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Geriatrics

Dr. Robert A Murden is a Professor of Clinical Internal Medicine in the Department of Internal Medicine and the Division of General Internal Medicine at the Ohio State University. He is the author of over 35 articles and book chapters on a variety of medical topics in Geriatrics, General Internal Medicine, and medical education.
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  •  My 93 year old mother had an ischemic stroke 9 month ago. She recovered miraculously, she eats right and exercises, but she lost a lot of weight and muscle mass. Her medications for heart are monitored, and all seems OK. Still she's losing a lot of weight and strength. What could be causing the rapid weight loss?

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  • How can I tell my 89 year old father-in-law that he needs to pay better attention to cleanliness and hygiene? He seems to not be showering and wearing clean clothes anymore. Is this a sign of dementia? 

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  • My dad is 77. He is relatively fit and healthy. He has never drank alcohol or smoked. Lately his voice is weaker and strained at times. He is stubborn about seeing a doctor. Have your any ideas why this might be happening? 

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  • My 93 year old father does not have a serious medical condition. Due to his age, he has age related medical issues. He no longer can drive. His doctor is pulling his license Thursday. I am the only caregiver left around to take care of him. He needs me and my hearing (he does have hearing issues and already wears hearing aids) to drive him to his appointments. Do you know if I can take FLMA for this type of assistance? If so, I'm unclear what to put on the FMLA paperwork for his "medical reasons." Any information you can provide will be a big help. 

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  • My 86 year old dad has a foley catheter and has a UTI infection. The problem is he has been on antibiotics for two weeks and the infection has not cleared up. They have taken two cultures and have changed the antibiotics, but nothing seems to work. What could be the problem? 

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  • My father is 86 with dementia and in a wheel chair. He's also diabetic, but not on meds for it--diet helps him. UTI infections are ongoing. He has had prostate issues for over 30 plus years, and he's currently on Flomax. The problem is that the pill form of antibiotics isn't working anymore and he has to have IV meds. His UTIs are happening very 6-8 weeks. He's had what I call the "rotor rooter" surgery for the urethra—they found over 200 jewels was the term I remember 2 years ago. Now it seems his UTIs are coming more frequent. He just got out of hospital for one 3 weeks ago and we think he's got another. He had a culture taken today to find out for sure. We just can't get him to drink enough fluids. He's on cranberry pills 3 times a day. I give him Crystal Light a lot because he hates the taste of water--at this point anything to change the taste of water! My question is this, does it seem or sound like he's spiraling down in his health, that his final days are coming sooner then later? 

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  • I am writing as I suddenly found my feet and ankles were quite swollen. The swelling has gone down to normal. I read the article regarding Peripheral Edema, especially that the most common cause is heart failure. Although the swelling has gone down to normal, should my doctor request the tests, especially heart, kidney and liver tests. 

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  • My mom has been in the hospital for 3 weeks. She had to have a feeding tube inserted and since then she hasn't been awake. The doctor is trying some kind of medicine to bring her out of the sleepy state. What is the name of the medicine he is using? 

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  • My 90 year old mom had a stroke and can't swallow. She has a feeding tube in her stomach. How do I keep her mouth moist? 

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  • My mother in law is diabetic and keeps falling out of bed at night and not remembering it. What could cause this problem? She is also on dialysis. 

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  • My mom is 88 and has been having UTIs for some time. She seems to be getting them one after the other. She has been on so many antibiotics that some no longer work on her. How does the UTI affect the rest of her organs since she has them so often? 

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  • Four weeks ago our 88 year old mother sustained a broken arm from a fall. Prior to the injury she was living alone and oriented. Now she has 24-hour aides due to nighttime disorientation and confusion, which we presume is due to the fact she is not sleeping at all. The aides say she is up 50 times a night. Sleeping pills do not help. Her healing is not going well. In the daytime she is lucid, awake and oriented. She takes a few naps of 20 minutes duration only. Pain was contributing factor early on, but that seems managed now, but still no sleep. Suggestions? We fear she is on her way to SNF because she can no longer afford the aides, which cost $3000 a week.  

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  • I have an 88-year-old female friend, a diabetic, who keeps her sugar levels very well regulated by insulin. Up until several days ago, she had no problems with her vision. She has had an eye examination within the last year and was told that her eyes were fine. She does wear bifocals. Up until this problem with her vision, she has been able to do crafts, read and navigate on her own. She also has had cataract surgery in the past. Can the lenses become blurry over time? This is a question she has asked me. I told her that I would go online to do research. I told her that she should get to her eye doctor asap. 

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  • What is a supplement to help with lack of energy in the elderly?  

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  • My doctor of several decades quit because of health care reform. Now we cannot find a doctor. Yesterday, Peacehealth Hospital and our Providence Medicare insurance tried to find us a doctor. No one will take us as patients because of Medicare. What are we to do? 
 

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  • My 93 year old Mother is complaining that her eyesight is getting worse. She had cataract surgery 8 years ago. She is completely chair confined, incontinent, and takes pain meds for arthritis, blood pressure and allergies, and stool softeners every day. She is starting to say that her vision is getting worse. Is this age? We try and watch about her becoming dehydrated. 

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  • My 75-year-old mother-in-law lives on her own. She is having visual, auditory and olfactory hallucinations. She believes the neighbors are persecuting her and trying to get into her house. She is repeatedly bothering the police. She has always been secretive and rather difficult to get along with. We suggested security cameras for her house, but she is still afraid and lives in fear of the “people” who live on her roof and are drilling holes into it, etc. The symptoms have been going on for a couple of years and are getting worse. My husband and I can't get her to go in for a medical checkup as she states that she is not crazy and there's nothing wrong with her glasses or her hearing aid. We do not know who her doctor is. She says she's been taking care of herself all these years and doesn't need our help. She clearly does. 

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  • My mother in law whom is 96 no longer knows when she is going to have a bowel movement. Therefore, she is going in her pants. We took her to a urologist and he gave her an antibiotics however, it did not help her. We have started to give her fiber. However, this has not helped yet. What can we do? The doctor said he could not help her because he only deals with urine problems. She seems to be in good health and goes out with friends. However, we are afraid they will not want to take her out if she continues to mess in her pants. Please help! 

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  • My mother, age 69, recently began losing weight, has constant anxiety, loss of appetite, and instant belching/gas when we can get her to eat. She complains of a knot in the pit of her stomach, she is constipated, and recently had a UTI. We took her to the doctor and he diagnosed her with depression and put her on prozac. She was on it for 4 days when she tried to harm herself. The ER ran blood work and took urine, also did CT scans of her abdomen, which came back clear. I am very concerned because up until a month ago my mother was the epitome of health. The last time she was in the hospital was giving birth to me 37 years ago. This was almost an overnight change. Can she really just go down hill this fast from depression? Could there be something else going on with her?  

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  • I am 81 and have mild hyperglycemia (readings up to 104). I heard that a possible solution is to have breakfast regularly with whole grain foods. Would you please comment? 

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  • My 94 year old Dad was diagnosed with UTI. He has finished his antibiotics, but he still very tired and his memory is still impaired. How long might these new changes to his behavior continue or is this his "new normal?" Also any suggestions as to how to have him wash his hands more regularly? 

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  • I am a Geriatric Care Manager and currently have an elderly female client who is incontinent. She is able to manage during the day, but does not awaken during the night to toilet herself and therefore is unable to stay with out-of-town friends overnight as she had been in the habit of doing. A relative of hers (MD) has developed a very detailed behavior management care plan for her, which included weighing wet incontinence briefs in the morning, etc. which my client isn't inclined to be doing. I am asking if there is a more reasonable approach to managing this problem? Thank you for your consideration! 

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  • My 80 year old mother in law has dementia and it seems to be rapidly getting worse. She is pretty strong physically. I try to take her out and visit to ease some of the burden on my husband, but she is very demanding of his time and attention. Her daughter lives far away and is unable to help (she lives about 5 minutes away from us). She is very restless at night and has called the police twice. She often calls my husband in the middle of the night for various issues, usually loneliness. She is resistant to anyone’s attention other than my husband. I don’t know what to do to help. Please give any suggestions. 

