Seven Neglected Areas That Sabotage Healthy Aging – P5

This is one topic I have not written much about, but it does affect the elderly. Having chronic difficulties controlling one’s bladder is a common problem for older adults, and tends to get worse with aging. It affects both men and women, although it may have different underlying causes, such as prostate enlargement in men. It is often embarrassing, can cause seniors to restrict their social or physical activities, and has been linked to depression.

Incontinence comes in different “types,” each of which can have different causes. Correctly identifying the type and causes is key to effective treatment. Finding suitable pads or underwear to manage leaks can also make a big difference. They are definitely not all equal, and doctors have little idea which is best. Remember that medications to treat bladder spasms are usually quite anticholinergic, hence risky for brain function. To help a doctor evaluate incontinence, it’s helpful to log your symptoms in a voiding diary for 3 days prior to the appointment.

For more information:

• What to Know About Bladder Control for Women
• Urinary Incontinence in Men

Other blogs:

http://www.mendosa.com/blog/?p=377

http://bobsdiabetes.blogspot.com/2015/03/nephropathy-part-5.html

http://bobsdiabetes.blogspot.com/2012/01/diabetic-neuropathy-part-1.html

Number 5 of 8 blogs.

Seven Neglected Areas That Sabotage Healthy Aging – P4

People with type 2 diabetes are more susceptible to depression. Although healthy older adults have lower rates of depression than the general public, depression is still a common problem that is easily missed. It’s more common in those who are struggling with illness, involved in caregiving, or socially isolated. It’s important to spot and treat depression, as this is key to better quality of life and greater involvement in social activities. It can also enable older adults to better manage any health problems they have, such as chronic diseases, type 2 diabetes, or pain.

One important sign of depression in seniors is “anhedonia,” which means one stops enjoying activities that used to bring pleasure. If you notice this in an older person, or yourself, it’s important to get help. Studies show that medication and psychotherapy are generally equally effective in mild-moderate depression, but non-drug treatment often isn’t offered unless you ask. Among medications, the selective serotonin reuptake inhibitors (SSRIs) sertraline and escitalopram tend to have fewer side effects and drug interactions. Avoid paroxetine (Paxil) as it is anticholinergic, which means it dampens brain function.

For more information:

• Depression in Older Adults and the Elderly
• Pharmacological Treatment of Depression in the Elderly (review article written for family physicians; walks the reader through a nice real-life example)

My blogs:

http://bobsdiabetes.blogspot.com/2015/02/do-you-understand-depression-part-1.html

http://bobsdiabetes.blogspot.com/2015/02/do-you-understand-depression-part-2.html

http://bobsdiabetes.blogspot.com/2015/02/do-you-understand-depression-part-3.html

http://bobsdiabetes.blogspot.com/2014/11/lessons-for-people-new-to-type-2_30.html

http://bobsdiabetes.blogspot.com/2014/05/five-distinct-types-of-depression.html

http://bobsdiabetes.blogspot.com/2012/01/some-blogger-suggestions-for-handling.html

http://bobsdiabetes.blogspot.com/2012/01/depression-and-diabetes-cycle.html

http://bobsdiabetes.blogspot.com/2012/01/types-of-depression.html

http://bobsdiabetes.blogspot.com/2011/08/depression-under-diagnosed.html

Number 4 of 8 blogs.

Seven Neglected Areas That Sabotage Healthy Aging – P3

Memory concerns often cause anxiety for older adults and their families. They may, or may not, reflect decreases in thinking abilities.

This is when evaluation helps by providing a more objective measure of whether a person is cognitively impaired, and to what extent. Even more importantly, evaluation can uncover treatable causes of decreased brain function, such as medication side-effects, thyroid problems, and a variety of other problems, which are common in older adults. Remember that diabetes has a link to Alzheimer's disease.

