Tag: geriatrics

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Aging gracefully after retirement is a challenge we all face.

Space Needle in Seattle. (Dr. Noorali Bharwani)
Space Needle in Seattle. (Dr. Noorali Bharwani)

Today, people are living longer than they did 60 years ago. Now we have extra 15 to 20 years. Barring any unfortunate incidence most people will live to 80 years. Women will live longer.

The question is: how to grow older in good health so that we can actually enjoy those extra years? A Consumer Reports survey of 2,066 Americans age 50 and older revealed that we are eager to maintain our quality of life into retirement and far, far beyond.

As we get older our health changes. This happens even if we don’t like it. These changes can be due to normal aging process or age-related diseases. Most of our activities in life depend on our health and how mobile we are. Our retirement goals, such as travel, choice of home, sports and a broad range of other activities depend on our health.

Financial independence is also very important. Have you saved enough to get the help you need in case you are dependent on others?

What kind of health issues we should be worried about in our retirement?

Here is a list of health issues you have to be prepared for as you get older:

Are you capable of driving? If your vision is not good and you have difficulty with concentration then you cannot drive. Make sure you see your eye doctor on a regular basis.

How mobile are you? Arthritis, stroke, feet problems, and other health issues affecting your mobility will create frustration and anger. Joint deterioration can compromise your ability to stay active or climb stairs. Some of these problems come with the aging process. Be active and keep your muscles strong to mitigate the effects of these problems.

Are you able to hear your friends and family talk? Are you able to enjoy listening to music and watch television? Hearing loss can interfere with your relationships and lead to isolation. Don’t be shy to wear a hearing aid. Be proactive. Do not wait till you are completely hard of hearing.

Do you have cognitive deterioration? That means you have difficulty thinking and making decisions that affect your everyday life. This is feared by all. Alzheimer’s in old age makes it difficult to interact socially. You become dependent on others. Maintaining an active social network for yourself and being a lifelong learner are the best ways to reduce the risk of cognitive decline.

How can we take a proactive approach to prepare ourselves to make a smooth life transition?

Unfortunately, there is no magic solutions to the problems mentioned earlier. The basic principles are to prepare for what is to come. Be proactive and prepare yourself when you are young and healthy. Understand the importance of exercise, healthy diet and good health habits like no smoking.

If you are living in a big house then think about downsizing. Do it early when you are still in good health and in sound mind. Do not depend on your family to do it when you have lost control of your life. If you want to have choice, control and independence throughout your life, you need to think about these things early.

Not able to drive can cause severe frustration and anxiety. You should plan carefully where to live. Your social life will rely on whether you can get around. People do not realise how so many elements of their retirement plans are dependent on transportation. The problem gets worse if your friends are of the same age and cannot drive.

It all comes down to keeping control of your life and anticipating and planning for lifestyle changes as we age.

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Regular Walking Prevents Memory Loss and Delays Alzheimer’s Disease

Sunset in Calgary, Alberta. (Dr. Noorali Bharwani)
Sunset in Calgary, Alberta. (Dr. Noorali Bharwani)

There are many health benefits to regular walking. It helps your heart, lungs, joints and muscles. It may even regulate your bowel movements. You can add one more benefit to that list. According to a recent Australian study, regular walking is the best defense against age-related memory loss.

The researchers at the University of Melbourne followed 387 women for two decades. They found that participants who did some form of movement every day were less likely to suffer memory loss in their 60s and 70s, compared to their sedentary peers.

The article, published in the American Journal of Geriatric Psychiatry, shows that little physical effort like walking can go a long way in improving cognition in old age. Dementia is one condition that affects older individuals and affects their cognition.

Dementia is a general term for a decline in mental ability severe enough to interfere with daily life. Dementia is not a specific disease. It’s an overall term that describes a wide range of symptoms associated with a decline in memory or other thinking skills severe enough to reduce a person’s ability to perform everyday activities. Memory loss is an example. Alzheimer’s is the most common type of dementia. It accounts for 60 to 80 percent of cases.

The Australian researchers set out to find risk factors for dementia that could be changed. The study participants were between the ages of 45 and 55 when the study began in 1992. The researchers tested their cognitive abilities at the outset to get a baseline measure.

In the study, regular physical activity had the most protective effect on short-term memory. But aerobic exercise – the kind that makes you breathe heavily – proved less important than frequency of movement. If a person walked more then the benefit was greater.

Researchers concluded that physical activity has a direct relationship with cognition, over and above any influence on weight and cholesterol. The idea is to move more and move often. If you have difficulty walking then take up swimming or other activity that will keep you moving.

A study published in 2014 says if you take your brain for a brisk walk three times a week then it delays dementia. Studies on men and women aged 60 to 80 found that taking a short walk three times a week increased the size of brain regions linked to planning and memory over the course of a year.

The results suggest that brain and cognitive function of the older adults remain plastic and highly malleable. We used to think that as you get older there is inevitable decline in your brain function. That is not true. Don’t give up on your brain.

Reports indicate there is a desperate need for any approach that could slow the rising epidemic of dementia. An estimated 44.4 million people now have dementia worldwide, and that number is expected to reach 75.6 million in 2030, according to figures from Alzheimer’s Disease International.