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  • My gramma is 93 and on pain meds. She always feels dehydrated, even though she drinks an ample amount of water. She also drinks Gatorade from time to time. Any advice on the best drinks, sports drinks or otherwise, to eliminate her frequent urination and dehydration? She has seen many doctors, to no avail.
     

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  • Our family cares for my 88 year old mother who, in the past eight months has had 3-4 UTIs. She has had Parkinson’s for over 20 years and is incontinent and uses pads. We bathe her every day and we see that she changes her pads frequently. Her cultures have shown E.Col and another bacteria. She has successfully used courses of Cipro. We have her on cranberry juice daily. Here are my questions: 1. Are the home strips to check for ua infections reliable for use? 2. What courses of preventative treatment can we take to decrease her infections? Daily antibiotics (after culture and sensitivity)? 3. Is a 5 day course of Cipro effective? (her MD prescribed this). Thanks so very much for your time!! 

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  • I had urine leakage 2006 when I started bleeding seriously. I can’t move without a pad, and I must change it three times during the day and at night. Since then I have not had sex with my spouse. What is the permanent solution? 

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  • My 81 year old mother-in-law has recently had a silent MI. She has a clot in her artery, which is being treated with Warfarin injections. She had had a fall a week before, cutting her head and scalding herself with tea. When she went into hospital we were told she also had a chest infection and a UTI. She reacts badly to some medications including statins and would be quite allergic to many things. None of the doctors have so far told us what the longer term outlook is for her. What can we expect? We're so worried. 

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  • My dad is 92. He had a stroke 6 weeks ago, but has recovered and is home following a 4-week stay in rehab. They inserted a Foley catheter, tried to take it out once, but he had groin pain and then reinserted it. When we went to the urologist, he suggested that we keep in the Foley catheter and have a nurse change it monthly. He also said that most elderly patients with catheters do have infections and he would not want to give antibiotics because that would cause a superinfection—we should look out for fever, chills or confusion. What are the downsides of keeping of keeping the catheter in? 

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  • My 92 year old Father has wet AMD. He was certified blind about 6 months ago. So far he has managed his disability well with the support of the family. My question: Just recently he has been complaining of "rolling eyes." Can you explain this? I think it’s just re-assurance he needs. Thank you.  

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  • I am worried about my parents. My dad is a diabetic and has been for a while now, but doesn’t check his sugar—he used to be really good about this, now he doesn’t check it and the paramedics have been called on several occasions when his sugar has bottomed out (to 25 the worst). He has prostate cancer and is incontinent, not really doing well at all. My mom also diabetic and we think she has Alzheimer’s, but doesn’t want to get checked for it—when we even mention Alzheimer’s, she gets very upset (her mom had it). She doesn’t take care of herself at all. She just stares at the floor all the time. I asked her what happened to my mom that had a lot of zest for life—she was always joking around with people, the life of the party, but she has lost her zest for life and now says she wants to die, she doesn’t want to live anymore. This breaks my heart. I don’t know what to do for them anymore. I have begged them to come live with one of us kids, but they want no part of it, yet also can’t and don’t take their medical conditions seriously. I worry about my parents living by themselves and their health and mental health. What do I do as a daughter? I love my parents and want them around for a long time. Please help.
 

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  • I have an 87 year old father who complains of weakness. Doctors have found nothing wrong. They have suggested adding more protein to his diet. Can you please suggest a protein drink that would benefit him, add energy and muscle strength. Can I add whey protein to Boost or Ensure? How much protein is too much? 

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  • Hi, my mum is 65 and she is very weak and always feeling tired. Just recently she had a severe chest infection and since then became very weak. Is there any kind of supplement or vitamin which she can take to boost her energy? Many thanks. 

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  •  I've suffered from incontinent for the last 2 years and get frequent urinary infections. Can this be prevented?

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  • Recently my Mom was in the hospital because of a UTI and was diagnosed dehydrated and anorexic, and had a blood sugar of 20. When I heard this I was alarmed because in the past her appetite was good. There has been a frequency of UTIs and her eating habits have changed. My biggest concern now is to do whatever it takes to hopefully prevent another infection. Can you tell me after she takes all of the antibiotics, how many days after should her urine be checked to determine if the infection is out of her system? 

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  • I am a caregiver to my Mother who is 99 years old. She has been experiencing recurring UTIs. I am wondering since she has characteristics like senior dementia during those episodes, what lasting effect does that have on her brain?  

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  • Dad is 93 and takes heart, blood pressure and prostate meds and allergy pills. He has a loud heart murmur. He is not eating right and won't drink enough fluids. He likes to drink wine and beer, but doesn't drink more than a glass of wine a week and can of beer a week. What am I doing wrong? Should he have Ensure every day? Please help. Thank You! (Last year he had a partial hip replacement. He was recently in the hospital for pneumonia. He's at home now.) 

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  • My Mom is 85 and in a nursing home. On Sunday she was very weak and lethargic. She was diagnosed with a urinary tract infection and started antibiotics on Monday. She is still weak, cannot walk by herself with her walker and needs assistance. Is this normal with a UTI? 

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  • While in rehab, my 93 year old mother was put in adult diapers with extra pads at night so she wouldn't have to get up in the middle of the night (she has mobility problems). We decided that was the safest thing for her and she is now used to wearing them every night. But one adult diaper with three extra pads (highest absorbency) aren’t enough and she still soaks her bed several nights a week. Besides using mattress protection, do you have any advice? 

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  • My friend's grandmother is having difficult swallowing food to the point that she is gagging and losing her appetite. She had been ill previously with a virus that has seriously affected her gag reflex. She is under the care of a doctor, but we are wondering what adult supplement drinks can she drink that are NOT thick. 

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  • Is it possible for UTI symptoms to be caused by sitting on a non-leather or plastic chair? I have recently changed from a cloth office chair to a plastic type chair. I have noticed irritating symptoms near the anus. Occasionally, I have a sensation that I have to urinate (only when lying down). I go to the restroom and urinate only a little. Go back to bed and no problems. The doctor has checked a specimen with no infection detected. This has gone on for a couple of weeks. For now, I'm switching back to my OLD chair to see if it improves.  

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  • My mother lives with my wife and I. She is 91 years old and of sound mind. She has never had the best hygiene habits. She always thought washing up was good enough. She has now gone over a year without a bath or shower. We have a nice shower at our northern home. Here in Florida for the winter, we have a shower, but it would be troublesome for her. Her brother has a shower and extra bedroom at his house, but of course she refuses that, too. Needless to say she is pretty ripe. I just don't know what to do. One day she is going to die and I don't want people saying it was my fault that I didn't do anything about this situation. Please advise.  

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  • I have recently become incontinent and had several test done by a neurologist. My issue is do to an old c3/c4 injury, which has been over time restricting and/or pinching the nerves that control the proper bladder function. I was told after several tests that the nerves have been restricted, which in turn over time have not been feeding the nerve cells what they need to stay healthy, and they have died. The doctor cannot guarantee that the nerve cells will grow back once we deal with the restriction, so I may be incontinent for life. Do you think I should get another opinion? 

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  • My Dad just turned 90 years old. He has emphysema and is on four different inhalers a day. He is on oxygen 24 hours a day. Now he has lost all taste—food has either no taste or, as he says, taste like dust. Is there anything he can do for this? 

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  • My aunt moved into an assisted living facility after my uncle died. She has early dementia, but is able to function somewhat independently, in spite of being wheelchair-bound. She forgets to call for help though and falls transferring in and out of her wheelchair. Her falls have been occurring more frequently, lately 2 or 3 a month. The Assisted Living facility tells me that they can provide for her, but I am not so sure they have the staff to properly supervise her. She’s already fractured a hip, and minutes ago, got home from the ED with a fractured clavicle. Isn't the next step a nursing home? I'm not sure that would be any safer.... 

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  •  My 92-year-old mother has been diagnosed with ExtraMammary Pagets Disease. Her gynecologic oncologist recently said that the Paget’s has turned into full-blown skin cancer at the border of the Paget’s, and he wants to remove a small section to slow down the cancer growth. What type of skin cancer would this be? What is the future regarding metastisizing of the cancer? Mom is considering the surgery (as strongly encouraged by her oncologist) to remove this small section of tissue, but is very uncertain. She is terrified of not being able to walk because of the surgery, recuperation period, etc.

