, exercise.
- Resume some small activity you used to like doing.
- Help other people.
- Find a spiritual focus and practice gratitude.
- Above all, give yourself a break!!!
If you find that the blues does not subside you may want to visit your family doctor to discuss ways to help you feel better.
Strategies to help manage your drug costs
Drug costs are a major topic of discussion in our country. If you take medications on a regular basis it pays to ask questions when you are with your doctor.
First, if the cost of a medication is an issue, let your doctor know. If he/she has this information it may be that a less costly drug may be appropriate for you. Keep in mind that doctors can not possibly know what your cost will be for every drug manufactured. Sometimes you will have to visit your pharmacy first to find the cost.
Sometimes doctors have sample packs of drugs. This could help you try a new medication to see if it will work before you need to pay for a prescription. Beware though, most drug samples are brand name drugs and tend to be the newer, therefore more costly, drug formulations. If you need to continue on it, it could be quite expensive.
Studies which compare some of our older, “tried and true” drugs with some of the fancy new ones are showing the newer ones are no better than the older ones. This is particularly true for the blood pressure drugs.
Ask your doctor if there are generic formulas available, about half the drugs on the US market have an FDA approved generic alternative. Generics are generally less expensive. You could print out the lists available from stores like Target and Wal-Mart that sell selected generics for a flat amount. With the lists in hand, you could ask your doctor if anything on the list would be an appropriate choice for you. Make it as easy as possible for your doctor by having the list in your hand for your appointment.
Other ideas:
- If you have a drug plan, ask if they offer a mail order or online pharmacy service that is less costly. Many folks find the mail order option can be more cost effective and you are often permitted to have a 3 month supply dispensed.
- Explore prescription assistance programs sponsored by the drug manufacturer if you need a particular drug and can’t afford it.
- If you have a specific illness, investigate whether there is an association for that illness such as the Alzheimer’s Association or American Cancer Society. These groups often know of sources or provide assistance for folks that can’t afford medications.
- If you are eligible to buy Part D for drug coverage, check each drug cost for the plans you consider -- plan coverage can change each year.
- Check for resources in the state in which you reside. Many states have assistance programs for low income folks and some can even get help with Medicare Part D costs.
- Some clinics and hospitals participate in a Federal program to provide lower cost drugs to those in need.
- Do some research to compare different drugs appropriate for your condition. Consumer Reports and AARP are good resources.
- Compare drug prices at different pharmacies. However, be aware that if you use a variety of pharmacies for your drugs you are defeating the drug interaction check used by many pharmacies.
It’s not easy work but your diligence could result in significantly lower drug costs for you or your loved one. As always, review the topic with your doctor before you make any of the changes described.
A final note: As our country debates healthcare reform, let your voice be heard if you feel strongly about any aspect of the proposals under consideration including ideas to reduce drug costs.
Elder suicide in Virginia
Our seniors in Virginia are at risk for suicide. I recently saw a reference to the findings of a report related to elder suicide in Virginia. I was shocked to see the statistics for suicide completion in our over 60 year old age group.
The report is titled “Elder Suicide in Virginia: 2003 to 2007 from the Virginia Violent Death Reporting System” issued by the Office of the Chief Medical Examiner, Virginia Department of Health. The report uses data collected from 2003 to 2007 through the Virginia Violent Death Reporting System (VVDRS). The Virginia reporting system is part of a national effort by participating states to track violent death trends in order to formulate prevention approaches and interventions to reduce these tragedies.
I found the following findings taken from the page 1 summary of the report very troubling:
“Highlighted Findings
- An average of 16.1% of Virginia’s population is elderly (persons ages 60 and older).
- There were 970 elder suicides from 2003-2007, for a rate of 16.0 per 100,000 persons.
- Elderly adults have a higher risk for suicide than non-elderly adults.
- Elderly males are six times more likely to commit suicide than elderly females.
- Whites are more than three times more likely to commit suicide than Blacks.
- As males age, their risk for suicide increases; as females age their risk decreases.
- Marriage is a protective factor for males, while other marital status’ increase risk. Being widowed or never married decreases suicide risk for females.
- A firearm is the most common method of fatal injury used by males and females; the rate of suicide by firearm is more than 12 times higher for males than females.