If you are able to walk then keep walking. If not then do some other physical activity that will keep your brain busy. Move more, move often.

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Medications That Put Our Seniors in the Hospital

Summer Flowers (Dr. Noorali Bharwani)
Summer Flowers (Dr. Noorali Bharwani)

I covered this topic about three years ago. It is never too early or too late to review the subject again.

A study published in the New England Journal of Medicine says 40 percent of people over 65 take five to nine medications every day. What this means is that hospitalizations for accidental overdoses and adverse side effects are likely to increase among this group.

The study found that every year, about 100,000 people in the United States over age 65 are taken to hospitals for adverse reactions to medications. Most of the patients are there because of accidental overdoses. Sometimes the amount of medication prescribed for them had a more powerful effect than intended.

The four most common groups of medications putting seniors in hospitals are: warfarin (a blood thinner), insulin injections for diabetes, antiplatelet drugs to thin the blood and oral diabetes drugs.

Warfarin accounts for the most visits due to adverse drug reaction. It accounted for 33 percent of emergency hospital visits. Warfarin (Coumadin) is an anticoagulant – popularly referred to as a “blood thinner.” In reality, it does not make the viscosity of the blood thin. What it does is that it acts on the liver to decrease the quantity of a few key proteins in blood that allow blood to clot.

It was initially marketed as a pesticide against rats and mice. Later it was found to be effective and relatively safe for preventing blood clots in humans. It was approved for use as a medication in the early 1950s and now it is the most widely prescribed oral “blood thinner” drug in North America.

Insulin injections were next on the list, accounting for 14 percent of emergency visits. Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body.

Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle. When control of insulin levels fails, diabetes mellitus will result. Patients with type 1 diabetes depend on insulin injections.

Antiplatelet drugs like aspirin, clopidogrel (Plavix) and others that help prevent blood clotting were involved in 13 percent of emergency visits. An antiplatelet drug is a member of a class of pharmaceuticals that decrease platelet aggregations and inhibit clot formation. They are effective in the arterial circulation, where “blood thinners” have little effect.

Lastly, diabetes drugs taken by mouth, called oral hypoglycemic agents, which were implicated in 11 percent of hospitalizations. Anti-diabetic medications treat diabetes mellitus by lowering glucose levels in the blood. There are different classes of anti-diabetic drugs, and their selection depends on the nature of the diabetes, age and situation of the person, as well as other factors.

The authors of the article say that in order to reduce the number of emergency hospitalizations in older adults we should focus on improving the safety of this small group of blood thinners and diabetes medications, rather than by trying to stop the use of drugs typically thought of as risky for this group. And patients should work with their physicians and pharmacies to make sure they get appropriate testing and are taking the appropriate doses.

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Enjoyment of Life Leads to Longer Survival Among Seniors

Early morning - a bird relaxing. (Dr. Noorali Bharwani)
Early morning - a bird relaxing. (Dr. Noorali Bharwani)

“Old age ain’t no place for sissies,” said Bette Davis, an American actress. Keeping that in mind there is a continuous effort to improve the quality of life of seniors. Pills and more pills is not always the best way to make life of seniors healthy and functional.

A research article in the Canadian Medical Association Journal (CMAJ March 4, 2014) titled Enjoyment of life and declining physical function at older ages says, “Positive affective well-being (i.e. feelings of happiness and enjoyment) has been associated with longer survival and reduced incidence of serious illness.”

The authors of the article go on to say that their objective was to discover whether enjoyment of life also predicted a reduced risk of functional impairment over an 8-year period in a large population sample.

This was a prospective study involving 3199 men and women aged 60-years or older from the English Longitudinal Study of Ageing. The results provided evidence that reduced enjoyment of life may be related to the future disability and mobility of older people. Researchers obtained similar results when they limited analyses to participants younger than 70-years at baseline.

Studies have also shown that when seniors are having a good time their life is associated with longer survival and reduced incidence of coronary heart disease and stroke. That means if a senior is not happy then there is a decline in physical function. This predicts early death. That is not good.

The authors looked into several lifestyle parameters including whether the participants enjoy the things that they do, enjoy being in the company of others, whether they look back on life with a sense of happiness and feel full of energy on a regular basis.

After eight-year-study, the authors found greater enjoyment of life was associated with reduced risk of developing impaired activities of daily living and with a slower decline in walking speed.

Slow walking speed was considered an early marker of disability and frailty, as well as a predictor of dementia, admission to a long-term health facility and death. That does not sound good either.

After analysing their research results, the authors came to the conclusion, “Our results provide further evidence that enjoyment of life is relevant to the future disability and mobility of older people. Efforts to enhance well-being at older ages may have benefits to society and health care systems.” A CMAJ Editor’s comment on the article says the degree of enjoyment of life remains an important predictor of future functionality, indicating the power of a positive outlook on life.

The message is quite simple and clear. Growing older gracefully and in good health requires attention and work. As Bernard Baruch, an American financier said, “Old age is always 15 years older than I am.” He also said that one of the secrets of a long and fruitful life is to forgive everybody, everything, every night before you go to bed. Can we do that? Go have fun now.

Start reading the preview of my book A Doctor's Journey for free on Amazon. Available on Kindle for $2.99!