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  • My mom is in the nursing home and has had frequent UTIs, which can be picked up on immediately. She makes no conversation at all and her eyes look as if they have a film over them. (Would this be a symptom of a UTI?) The doctor put her on a low dosage antibiotic, but she continues to have the UTIs. She is acting as if she has one now. When I contact the doctor, he had her tested, but said he most elderly patients will test positive for a bacteria infection in their urine, but he cannot continually keep her on antibiotics because she will eventually become immune to them and when she needs an antiobiotic for other ailments, it will do her no good. Could he change the type antibiotic for any other ailment? Also, if she is not going to be responsive with the UTI, wouldn't it be better for her to be on the antibiotic? I am not bashing her doctor—I feel as though he is saying in around about way there is nothing more he can do. 

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  • My father is 96 and totally aware and able to take care of himself. He is in basically good health except that he has lost most of his hearing. He wears 2 hearing aids that may at times give him some help, but generally not. He reads papers, etc, and is on top of current events. My dilemma is how to help him with communications so he is more involved when in company. My last resort seems to get different sizes of dry erase boards so he can take them with him for people to write things and share with him. There MUST be something better. My father has not technical skills and therefore, an iPad type seems to not be quite appropriate. When we were kids, we used to have these little pads you wrote on, pull the top up and it erased...again, too simplistic. There must be something to help elderly with hearing loss so they can communicate without having to learn sign language, which is just too difficult at this point in his life and no one else knows it as well. Any help is greatly appreciated.  

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  •  Mom's personal hygiene is not attended to...how do I talk with her to allow someone to help her with showers?

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  • Is there anything out there to help regain eyesight after suffering a stroke?
     

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  • My friend's husband is in a nursing home. He is paralyzed on one side and was recently started on Klonopin for anxiety. The nursing home won’t use a bedrail with him (they took them away from all the patients). They said the "government" made them stop because a study showed the bedrails were dangerous. My friend's husband has fallen out of bed twice since they took away the bedrail and has had to be hospitalized for one fall. He has returned to the nursing home and they still won't use a bedrail. What should we expect as far as use of a bedrail? They said there was no waiver she could sign to allow it.
     

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  • A recent EKG taken to give clearance for me for cataract surgery revealed, according to the on-call doctor, that I had had two previous heart attacks. No time in my 81 year history have I experienced anything like a heart attack. I have survived rectal cancer and the surgery, chemo and radiation. I get a little out of breath when I walk too far. I take yoga, live alone, drive, and thought I was in good health. How could I have experienced a heart attack and not known it. I know about silent heart attacks in diabetics, but I am not diabetic. I have had stress tests and cat scans. 

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  • I visit a 93 year old woman every week. Over the last six months I have seen a decline in her mental state. We use to sit and talk for an hour. Now we cannot have a conversation because she will not stay seated. She gets up constantly and walks, with her walker, in circles in the room. She does this all day long. It is exhausting for her and her caregivers. Any advice on why she wanders and what we can do to help her? 

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  • My 93-year old father spends many hours a day in bed and has(sometimes) several bowel movements a day. He doesn't eat much, but what he eats is normal fare–toast, meat, some vegetables, etc. He also drinks orange juice and Coca-Cola. Is it normal to have several messy movements? What might cause this? His only medications are Omaprazole, Ranitidine and Sucralfate.
     

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  • My stepfather has gone from being very active to dragging his feet and falling within a short period of time—he has no dizziness, extensive scans and bloodwork are all negative and only normal shrinkage of brain for 72 years of age. Any ideas?
     

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  • I have severe neuropathy of the feet. The pain is almost unbearable at times. I take 300mg of Lyrica a day. I also use an electric stimulator called the Rebuilder 300 once a day. I use a topical cream with capsaicin twice a day. All of these seem to help some. Is there anything else I should be doing to ease or stop the pain? My last A1c was 6.8. When I test after a big meal my usual range is 150. My fasting is about 90. Please help. Thank you.  

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  • My 86 year old dad has had some health problems for the past 8 years, namely prostate and bladder cancers, also, very serious sepsis and frequent UTIs. He was depressed and his dpctor prescribed lexapro, which was intolerable for him. Next was xanax, also intolerable. During this time it was discovered that the levequin he was given was also not agreeing with him. So he was taken off those, prescribed ativan and has been on it for several months. We cannot however manage the dosing. We've tried everything and cannot get it right and his primary doctor doesn't really help. Now he's taking 1 mg every 4 hours, which I think is too much. He's lethargic, tremoring, depressed, cannot walk without help, speech is mumbled, sleeps most of the time and sometimes he sees things that aren't there. He does not have dementia, knows everyone, knows what's going on and has said “I don't know what's wrong with me.” He is able to answer if you ask him a question, knows the year, day, etc. We just don't know where to turn to get him better. I believe it's the ativan causing all of these symptoms but family members disagree. I know there must be a doctor who can help, but not sure which specialty. Can you advise? 

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  • In an older adult, what can be the number one cause of hypotension--is it low sodium diet, gastrointestinal bleeding, antihypertensive agents or early urosepsis?

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  • Q:

    Is there an alternative to catheterization for urinary retention?


    Suzanne from FL
    A:

    This depends on the cause of the retention. Retention can be due to a physical blockage, like a large prostate in men, to the bladder muscles being stretched so much from a prior blockage that they do not work anymore, to medication that blocks the bladder muscles from working, or to the bladder muscles not working to empty the bladder caused by the nerves to the bladder not working. Most commonly the latter comes from a disease such as diabetes.

    If it is due to medications, the medications causing it can be stopped and sometimes the retention will resolve.

    If it is due to a prior blockage stretching the muscles, initially it is treated with catheterization, but sometimes it improves with time and the person no longer needs a catheter.

    If it is due to the nerves not working from a disease like diabetes, there are medicines that help sometimes, but other times they are not enough and a catheter is still needed.

    If it is due to a physical blockage, then a catheter is needed. If a catheter is needed, it can be either an indwelling catheter that is there all the time, or intermittent catheterization when the person puts one in 3 or 4 times a day to drain the bladder, and then removes it. This works in some cases and reduces the chance of infection if done properly.

    You would have to find out the cause of the retention and whether an intermittent catheter would work from the person’s physician.
     

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    Q:

    My father is 94 years of age living in his home in New York State. Two weeks ago he had a Foley catheter placed due to strictures in his urethra. He drinks some water but not enough. This morning his balance was so poor that he was unable to get out of bed without help. I feel that he is severely dehydrated. Should we get him medical attention? Is the catheter causing dehydration? 


    Linda from CO
    A:

    You have two questions. The second one is easy—the catheter is not causing dehydration. It can be uncomfortable and lead to infections, but not dehydration. The first question is tougher. There is a long list of problems that could cause him to have poor balance. At the least you should call his physician to discuss whether he should go in for a visit to evaluate this problem. 

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    Q:

    Do you think a 92 year old should have to stay awake after 5:30pm to 10pm? Do you think at 92 you should be able to eat the food she likes? 


    Judy from NY
    A:

    This is a very interesting set of questions and the answers are not at all straightforward. It would be interesting to know if this question is from a 92 year old who is being pestered, or by a caregiver who is uncertain what to suggest.

    In terms of bedtimes, there are no recommendations for people in general for their health. There also are no generalities for aging and bedtimes. Once people stop working, so that their bedtimes no longer are controlled by outside demands, people tend to revert to their natural tendencies of being either early risers or night owls. I have many older patients who stay up until 3am and sleep until noon, and others who go to bed at 7pm and arise at 4am. No one pattern is preferred.

    Why is the question being asked? If the 92 year old is in a nursing home, he/she often have limited options as to when to offer food and medicines, which can alter people’s natural bedtimes and are often unavoidable. If the person is in the community and living with others, there may be issues of noise or other people’s bedtimes that need to be negotiated, as neither the older person nor the people he/she lives with have the right to absolutely dictate bedtimes to others, so it becomes a negotiation. If the older person lives alone, they can go to bed whenever they want.