People are often reluctant to have memory concerns evaluated because they are worried that it could be Alzheimer’s disease or another dementia. They also may believe that “nothing can be done.” It can help to tell people that we can often find ways to improve a person’s brain function, either by identifying and treating an underlying health problem or by encouraging the activities that promote brain health.

For more information:

• What’s Causing Your Memory Loss? It’s not necessarily Alzheimer’s
• Is It Really Dementia?
• How We Diagnose Dementia: The Practical Basics to Know
  

My blogs:

http://bobsdiabetes.blogspot.com/2015/04/alzheimers-disease-part-1.html

http://bobsdiabetes.blogspot.com/2015/04/alzheimers-disease-part-2.html

http://bobsdiabetes.blogspot.com/2015/04/alzheimers-disease-part-3.html

Number 3 of 8 blogs.

Seven Neglected Areas That Sabotage Healthy Aging – P2

This series is important and everyone needs to know something about this as they age and/or their parents age. I will be using people (including myself) with type 2 diabetes as examples and for most of the discussion. I will be listing some of my blogs that are on topic where I have blogs. I found this information in a blog by Dr. Leslie Kernisan.

Falls are problems for many as they age. People with type 2 diabetes are at risk and risk generally more severe injuries because of diabetes. Falls are common for the elderly. Many falls cause only minor injuries, but they are scary and can cause older adults to restrict their activities. In fact, fear of falling is common and has been linked to decreased involvement in activities. It is also a risk factor for future falls.

More injurious fall can cause life-changing injuries such as broken hips and head injuries. These falls are a major reason for people having to leave their homes.

Most falls in the elderly are due to a combination of underlying risk factors or health problems. Insufficient strength or balance is usually one of the problems. This can be addressed with the right exercises, but it’s good to check for other factors, such as medication side-effects or even a new illness.

For more information:

• CDC STEADI Materials for Older Adults (see here for PDF to check your risk factors)
• Why Older People Fall
• How to Prevent Falls: 5 Proven Approaches to Ask the Doctor About
• 8 Things to Have the Doctor Check After an Aging Person Falls
• NIHSeniorHealth Balance Exercises for Fall Prevention (includes videos)
  

My blogs:

http://bobsdiabetes.blogspot.com/2014/05/this-may-be-partial-cause-of-falls-in.html

http://bobsdiabetes.blogspot.com/2014/06/new-glasses-for-elderly-often-equals.html

http://bobsdiabetes.blogspot.com/2015/10/more-causes-for-elderly-falls.html

Number 2 of 8 blogs.

Seven Neglected Areas That Sabotage Healthy Aging - P1

A Healthy Aging Checklist summarizes the six fundamental activities recommended when asked what to do to maintain the best possible health while aging.

The following are some of the points promoted for healthy aging:

1. Promote brain health and emotional well-being.
2. Promote physical health.
3. Check for and address common senior health problems (such as falls, memory concerns, depression, incontinence, pain, isolation, polypharmacy).
4. Learn to optimize the management of any chronic conditions.
5. Get recommended preventive health services for older adults.
6. Address medical, legal, and financial advance care planning.

In the next seven blogs, I’ll cover the third item above addressing commonly neglected senior health problems that routinely sabotage healthy aging.

These issues are sometimes referred to as geriatric syndromes. They affect health and quality of life, and although they happen more in people who are older or frailer, they affect countless people in the 60s and 70s as well.

Virtually all of these issues affect a senior’s ability to socialize, be physically active, and take good care of himself or herself. So discussing these is key to helping you be healthier while aging, or help you guide a parent to be healthier in their aging.

Unfortunately, these issues routinely fall through the cracks of usual medical care. People often suffer from these problems for years without anyone taking effective action. This may be because many people, doctors, seniors themselves, or family members, assume nothing can be done about these, and that they are just “part of getting old.”

Don’t believe that. These problems are studied in geriatrics and most of the time, correctly evaluating and then managing these problems helps older adults and their families feel better, live better, and sometimes even live longer.