- Elder suicide rates are typically higher in the southwestern region of Virginia and lower in the northern region.
- Mental health problems were noted for 46.5% of elder suicide victims; physical health problems were a factor for 52.0%.
- Most elder suicide victims do not present classic warnings of suicide by disclosing intent to commit suicide or having prior suicide attempts.”
I was struck by the significant influence of marital status on the male suicide statistic. It seems that elder males who committed suicide were far more likely to be widowed, divorced or never married. Females did not have similar risks associated with their marital status. I am at a loss to explain this difference but it is significant. Maybe single men are more isolated than women? Maybe loneliness plays a role? Maybe they don’t get needed support or help managing health problems? The report also notes that many of the elder suicide victims had experienced a crisis of some sort within the 24 hours prior to the suicide.
So, what can we do? Increase our awareness of the risks for suicide in our senior population. Understand the impact marital status has on the elder male suicide risk in particular. Be alert for the influence of physical and/or mental health problems on suicide risks in this population. Be especially watchful when our elders experience a crisis of any sort.
If you are concerned about yourself or someone you love consider speaking to a qualified mental health professional. This could be someone in private practice or someone associated with a municipal Mental Health Department. Please don’t overlook your physician as a resource as well.
The National Suicide Prevention Lifeline is available 24/7 if you have concerns you would like to discuss. 1-800-273-TALK (8255)
Follow this link to read the entire report.
Other reports and publications from the Office of the Chief Medical Examiner for Virginia are available at the Virginia Department of Health web site.
If you are not from Virginia, contact your State Medical Examiner’s Office to check for similar reports.
Pathological Gambling to be Recognized as an Addiction
- Ben Thomas M.Ed., CSAC
The American Psychiatric Association (APA) is revising the Diagnostic and Statistic Manual, the fifth edition (DSM-5) of which is due for release 2013. One of the proposed changes is to rename the category for Substance Use Disorders to Addictions and other related Disorders. Additionally, Pathological Gambling will be moved from Impulse Control related Disorders to the new Addiction Category. This shift in classification has significant implications since it is the first non-chemical related disorder to be proposed for inclusion in this category. It will also be renamed Disordered Gambling.
The re-classification makes sense in terms of the strong parallels between problematic and pathological gambling to the substance related disorders of abuse and dependence. Both the current diagnostic criteria and the proposed criteria for Pathological/Disordered Gambling include elements of preoccupation, tolerance, and withdrawal as well as psychosocial consequences that may include legal, financial, employment and relationship issues all of which are commonly associated with addiction to a chemical such as alcohol.
According to the National Opinion Research Center of the University of Chicago (NORC) 1999 study submitted to the National Gambling Impact Commission, gambling behavior among individuals older than 65 years of age has shown the largest increase of any other age group. Research has shown that about 1% of the general population meets full criteria for Pathological Gambling and up to 3% would meet partial criteria, being described as problematic gamblers. However, Casino Watch reports that casinos actively recruit and target individuals over the age of 65, sending buses to retirement homes and centers. Casino Watch estimates that pathological gambling rates for individuals older than 65 years of age may be much higher.
The proposed criteria as published on APA DSM-5 website are as follows:
- Persistent and recurrent maladaptive gambling behavior as indicated by five (or more) of the following:
- is preoccupied with gambling (e.g., preoccupied with reliving past gambling experiences, handicapping or planning the next venture, or thinking of ways to get money with which to gamble)
- needs to gamble with increasing amounts of money in order to achieve the desired excitement
- has repeated unsuccessful efforts to control, cut back, or stop gambling
- is restless or irritable when attempting to cut down or stop gambling
- gambles as a way of escaping from problems or of relieving a dysphoric mood (e.g., feelings of helplessness, guilt, anxiety, depression)
- after losing money gambling, often returns another day to get even (“chasing” one’s losses)
- lies to family members, therapist, or others to conceal the extent of involvement with gambling
- has jeopardized or lost a significant relationship, job, or educational or career opportunity because of gambling
- relies on others to provide money to relieve a desperate financial situation caused by gambling
- the gambling behavior is not better accounted for by a Manic Episode
As with acceptance of Alcoholism as a disease in the 1950's, this is a significant step forward for those who suffer from Pathological Gambling in terms of the conditions acceptance as a mental illness and an addiction. Hopefully, this will help reduce the stigma and self loathing that often accompanies addictions and that often serve as an obstacle to seeking treatment. Additionally, as research continues to advance the field's understanding of addictive behaviors this may open the door to better understanding of compulsive behaviors such as over eating or compulsive sexual behaviors.