    In terms of foods, it depends on the person’s overall health and priorities related to that, and on the person’s specific health conditions. For older people who are losing weight, not from a specific correctable cause, the important need is calories more than good nutrition, so ice cream all day is often great. For people with a very short remaining life span they should eat whatever makes them happy. For 92 year olds who hope to and expect to live several more years, choice of food may be much more important. Cholesterol- lowering diets and medications take up to three years to make any real effects so someone who does not expect to live longer than that need not worry about fats. However, someone with severe diabetes could die in a few days from eating the wrong foods so if they want to live many years they should not eat what they want if that is food high in sugar. It all comes down to a person’s health problems, and their personal desires as to how to live their lives.
     

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    Q:

    My 82 year old father had prostate radiation in 2008, then was diagnosed with a low grade bladder cancer in January 2013 that was successfully removed. Since then, he has suffered urinary blockage followed by catheters for periods varying from three or four weeks to three months. When the catheter is removed, he is partially incontinent for two to three weeks and hardly gets any sleep during that time. One urologist suggested a TURP intervention because the blockage was due, in his opinion, to prostate scar tissue related to the radiation, but his own urologist refuses to entertain this because of his age. The only medications he takes are Flomax and a baby aspirin, both daily. Should he ask his own urologist for a referral to another specialist? 


    Pierre
    A:

    It would be hard for me to say what the cause of this is, but since it does bother him a lot I would suggest a referral to another specialist. At 82 he is not old at all for minor surgery and that should not limit him if the procedure will help. 

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    Q:

    My grandmother is 77 and has dementia. I take care of her 5 days a week. She has incontinence. Her doctor has told us that she's not drinking enough water. Part of it is that I believe her train of thought is that if she drinks more she will go to the bathroom more often. Another issue is that she is just not thirsty—she will complain about being dry all the time (mouth, eyes, skin), but says she's not thirsty. Is there any way I can get to increase her water intake for her health? 

     


    Ashley from NC
    A:

    As people get older one of the changes everyone goes through is that the thirst response gets worse, meaning that if older people are dehydrated they still do not feel thirsty so do not drink enough. There is no treatment for this so all we can do is tell people they have to drink more than they think they should, and to drink regularly throughout the day even if they do not feel thirsty. It is often a struggle to get older people to comply with this, and it is even worse when they have dementia. The best suggestion is to find a tall drinking mug and tell her she have to drink a specific number of those mugs with liquid every day (to get about 80 ounces a day).

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    Q:

    My 68-year-old father recently had open heart surgery (he had to have a heart pump put in prior to surgery). He has diabetes and is on dialysis 2x a week. Two or three days following the surgery, as my children, husband, and I entered his hospital room, he shouted that he hoped we all died and that I got cancer to the bone. It was very upsetting. I stuck with him, and he has not repeated this kind of behavior, but he is surly and demanding. He is sapping all of my energy. Recently, he had me take him to the emergency room, and his blood pressure was 260/126. They re-admitted him, and he is back in rehab. I am dreading him coming home (he lives with us now). His short-term memory is shot (they think he had a series of undiagnosed strokes following the surgery). I get physically ill when I visit him. Help! 


    Kayla from KY
    A:

    I am sorry for what you and he are going through. If he was not like this before the surgery, the advice you got is likely correct, he had one or more strokes and that often changes a person’s personality. Unfortunately that cannot be corrected. There are medicines that can help with behaviors such as sudden outbursts, but not the surly and demanding nature. It is very difficult for caregivers, family or medical personnel, to deal with such behaviors at times, and it is understandable if it is too much for you. I suggest you talk with his doctor, or with a social worker at the hospital, and discuss your frustrations. For many families, they need to come up with alternative living arrangements because it will not be good for him, not to mention you, if you are seriously stressed out by his behavior. 

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    Q:

    My husband had a stroke 8 years ago and was taken off Coumadin because he falls so much. The last of August he had a knee replacement and had a blood clot in the lungs. They put him on Coumadin. I am confused as how much vitamin K he can have a day. I have read anywhere to 40 to 120 mcg. Can you give me the correct amount? 


    Margie from GA
    A:

    The important things about Vitamin K are to avoid high doses and to take the same amount every day. As long as he does not eat a very large dose of vitamin K, the Coumadin dose can be adjusted for the amount he does eat. Some people eat very little to none, others a modest amount, and the dose can be adjusted for that. We tell people who like salads, for example, to have a small one every day, just not a huge one ever and not salads on some days but not others. 

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    Q:

    My mom is 84 and of sound mind and body. She's always been very healthy and strong. She still does a lot of the cooking and kitchen work, plus the laundry and taking care of my brother's two sons, 7 and 10. I'm concerned with the amount of work she's doing. She's having trouble with her legs. She has pain when standing up and difficulty to start walking. Once she gets going, she's ok. I notice she has trouble with the stairs. My brother believes the work keeps her healthy and sharp. What is causing her leg pain and what can be done to help her?


    Luisa from FL
    A:

    Without actually seeing her, all I can use is clinical judgment about the cause of your mother’s problems. It sounds more like arthritis than anything else. There are lots of medicines for arthritis such as Tylenol, ibuprofen, and arthritis creams, but some of them are dangerous when used with other medicines or with certain medical problems so she would have to ask her doctor if they are safe. Heat such as a heating pad or warm water also helps. Modest exercise and activity is good for arthritis, overdoing it is not. For any one person, overdoing it is defined as when she feels pain or stiffness. On the other hand, too much rest makes the stiffness worse. I hope this helps. 

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    Q:

     My 93 year old mother had an ischemic stroke 9 month ago. She recovered miraculously, she eats right and exercises, but she lost a lot of weight and muscle mass. Her medications for heart are monitored, and all seems OK. Still she's losing a lot of weight and strength. What could be causing the rapid weight loss?


    Hanna from CA
    A:

    First of all you said she is eating right now. Does that mean consuming a good amount of food, or that she is eating very healthy? If you meant that she is eating healthy now and was not before, she could be consuming a lot less calories than before, which might explain the weight loss. Also if she is exercising a lot and was sedentary before, that could explain some weight loss. On the other hand, if you meant she is eating the right amount now and exercising modestly now and still losing weight, that is a concern. I would first look at her medicines and see if any could cause weight loss. Otherwise a doctor would need to evaluate her for any of a large number of other conditions that could cause weight loss and may be completely unrelated to her stroke.

    If she lost the weight shortly after the stroke and is no longer losing it, the weight loss could all be related to the acute illness and poor intake at that time.

    At age 93, a major problem like the stroke will always cause some loss of strength and muscle mass and it is very difficult to return to normal strength at that age without vigorous exercise. I would worry less about the strength loss than the weight loss.
     

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    Q:

    How can I tell my 89 year old father-in-law that he needs to pay better attention to cleanliness and hygiene? He seems to not be showering and wearing clean clothes anymore. Is this a sign of dementia? 


    Sheryl from CT
    A:

    There can be many causes for reduced hygiene with aging. Dementia is certainly one of the most common and his doctor could investigate that possibility. A second issue is loss of smell and vision with aging—he could honestly not notice that his clothes are soiled. In addition, showering or bathing becomes physically more difficult for some frail elderly individuals, and doing the laundry also may be difficult or even expensive if using a laundromat so some people may choose to decrease the frequency of these activities. Finally if he is having some incontinence that might be contributing to the poor hygiene and he might be embarrassed about it.

    In terms of how you can approach him on this topic, be as gentle as possible. Ask him if he needs help with his laundry. Go to his house and see what the conditions are—is there a working laundry, a safe shower or tub, are there piles of dirty clothes lying around or evidence of incontinence?

    If there is evidence of incontinence you could offer to take him to the doctor for that, or for a dementia evaluation if you suspect that. You might have to be a somewhat honest though if he does not recognize the need to improve and state what you are noticing.
     

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    Q:

    My dad is 77. He is relatively fit and healthy. He has never drank alcohol or smoked. Lately his voice is weaker and strained at times. He is stubborn about seeing a doctor. Have your any ideas why this might be happening? 