Remember, healthy aging is not just about preventing problems. It’s also about spotting them and addressing them before they get worse, or drag down the rest of your health and independence. So, for healthier aging, be proactive in checking for these oft-neglected problems.

Then remember: sub-optimal treatment of these problems is all too common. So you’ll need to be proactive about getting them correctly managed, which might mean either seeing a geriatrician (if you can find one) or making sure your usual doctor is thinking like one.

Now, I’ll admit that it can be very difficult to completely eliminate the problems talked about, in some older adults. You have to try, especially if the problem is bothering you or interfering with life activities. In addition, you have to find professionals who will use the best-available knowledge to help you, do so.

When we make a good effort, we can almost always improve our (yes, I am considered in the elderly group) ability to be out in the world, doing the things they want to be doing, and doing things that are good for our health. This promotes healthy aging. So don’t let these problems fester and sabotage late-life health. Let me know below if you have questions.

Number 1 of 8 blogs.

Resilience to Better Manage Diabetes

The concept of resilience is something people with diabetes need and many understand the need. A positive attitude goes hand in hand with resilience and is also part of being resilient.

Resilience is the ability to recover readily from illness, depression, adversity, etc. Characteristics associated with resilience include optimism, an active or adaptable coping style, and the ability to tap into social support.

A study published in the Journal of the American Academy of Nurse Practitioners in 2011 showed that high levels of resilience were significantly related to lower HbA1c levels indicating better glycemic control.

Another study with similar results was published in the British Journal of Health Psychology in 2008. It showed that those with low and moderate resilience levels showed a strong association between rising distress and worsening HbA1c results. Those with high resilience scores didn't show this same association.

Some people are fortunate enough to be born with a high level of resilience, but even if you're not one of them, there are things you can do to boost your resilience. The American Psychological Association offers the following 10 suggestions for building resilience:

• Make connections: Good relationships with close family members, friends or others are important.
• Avoid seeing crises as insurmountable: You can't change the fact that highly stressful events happen, but you can change how you interpret and respond to them. Try looking beyond the present to how future circumstances may be better.
• Accept that change is part of living: Certain goals may no longer be attainable as a result of adverse situations. Accepting circumstances that can't be changed can help you focus on circumstances that you can alter.
• Move toward your goals: Develop some realistic goals. Do something regularly, even if it seems like a small accomplishment that enables you to move toward your goals.
• Take decisive actions: Act on adverse situations as much as you can. Take decisive actions rather than detaching completely from problems and stresses and wishing they would just go away.
• Look for opportunities for self-discovery: People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss.
• Nurture a positive view of self: Developing confidence in your ability to solve problems and trusting your instincts helps build resilience. A positive attitude really helps in the confidence factor.
• Keep things in perspective: Even when facing painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.
• Maintain a hopeful outlook: An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.
• Take care of yourself: Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly.

Living with a chronic disease such as diabetes can be stressful and demanding. Arm yourself with the power of resilience and a positive attitude for success.

Understand Your HbA1c

The HbA1C test is known as the A1C test by most people. The A1C test measures the blood glucose level for the last four months. The prior month accounts for 50 percent of the A1C. The month prior to the last month accounts for 25 percent of the A1C, and the third and fourth prior months contribute the remaining 25 percent of the A1C value.

Doctors use the A1C value as a measure of how well you are managing your diabetes or not managing your diabetes. This is the reason we as patients need to use our meters to measure our daily blood glucose readings.

If you did not have diabetes, your typical A1C level would be about 5 percent. For people with diabetes, the experts can't agree on what the A1C target level should be. The American Diabetes Association (ADA) recommends an A1C target of less than or equal to 7 percent. The American Association of Clinical Endocrinologists (AACE) recommends a target of less than or equal to 6.5 percent.

Hemoglobin A, a protein found inside red blood cells, carries oxygen throughout the body. When there is glucose in the bloodstream, it can actually stick (glycate) to the hemoglobin A protein. More glucose in the blood means that more glucose sticks to hemoglobin, and a higher percent of hemoglobin proteins become glycated.