If you are concerned about your gambling behavior or that of a loved one, help is available at 1-800-GAMBLER. Additionally, we do interventions to help people become ready to receive treatment for Pathological Gambling and other addictive disorders. Contact us via email or by calling 703-734-8760.
Links to resources used for this article are:
American Psychiatric Association DSM-5 Development
NGISC Gambling Impact and Behavior Study
What’s the meaning of ADL, IADL, and EF and why does it matter? Part 1
You may encounter these abbreviations in many settings. These abbreviations are used as a common language in the health care industry. These terms are important because they are used to describe the current functional status of folks. This common language helps professionals communicate important information in order to create a plan of care that matches services to an individual’s needs. If you have a familiarity with these terms it will help you understand recommendations. Familiarity with these terms can also help you if you are investigating care settings for a loved one.
ADL means “activities of daily living”. ADLs describe the basic functions of self care.
IADL means “instrumental activities of daily living”. IADLs relate to activities that are elements of independent living.
EF means “executive function”. This refers to the cognitive abilities that contribute to decision making, information processing and application of the information.
This article will focus on the ADL term. Following articles will describe the terms IADL and EF in more detail.
Many facilities base admission inclusion and exclusion criteria on ADLs, IADLs and EF. This is to assure that they only accept patients whose needs can be met appropriately. For example, if someone needs help with at least two ADLs, but no more than 4 ADLs they may be appropriate for an assisted living setting. If they need help with more than 4 ADLs they may need more help with daily activities than some assisted living programs can provide. This might indicate a more supportive environment like a nursing home. Keep in mind that a medical condition can contribute to a person needing help with these basic activities of daily living. A cancer patient could be so disabled by their illness that they need a significant amount of assistance with basic care.
There are some possible choices for medical care in the home for folks quite disabled if staying at home is the highest priority. Service providers must be carefully screened for competence to provide this level of care in the home environment. Keep in mind, sometimes the needs are so great they can not be provided safely in the home setting.
Since ADLs describe the very most basic functions they may also play a role in qualification for assistance programs, disability ratings, use of long term care insurance and tax deductibility for costs of care.
Examples of ADLs are:
- Bathing
- Dressing and undressing
- Eating recommended diet and drinking fluids
- Transferring from bed to chair and back, changing positions in bed
- Continence of bladder and bowel
- Use of toilet/bedside commode including transfer on and off
- Walking, often called “ambulation”
When you review the list of activities you can see how the descriptions would help with placements. A person that needs help with several ADLs needs more staff attention, oversight and skilled services than someone that is able to do many activities for themselves.
Medical Advocates of Virginia can help you sort through the maze of confusing terms and suggest an appropriate referral for care for your loved one. Contact us if we can be of service.
Obesity - How Did I Get Here? What is the Big Deal? What Can I Do About It?
Obesity is linked to life threatening diseases such as cardiovascular disease, diabetes, stroke and some types of cancer. When one’s weight increases towards an obese state, the percentage of possible disease increases dramatically. Excess stress on the body from the surplus fat storage and weight distribution not only promotes disease formation, but also increases the amount of orthopedic stress on the lower extremity. This added stress often leads to an increased occurrence of knee and hip replacements as well as foot and ankle problems. In addition to all of the physiologic stressors that obesity provides, emotional and psychosocial health may be negatively affected. There are a variety of factors that play a role in obesity making this a complex health issue. These factors are behavior, environment and genetics.
Behavior:
What are your nutritional weak points? In order to establish good nutritional habits, try to recognize your weak ones. What are your triggers for eating too much or the wrong foods? If you have several nutritional weak points, focus on one at a time. Restricting yourself entirely of the foods that you like and are use to eating does not work. You will see that slowly over time your tastes will change. Changing how we think about food and changing our behavior over a period of time is the key. Nutrition – gives us the power to grow, learn and develop. Choose fruits and vegetables that are dark and rich in color. Select top quality meats, chicken and fish minus the chemicals and additives. Stay close to the source and you can’t go wrong. Look at food labels not just for the calorie content but also for the nutritional return.