    Susan
    A:

    There are multiple things that could cause this. He could be getting silent acid reflux with no symptoms other than the voice change. He could be developing a benign polyp on his vocal cords. He could be developing a neurologic problem such as myasthenia or any of a number of other neurologic conditions that affect the voice muscles. There are undoubtedly other possibilities, but these are the first that come to mind. The first ones are benign conditions so maybe telling him this would allow him to feel comfortable going to the doctor. 

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    Q:

    My 93 year old father does not have a serious medical condition. Due to his age, he has age related medical issues. He no longer can drive. His doctor is pulling his license Thursday. I am the only caregiver left around to take care of him. He needs me and my hearing (he does have hearing issues and already wears hearing aids) to drive him to his appointments. Do you know if I can take FLMA for this type of assistance? If so, I'm unclear what to put on the FMLA paperwork for his "medical reasons." Any information you can provide will be a big help. 


    Cheryl from NJ
    A:

    Most FMLA forms include sections where you are taking off time for yourself, and sections where you are taking off time to care for someone else. In either case, you can take off for one episode or request time off periodically (such as to go to visits once a month). Only your HR person can say if your organization will allow that, but the spirit of FMLA would allow that up to a certain frequency of time off and the standard FMLA forms have a section for just such a request as you have. 

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    Q:

    My 86 year old dad has a foley catheter and has a UTI infection. The problem is he has been on antibiotics for two weeks and the infection has not cleared up. They have taken two cultures and have changed the antibiotics, but nothing seems to work. What could be the problem? 


    Rose from NJ
    A:

    First of all, he could be colonized with bacteria. This happens to older people sometimes, more often if they have a foley catheter, and it means that there is always bacteria in his bladder but it is not causing an active infection, meaning it is not bothering him. If he is not having signs or symptoms of a UTI such as abdominal or back pain, an elevated white blood cell count in the blood or fever, this is a possibility. We suggest that the doctor check a urinalysis for white blood cells. If those are absent it is not an active infection and they can ignore the colonization. It is often impossible to get rid of this colonized bacteria, but again it is not bothering him if this is the case.

    If he is having symptoms of a UTI and they have checked cultures and given antibiotics that are supposed to work according to the cultures, it could be due to the foley catheter, which makes it more likely to get and harder to get rid of an infection. If possible, they should remove the foley catheter, give another round of indicated antibiotics, then recheck a culture.
     

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    Q:

    My father is 86 with dementia and in a wheel chair. He's also diabetic, but not on meds for it--diet helps him. UTI infections are ongoing. He has had prostate issues for over 30 plus years, and he's currently on Flomax. The problem is that the pill form of antibiotics isn't working anymore and he has to have IV meds. His UTIs are happening very 6-8 weeks. He's had what I call the "rotor rooter" surgery for the urethra—they found over 200 jewels was the term I remember 2 years ago. Now it seems his UTIs are coming more frequent. He just got out of hospital for one 3 weeks ago and we think he's got another. He had a culture taken today to find out for sure. We just can't get him to drink enough fluids. He's on cranberry pills 3 times a day. I give him Crystal Light a lot because he hates the taste of water--at this point anything to change the taste of water! My question is this, does it seem or sound like he's spiraling down in his health, that his final days are coming sooner then later? 


    Jo
    A:

    You main question seems to be is he spiraling downhill, and in responding to an email without seeing your father I cannot even make a wild guess about that. I can only comment on the frequent UTIs.

    Many older people have bacteria in their urine often or always that is not causing symptoms and should not be treated, so the first thing to decide is if these are real infections or just positive cultures. If they are true infections each time, the second thing to check is if the infection truly goes away, so someone needs to check urine cultures about a week after finishing the antibiotics each time to see if it does become normal in between. If the culture is still positive, either it is not a true infection or the antibiotics need to be changed or given for a longer period. If the culture becomes negative in between each time he should see a urologist to see if something is causing the repeated infections, and to consider whether he should take a low dose of antibiotics every day to prevent them.
     

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    Q:

    I am writing as I suddenly found my feet and ankles were quite swollen. The swelling has gone down to normal. I read the article regarding Peripheral Edema, especially that the most common cause is heart failure. Although the swelling has gone down to normal, should my doctor request the tests, especially heart, kidney and liver tests. 


    Jayne from CA
    A:

    There are a large number of causes of swelling like that. Generally the doctor will look at your medications, your known problems and your risks for certain problems, and examine you for other signs in addition to the swelling, then decide what tests are appropriate. These would include heart and kidney tests in some people, but not everyone. You should bring these concerns to your doctor. 

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    Q:

    My mom has been in the hospital for 3 weeks. She had to have a feeding tube inserted and since then she hasn't been awake. The doctor is trying some kind of medicine to bring her out of the sleepy state. What is the name of the medicine he is using? 


    Jennifer from KS
    A:

    I could not know what medicine the doctor is giving your mother. There are medicines that counteract sleepiness side effects from other medicines, antibiotics for sleepiness if it is due to an infection in the brain, or psychiatric medicines that are designed to activate, or wake up, the brain in anyone, so it could be any of these medicines.

    PG Note: In these situations, you need to talk directly to the patient's doctors and ask questions. The floor nurses should be able to give you an idea of when they will make rounds and visit patients.
     

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    Q:

    My 90 year old mom had a stroke and can't swallow. She has a feeding tube in her stomach. How do I keep her mouth moist? 


    Jack from GA
    A:

    The best way to keep the mouth moist in people who cannot or should not swallow due to risks are to get mouth swabs. They frequently come in a lemon-glycerin formula, but there are other types of swabs are soothing and are moisturizing. You can find them by clicking here: http://www.parentgiving.com/shop/oral-swabs-380/c/
     

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    Q:

    My mother in law is diabetic and keeps falling out of bed at night and not remembering it. What could cause this problem? She is also on dialysis. 


    Reba from TN
    A:

    The initial worry in the problem you describe is whether she gets low blood sugar at night, which would affect her memory. Her sugar should be tested if she falls out of bed again to see if that is the cause. If her sugar is normal, however, she should be evaluated for general causes of memory loss, such as early dementia. That could happen to anyone and may not be related to the diabetes or kidney failure. She could fall out of bed more easily due to nerve damage from diabetes, but that would not prevent her from remembering the fall. 

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    Q:

    My mom is 88 and has been having UTIs for some time. She seems to be getting them one after the other. She has been on so many antibiotics that some no longer work on her. How does the UTI affect the rest of her organs since she has them so often? 


    Adele from GA
    A:

    The UTIs primarily affect her kidneys, although with any one infection an older person can have trouble with confusion. She should have cultures taken in between infections to see if there is always an infection present, she should always get cultures when she has symptoms to make sure she is getting the right antibiotics, she should get kidney tests regularly, and she should only be treated for UTIs if she has symptoms and her urine white blood cells are high, as people sometimes have persistent organisms in the urine that are not causing true infections and repeated antibiotics for this issue are dangerous. 

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    Q:

    Four weeks ago our 88 year old mother sustained a broken arm from a fall. Prior to the injury she was living alone and oriented. Now she has 24-hour aides due to nighttime disorientation and confusion, which we presume is due to the fact she is not sleeping at all. The aides say she is up 50 times a night. Sleeping pills do not help. Her healing is not going well. In the daytime she is lucid, awake and oriented. She takes a few naps of 20 minutes duration only. Pain was contributing factor early on, but that seems managed now, but still no sleep. Suggestions? We fear she is on her way to SNF because she can no longer afford the aides, which cost $3000 a week.  


    EC from CA
    A:

    There are many possible issues going on. First, there could be an undiagnosed problem such as low oxygen, abnormal electrolytes or undiagnosed infection, which could be causing this. These possibilities need to be addressed. Otherwise, the two likely causes are poor sleep or reaction to her medicines. Trying to figure out why she is not sleeping would help as if there is an obvious cause that can be addressed. If there is not an obvious cause the usual strategy is to prevent daytime naps so she is sleepy at night, use sleeping medicines, and make sure she is comfortable. Additionally, many medicines can cause confusion so someone should review her medicines for this possibility. 