Once glucose sticks to a hemoglobin protein, it typically remains for the lifespan of the hemoglobin A protein — as long as 120 days. The A1C test measures how much glucose is actually stuck to hemoglobin A, or more specifically, what percent of hemoglobin proteins are glycated. Thus, having a 7% A1C means that 7% of the hemoglobin proteins are glycated.

This is where disagreement often comes into play. For people with well-managed type 2 diabetes, visits to the doctor may only be required twice a year. However, for those that have poorly managed diabetes or are on insulin (not that these people have poorly managed type 2 diabetes) probably will see their doctor at least four time per year. Always be prepared to see the doctor on a different schedule.

The A1C test, typically performed by a health care professional, often doesn’t hurt. Only a single drop of blood is needed, and the sample is either analyzed on-site or is sent to a laboratory for testing. Some doctors prefer doing the A1C test from a blood draw.

While the A1C is a good measure of overall glucose control, it cannot replace self-monitoring of blood glucose (SMBG). Like other tests, A1C results may vary from lab to lab. The A1C test is not calibrated the same everywhere, though an international effort is underway to standardize the A1C test to a new International Federation of Clinical Chemistry and Laboratory Medicine standard.

A1C results can be misleading when red blood cell survival is prolonged or reduced; some health conditions can result in falsely high A1c results (as in cases of anemia) or falsely low (as in cases of hemolysis). There are other factors that can affect the A1C results.

One piece of good news: When someone has his or her A1C checked, that person does not need to worry about fasting; food eaten on the same day won’t affect the score.

See a Podiatrist If You have Diabetes – Part 2

This is something I will criticize many doctors and even patients with diabetes for not doing. There are many things that you can do at home, or your spouse can help you with these suggestions.

Check your feet daily: This is especially important if you have been diagnosed with a loss of sensation or neuropathy. A quick visual inspection will do - check the bottoms of your feet and between your toes. If you notice a change - an open cut that isn't healing or a fungal infection contact your doctor or podiatrist.

Wear protective shoes: Do not walk around barefoot or in open toed shoes. If you have any type of neuropathy, you may not sense a hot surface or an object that is caught on your foot. It's important to purchase protective shoes that conform to your feet. Avoid getting shoes that fit too snugly, which can increase the risk of rubbing your feet, creating blisters or broken skin.

Shake out your shoes before putting them on: You never know what has made its way into your shoe - a pebble, your dog's toy - shaking out your shoes reduces the risk of foot injury if you have neuropathy. Also, some spiders can bite a toe and you may not know it until it becomes a large sore. Depending on where you live will determine how carefully you need to shake out your shoes.

Dry well between your toes: Excess moisture can be a breeding ground for fungal infections. After bathing or showering, it's important to dry your feet well especially between your toes.

Keep good hygiene: Change your socks daily. Purchase cotton socks and do not go sock less in your shoes.

Do not apply lotions between your toes: Avoid putting lotion between your toes, because this can increase the risk of fungal infections. You can apply lotion to the heels of your feet to prevent dry, cracked skin.

Avoid nail salons: Getting pedicures at nail salons may not be the best idea. Nail salons can be a breeding ground for bacteria and fungus. You might be better off getting a 'pedicure' by your foot doctor where you'll know that your nails will be cut straight across and not too short with sterilized tools. If you must go to a nail salon, request that they clean the foot bath in front of you and purchase your own set of tools or bring your own from home.

Following or doing the above is important and gives you a better chance to avoid some foot problems. With diabetes, we are more susceptible to foot problems and good foot care is needed. Several of our single support group members have mirrors that they use to look at the bottom of their feet and they also see a podiatrist at least quarterly. This is something that the support group emphasizes and we have had foot inspections one time for everyone. Yes, there was some grumbling, but when it was done, everyone was glad it was done and had more questions of the two podiatrists that participated.