Here are a few tips:
- Eat breakfast
- Eat as a family whenever possible
- Eat fruits and vegetables daily
- Drink lots of water
- Eat only when you are hungry
- Limit fast food
- Don’t skip meals or get too hungry
- Keep snack foods to a minimum
Environment:
One key factor that can lead to obesity is excessive calories, particularly dietary fat. Although an excess of calorie input will lead to weight gain the main culprit is dietary fat. There may be several reasons for this association. Dietary fat is highly palatable to most individuals encouraging overconsumption. It contains more calories per gram, and may not provide the same satiety as carbohydrates and protein. Research has shown that the body systems respond quickly to protein and carbohydrates but slowly to fat. That is why we tend to consume more calories when our food is high in fat content. Exercise and physical activity are important factors in preventing obesity. Once an individual becomes obese, physical activity decreases, setting up a vicious cycle of increasing body weight and even less physical activity. A little exercise goes a long way. In a study at Duke University, obese individuals that participated in exercise more than one hour per week stated improvements in daily function and quality of life. Reductions of only 5% of an obese person’s body weight have been attributed to enhancement in overall health and reductions in necessary medications.
Genetics:
Genetics and environmental factors do not cause obesity. They do, however, increase the chances of becoming overweight or obese. Researchers do agree that the environmental changes such as the availability of food and a decrease in exercise are a contributing factor in obesity. These factors are partially a result of the rising rate of obesity. However, genes do influence body weight. The ability to capture, circulate, and accumulate energy in the human body is so finely regulated that genetics must be involved. Diversity exists, however, in the way that people are affected by environmental changes. Not all people living in industrialized countries, for example, are obese or will become obese. In addition, among the obese, the health consequences of obesity vary. These differences that researchers are finding are even among those with the same racial or ethnic background and within families living in the same environment. These observations hold true with the theory that obesity is influenced by genetic diversity interacting with environment changes.
In conclusion, obesity results when there is chronic energy imbalance (calories consumed exceed calories expended). Try to eat foods that provide the most nutrition and the least amount of calories. View each day as a new beginning, a new start. Do this for yourself – you are worth it!
FYI...each month I will be offering helpful tips on proper nutrition and physical activity. These tips will provide information that will help you stay on track or get started in becoming healthier and stronger. You can contact me personally through email. Visit this website often to obtain information on medical advocacy and care giving. Our experts are here to provide the assistance and support you may be looking for. Please know that we are only a phone call or click away…
- Mary Lou Shehadi
Contact Mary Lou for more information.
References: The American College of Sports Medicine Journal, Aquatic Exercise Association, Nutrition for Health, Fitness & Sport
More about ADLs, IADLs and EF, Part 2
Last month we introduced you to three terms: ADL, IADL, EF and described the importance of understanding what the terms mean and how they are used to describe the functional status of individuals. (Part 1 of this article is located in our archives.)
Today we will focus on the term IADL. IADL means “instrumental activities of daily living”. IADL activities are beyond the basics like bathing, eating, and transfer. IADLs help describe how independent a person can be. A list of some of the more frequently used IADLs include:
- Meal preparation and clean up
- Shopping for groceries and needed items
- Managing money
- Using the phone
- Taking medications
- Monitoring health conditions, if needed, like glucose levels or blood pressure
- Doing light housework
Some problems with IADLs might only need some oversight to address. If the person can not drive, a grocery delivery service might help. If they have trouble with meal preparation perhaps a family member could assist? If managing money is a problem, perhaps an outside service could be employed to help relieve the senior of this task? You can see that some types of help might be only occasionally needed and other needs may be of a daily type. Many times family members can take care of meeting these needs within the family. Some families may want to investigate hiring professional, non-medical assistance on a regular basis. Assistance with IADLs can mean your senior can safely stay in their present surroundings.
Medical Advocates of Virginia is available to assist you with finding the right combination of services to help your loved one stay as independent as possible; whether your family will supply the assistance or you want to investigate retaining an outside company... or a combination of both.