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    Q:

    I have an 88-year-old female friend, a diabetic, who keeps her sugar levels very well regulated by insulin. Up until several days ago, she had no problems with her vision. She has had an eye examination within the last year and was told that her eyes were fine. She does wear bifocals. Up until this problem with her vision, she has been able to do crafts, read and navigate on her own. She also has had cataract surgery in the past. Can the lenses become blurry over time? This is a question she has asked me. I told her that I would go online to do research. I told her that she should get to her eye doctor asap. 


    Esther from VA
    A:

    If the vision truly changed significantly just a few days ago that would suggest an acute problem and she needs to see the eye doctor. In regards to your question about the blurriness over time in relation to diabetes, diabetes can affect the vision in two ways. It can cause damage of the retina, which accumulates over time, or it can cause the lens to change and cause blurriness. Lens changes causing blurriness are due to changes in blood sugar level, and either recent high sugar levels if they were previously good or recent good blood sugar control if it was previously bad for a long time can cause the blurriness. This is related to fluid moving in and out of the lens as the sugar moves in and out. Usually these lens changes causing blurriness are reversible when the sugar level finally stabilizes and no longer changes much from day to day. 

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    Q:

    What is a supplement to help with lack of energy in the elderly?  


    Ruth from NC
    A:

    A strategy to Improve a lack of energy in an elderly person would need to be individualized to that person and what the cause of the poor energy is. Poor energy can be due to multiple issues including inadequate sleep, depression, anemia, medication side effects, poor nutrition, heart problems, lung problems or any of a number of undiagnosed medical problems. The person would need to see a physician first to determine the cause. If there truly is no specific cause, a program of exercise and proper nutrition (including reduced carbohydrates, which can cause sluggishness) would be the best. There is not good evidence that supplements are helpful in general and most physicians do not recommend them. 

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    Q:

    My doctor of several decades quit because of health care reform. Now we cannot find a doctor. Yesterday, Peacehealth Hospital and our Providence Medicare insurance tried to find us a doctor. No one will take us as patients because of Medicare. What are we to do? 
 


    Joyce from OR
    A:

    Usually your insurance company is the best source to help find you a new doctor as they usually know which doctors in your area take your form of Medicare. In addition, if there is a local Medical Association, either a county or a state medical association, they are also often a very good source to find a new physician. This is often more difficult in small towns or rural areas unfortunately, if that is your situation.

    As an aside, health care reform is very beneficial to primary care practitioners and increases Medicare payment to primary care physicians to help keep them in practice. Even with this increase in payments, however, Medicare does not pay physicians as much as private insurances. As a result some physicians unfortunately decide to not accept Medicare patients. This should happen less often under the Affordable Care Act, but still can be an issue, which can be worse in a small town with limited numbers of physicians so the decisions of 1 or 2 of them can make a major impact.
     

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    Q:

    My 93 year old Mother is complaining that her eyesight is getting worse. She had cataract surgery 8 years ago. She is completely chair confined, incontinent, and takes pain meds for arthritis, blood pressure and allergies, and stool softeners every day. She is starting to say that her vision is getting worse. Is this age? We try and watch about her becoming dehydrated. 


    JoAnn from TX
    A: Answered by Douglas Scharre, MD

    There are many potential causes for decreased vision, but it would not just be old age. She should be seen by an eye doctor to identify the cause of her vision complaints and to suggest a management plan.  

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    Q:

    My 75-year-old mother-in-law lives on her own. She is having visual, auditory and olfactory hallucinations. She believes the neighbors are persecuting her and trying to get into her house. She is repeatedly bothering the police. She has always been secretive and rather difficult to get along with. We suggested security cameras for her house, but she is still afraid and lives in fear of the “people” who live on her roof and are drilling holes into it, etc. The symptoms have been going on for a couple of years and are getting worse. My husband and I can't get her to go in for a medical checkup as she states that she is not crazy and there's nothing wrong with her glasses or her hearing aid. We do not know who her doctor is. She says she's been taking care of herself all these years and doesn't need our help. She clearly does. 


    Kelli from WA
    A:

    This is a difficult situation. First, to clarify, this might not be hallucinations. Many people have delusions, which are false beliefs. They believe people are getting into their houses by "evidence" they find, but they do not actually see or hear people who are not there. You should find out if she sees or hears them, or just "knows" that this is happening.

    Actual hallucinations can be due to dementia (such as Alzheimer’s or other dementias), can be due to psychiatric disease such as mild schizophrenia, can be due to problems in the brain such as strokes or even tumors, or can be a side effect of medications. If she is having hallucinations, nothing will help other than getting her to a doctor for an evaluation. I don't have any magic tricks for getting her to agree, other than saying you are concerned there might be an undiagnosed physical problem.

    If these are delusions, there tend to be two most likely causes. People with longstanding paranoia (you described her as always secretive) can get worse with age. Additionally, a specific problem with aging is something called paraphrenia. It is when people act suspicious because they believe things are happening like people spying on them or getting into their houses, but the cause is very poor hearing and vision so they misinterpret things they see and hear. Again, deciding which is the problem would require a medical evaluation.

    As a last resort, if this gets to be a dangerous problem for her you can take her to an ER and get her admitted to sort things out, but she would have to be having enough problems to be considered unable to make her own decisions. Good luck with this difficult situation.
     

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    Q:

    My mother in law whom is 96 no longer knows when she is going to have a bowel movement. Therefore, she is going in her pants. We took her to a urologist and he gave her an antibiotics however, it did not help her. We have started to give her fiber. However, this has not helped yet. What can we do? The doctor said he could not help her because he only deals with urine problems. She seems to be in good health and goes out with friends. However, we are afraid they will not want to take her out if she continues to mess in her pants. Please help! 


    A:

    I have two suggestions for this. In terms of trying to treat this, the body has a natural tendency to have a bowel movement in the morning after breakfast. One option is to have her eat a big breakfast and use a mild laxative in the morning, then sit on the toilet for awhile. Sometimes this is successful every morning and there are no worries about accidents later. The second suggestion is to see a gastroenterologist. The problem can be due to damage of the rectal muscles or nerves, or to rectal diseases, and an examination including rectal and colon exam can find a treatable cause. 

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    Q:

    My mother, age 69, recently began losing weight, has constant anxiety, loss of appetite, and instant belching/gas when we can get her to eat. She complains of a knot in the pit of her stomach, she is constipated, and recently had a UTI. We took her to the doctor and he diagnosed her with depression and put her on prozac. She was on it for 4 days when she tried to harm herself. The ER ran blood work and took urine, also did CT scans of her abdomen, which came back clear. I am very concerned because up until a month ago my mother was the epitome of health. The last time she was in the hospital was giving birth to me 37 years ago. This was almost an overnight change. Can she really just go down hill this fast from depression? Could there be something else going on with her?  


    Randi from MS
    A:

    Usually when I see someone that has had a dramatic change as you describe, I assume there is something new that needs to be discovered. There is a long list of possible causes, too long to go into here. You mentioned bloodwork, which would be important to have, and there are many studies that should be done. If there is any associated confusion, even studies such as a head CT scan should be considered, and there are many gastrointestinal studies which could be done, given her complaints. While someone can go downhill that fast from depression, depression first starting at age 69 without an obvious precipitating traumatic emotional event is very unusual. I would encourage you to go to her doctor and discuss an even more thorough evaluation than she has already received.
     

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    Q:

    I am 81 and have mild hyperglycemia (readings up to 104). I heard that a possible solution is to have breakfast regularly with whole grain foods. Would you please comment? 


    Fred from KY
    A:

    I can certainly recommend the hearty breakfast you describe. Eating three regular meals a day with good nutrition and low in carbohydrates helps everyone. That being said, your glucose level is technically normal and I would not describe that as hyperglycemia, which is usually reserved for 107 and above. 

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    Q:

    My 94 year old Dad was diagnosed with UTI. He has finished his antibiotics, but he still very tired and his memory is still impaired. How long might these new changes to his behavior continue or is this his "new normal?" Also any suggestions as to how to have him wash his hands more regularly? 


    Sharye from NY
    A:

    Older people who do not have memory problems to begin with can get a temporary loss of memory and other brain functions with infections such as a UTI, but the brain function virtually always returns to the person's baseline level well before the antibiotics are finished. People who have underlying problems such as dementia can have a set back after any medical illness, including infections, that lasts longer and may or may not return all the way to the baseline that existed before the infection. Other possibilities for your father include the possibility that he did not receive an effective medicine for his UTI and it still exists, which his doctor can test for, and that the UTI was treated, but he has side effects from the antibiotics, which have caused the fatigue and can be looked for. Finally, there could have been another factor besides the UTI that was contributing to, or the sole cause of, the memory problems and fatigue initially and may not have been discovered or treated yet. 

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    Q:

    I am a Geriatric Care Manager and currently have an elderly female client who is incontinent. She is able to manage during the day, but does not awaken during the night to toilet herself and therefore is unable to stay with out-of-town friends overnight as she had been in the habit of doing. A relative of hers (MD) has developed a very detailed behavior management care plan for her, which included weighing wet incontinence briefs in the morning, etc. which my client isn't inclined to be doing. I am asking if there is a more reasonable approach to managing this problem? Thank you for your consideration! 


    Paulette from RI
    A:

    There are two possible approaches to this problem. First, it is important to know what kind of incontinence she has. There are specific treatments for stress incontinence, which is rarely a problem at night, urge incontinence and overflow incontinence, and knowing which kind of incontinence she has is important in order to design a specific plan for her. If she has urge incontinence, there are medicines she could take at night to reduce the problem. If she has overflow incontinence she would need to empty her bladder just before bed and possibly wake up on a scheduled basis during the night to empty again and prevent incontinence.

    Second, if the problem seems to be entirely due to her sleeping through the need to use the bathroom, you could consider having her wear a bedwetting alarm that is used for young children that have trouble with bladder training. That sends either a vibration or noise alarm when the incontinence starts and may awaken her enough to stop it and use the bathroom.
     

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    Q:

    My 80 year old mother in law has dementia and it seems to be rapidly getting worse. She is pretty strong physically. I try to take her out and visit to ease some of the burden on my husband, but she is very demanding of his time and attention. Her daughter lives far away and is unable to help (she lives about 5 minutes away from us). She is very restless at night and has called the police twice. She often calls my husband in the middle of the night for various issues, usually loneliness. She is resistant to anyone’s attention other than my husband. I don’t know what to do to help. Please give any suggestions. 


    Gisele from LA
    A:

    This is a very difficult situation, as is often the case with dementia. It sounds as if she needs a different living situation. If she had a home aide live with her as many hours a day as feasible and maybe in the night, she could potentially be less lonely and potentially not be calling people so much. The down side of that, other than the expense, is that some people with dementia do not get along with strangers and could potentially not get along with the home aide. Another alternative is a completely different living situation such as an assisted living facility or a nursing home. The downside of that, again in addition to expense, is that it is a new location, and dementia patients tend to have a mildly worse dementia for about 6 months when exposed to a new living location. There are not any medications that help this other than the basic medicines for dementia, which help some behavioral issues a little. Caregiver stress, on the other hand, is a major problem with dementia, and if your husband, and you, are the only real caregivers, you must avoid debilitating stress or she will have no caregivers. You should have a long talk with her doctor about these issues. 

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    Q:

    My gramma is 93 and on pain meds. She always feels dehydrated, even though she drinks an ample amount of water. She also drinks Gatorade from time to time. Any advice on the best drinks, sports drinks or otherwise, to eliminate her frequent urination and dehydration? She has seen many doctors, to no avail.
     


    Stefanie from MI
    A:

    In general the best drinks for hydration are water (best) or something like Gatorade (second best). If she drinks a lot and is truly dehydrated, based on lab tests and examination, that suggests a kidney problem or a medicine that makes her dehydrated. On the other hand, she could just feel dehydrated without truly being dehydrated, which could be due to any of a number of medications or diseases. 

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    Q:

    Our family cares for my 88 year old mother who, in the past eight months has had 3-4 UTIs. She has had Parkinson’s for over 20 years and is incontinent and uses pads. We bathe her every day and we see that she changes her pads frequently. Her cultures have shown E.Col and another bacteria. She has successfully used courses of Cipro. We have her on cranberry juice daily. Here are my questions: 1. Are the home strips to check for ua infections reliable for use? 2. What courses of preventative treatment can we take to decrease her infections? Daily antibiotics (after culture and sensitivity)? 3. Is a 5 day course of Cipro effective? (her MD prescribed this). Thanks so very much for your time!! 


    Freda from GA
    A:

    The home strips can indicate if there is a likely infection, but cannot provide a certain diagnosis. In terms of prevention, it is first important to determine if these were truly several different infections. Some people have their symptoms disappear, but the bacteria in the urine remains. When people seem to get frequent infections, it is important to check cultures after the infections appear to be resolved to see if they are negative. Only if they are negative can one assume this is several different infections in order to consider a preventive treatment. If there have been several clearly different infections, prevention is controversial. Some people advocate one week of antibiotics a month to prevent further infections, some advocate a low daily dose of antibiotics, and others say that the side effects of frequent antibiotics are worse than that of frequent infections and advocate no preventative therapy. Finally, most early uncomplicated urinary infections can be treated with a 3-day course of antibiotics, but if it is complicated by being in the kidney, having anatomic problems in the kidney or bladder, or spreading to the bloodstream, than a longer course is necessary.


     

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    Q:

    I had urine leakage 2006 when I started bleeding seriously. I can’t move without a pad, and I must change it three times during the day and at night. Since then I have not had sex with my spouse. What is the permanent solution? 


    Francisca from LA
    A:

    I wish I could answer your question and help you, but it is hard without more information. If you had a surgery in 2006 there might be one answer, and if you did not there might be another answer. It also depends on what you have tried so far that has not worked. It is important that you see an experienced gynecologist and urologist.

     

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    Q:

    My 81 year old mother-in-law has recently had a silent MI. She has a clot in her artery, which is being treated with Warfarin injections. She had had a fall a week before, cutting her head and scalding herself with tea. When she went into hospital we were told she also had a chest infection and a UTI. She reacts badly to some medications including statins and would be quite allergic to many things. None of the doctors have so far told us what the longer term outlook is for her. What can we expect? We're so worried. 


    Glenda from IA
    A:

    Unfortunately there is not an easy answer to your questions as it depends on so many factors. If she is otherwise fairly healthy and the clot is a partial clot in a small artery her long term outlook is excellent. If it is a complete clot in a larger artery, it depends on whether that artery is receiving blood from other arteries, which happens sometimes but not always. If she is not very healthy to begin with, the long-term outlook is worse, regardless of how big an artery it is. If she has good heart muscle function, no abnormal heart rhythms, and fairly good cholesterol, it is a much better outlook than if some or all of those factors are worse. These are all factors that her doctors would be aware of so the best advice is to ask them your question directly. 

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    Q:

    My dad is 92. He had a stroke 6 weeks ago, but has recovered and is home following a 4-week stay in rehab. They inserted a Foley catheter, tried to take it out once, but he had groin pain and then reinserted it. When we went to the urologist, he suggested that we keep in the Foley catheter and have a nurse change it monthly. He also said that most elderly patients with catheters do have infections and he would not want to give antibiotics because that would cause a superinfection—we should look out for fever, chills or confusion. What are the downsides of keeping of keeping the catheter in? 


    Susan from PA
    A:

    The downsides of keeping in a catheter are many. There is a significantly higher likelihood of an active urinary infection. There is a slight chance of irritation around the catheter, and there is a chance for internal scarring from the catheter that causes trouble urinating in the future. Elderly people with catheters are less healthy than those without catheters. If someone has a significant bladder problem, however, sometimes they cannot urinate on their own without a catheter and it is necessary, but they should be avoided if not necessary. To address your question, the first thing to determine is what you mean by frequent infections. Some older people frequently, or almost always, have bacteria in their bladders, which will show up on a urine culture, but which does not cause an active infection or symptoms. If this is the case then no treatment is recommended. If, however, he is having frequent infections which include either an abnormal urine test that shows and active infection (which we can tell if there is a high white blood cell count in the urine) or includes symptoms of an active infection (frequent and/or painful urination), there are several things to check. If a urine culture shows infection, he should receive the appropriate antibiotics and then have a urine culture checked after he is finished antibiotics to see if the infection was completely treated. If the infection was not completely treated (a culture is still positive for the same exact infection after receiving the correct antibiotics for that infection), he should receive a longer course of antibiotics, and if it does not go away then he needs to have a cystoscope of the bladder looking for a cause of frequent infections. If the infections go away then come back frequently, he should again have a cystoscope to see if there is a reason for frequent infections. If no cause can be found, some people suggest one week of a simple antibiotic each month to prevent new infections, but others feel that is not safe (due to the frequent antibiotics). 

     

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    Q:

    My 92 year old Father has wet AMD. He was certified blind about 6 months ago. So far he has managed his disability well with the support of the family. My question: Just recently he has been complaining of "rolling eyes." Can you explain this? I think it’s just re-assurance he needs. Thank you.  


    Annette
    A:

    I asked ophthalmologist Alan D Letson, MD to comment on your question. Here is his response: “I am not sure what "rolling eyes" as a complaint really means. Is this a visual phenomenon or a sense that his eyes are actually physically, moving in uncontrolled rolling movements? Have you observed the "rolling"? If so, this could be a neurological problem. He should probably see his ophthalmologist. "Rolling eyes" is not typically a complaint that we hear in the retina world, and if it is a movement disorder it is not related to his AMD.” 

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    Q:

    I am worried about my parents. My dad is a diabetic and has been for a while now, but doesn’t check his sugar—he used to be really good about this, now he doesn’t check it and the paramedics have been called on several occasions when his sugar has bottomed out (to 25 the worst). He has prostate cancer and is incontinent, not really doing well at all. My mom also diabetic and we think she has Alzheimer’s, but doesn’t want to get checked for it—when we even mention Alzheimer’s, she gets very upset (her mom had it). She doesn’t take care of herself at all. She just stares at the floor all the time. I asked her what happened to my mom that had a lot of zest for life—she was always joking around with people, the life of the party, but she has lost her zest for life and now says she wants to die, she doesn’t want to live anymore. This breaks my heart. I don’t know what to do for them anymore. I have begged them to come live with one of us kids, but they want no part of it, yet also can’t and don’t take their medical conditions seriously. I worry about my parents living by themselves and their health and mental health. What do I do as a daughter? I love my parents and want them around for a long time. Please help.
 


    Barbara from VA
    A:

    There are two important things you can do for your parents. The first is to get them to a doctor who can make diagnoses and decide exactly what is wrong and what needs to be done for them. The second is to get someone to help them on a regular basis. It sounds as if they are not thriving while living by themselves. There are several possible alternative arrangements that could help. One can be to have a family member go over there on a regular basis. Sometimes once a week does the trick; sometimes there needs to be daily contact. If that is not available, you can consider a home health aide that can come in for specified amounts of time a week. This can often be paid for by insurance including Medicare, although sometimes families have to pay out of pocket. In more severe cases elder parents need to move in with their relatives or even to a place such as an assisted living facility. As a last resort, if you continue to be very worried about them and they refuse all of the options above, you can refer them to Adult Protective Services by calling Adult Protective Services and explain why you are worried about them. They will then go to the home and assess what they need. 

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    Q:

    I have an 87 year old father who complains of weakness. Doctors have found nothing wrong. They have suggested adding more protein to his diet. Can you please suggest a protein drink that would benefit him, add energy and muscle strength. Can I add whey protein to Boost or Ensure? How much protein is too much? 


    Jan from CA
    A:

     The protein drink with the most protein is Ensure High Protein. It has more than double any other drink. If you can’t find that one, they are all about the same. You could add whey protein to the drinks, though it might not taste good. You would not need that if you can find the Ensure High Protein.

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    Q:

    Hi, my mum is 65 and she is very weak and always feeling tired. Just recently she had a severe chest infection and since then became very weak. Is there any kind of supplement or vitamin which she can take to boost her energy? Many thanks. 


    Saeedeh from UK
    A:

    There are many reasons she could be tired and low on energy. She could be dehydrated or undernourished due to feeling bad when she was ill and not taking in enough nutrition, in which case increasing her fluids and taking something like Ensure would help. She could be anemic or deficient in minerals like sodium or potassium and would need blood tests to determine this and decide what treatment was needed. She could have what we term deconditioning, which is basically being very out of shape, left over from the infection, in which case she would need physical therapy and good nutrition. She could have a low level of depression from her recent illness and could need medicine for depression. It is possible her infection has not quite healed or the infection has but the lungs have not and she might need rehabilitation for her lungs. Since there are so many possibilities, you need to have her see her doctor and make a diagnosis of what is causing her fatigue, then you can make plans to help her.
     

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    Q:

     I've suffered from incontinent for the last 2 years and get frequent urinary infections. Can this be prevented?


    John from TX
    A:

    There are several types of urinary incontinence. All can be treated, but each type has a different treatment so you would need someone to tell you what type of incontinence you have in order to try a specific treatment for it. Treating the incontinence can help prevent infections. Urinary infections come from bacteria from the bowel getting into the bladder. Even using a catheter increases the chance for an infection so if you are using a catheter for your incontinence, stopping the catheter use can prevent infections. Infections also start more easily in warm, moist environments, so if you wear something like a Depend and don’t change it often, that will lead to increased infections. Keeping the area between the rectum and your genitals clean also can prevent infections. 

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    Q:

    Recently my Mom was in the hospital because of a UTI and was diagnosed dehydrated and anorexic, and had a blood sugar of 20. When I heard this I was alarmed because in the past her appetite was good. There has been a frequency of UTIs and her eating habits have changed. My biggest concern now is to do whatever it takes to hopefully prevent another infection. Can you tell me after she takes all of the antibiotics, how many days after should her urine be checked to determine if the infection is out of her system? 


    Linda from NC
    A:

    Frequent urinary tract infections can be due to many problems. The infections can be not completely healing, as you are worried about. Checking the urine culture 3-7 days after the antibiotics are finished should tell you whether there is still an infection. Having a local problem in the urinary tract like a kidney stone or a bladder that does not empty correctly can cause repeated infections and might be looked for. Finally, predisposition to infections such as poor hygiene or incontinence should be treated. A final thing to consider is that some older people always have bacteria in their bladders and it often is not causing problems, so if the repeat urine culture grows an organism, you need to discuss with her doctor whether this is a true infection or what is called colonization that does not need treating. 

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    Q:

    I am a caregiver to my Mother who is 99 years old. She has been experiencing recurring UTIs. I am wondering since she has characteristics like senior dementia during those episodes, what lasting effect does that have on her brain?  


    Linda from NC
    A:

    Infections like UTIs that are bad enough to cause delirium or sepsis can cause long lasting effects on the brain among other organs. Delirium is temporary worsening of brain function characterized by excess sleepiness, poor concentration and disorientation that fluctuates from day to day. Sepsis is infection bad enough to cause high fever, low blood pressure, high pulse and breathing rate and high white blood cell count. Both of these conditions are usually just seen in people with bad enough infections to be hospitalized. More typical UTIs that are managed at home without symptoms this severe do not usually cause long lasting effects on the brain, even if frequent. 

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    Q:

    Dad is 93 and takes heart, blood pressure and prostate meds and allergy pills. He has a loud heart murmur. He is not eating right and won't drink enough fluids. He likes to drink wine and beer, but doesn't drink more than a glass of wine a week and can of beer a week. What am I doing wrong? Should he have Ensure every day? Please help. Thank You! (Last year he had a partial hip replacement. He was recently in the hospital for pneumonia. He's at home now.) 


    Maria from CA
    A:

    Don’t be worried that you are doing anything wrong. Your Dad could be eating poorly due to many possible problems. He could still be weak and not truly be over his pneumonia. He could be getting problems from his medicines, although we would need to know the specific medicines to be able to say that with more certainty. With that murmur you mentioned, his heart function could be poor, which causes a poor appetite. He could be depressed from all that is going on and not want to eat. He could have any of a number of abnormal blood levels such as low sodium, low red blood count, high creatinine (which reflects poor kidney function), all of which would reduce his appetite. He could have a stomach problem that makes it difficult for him to eat so he is avoiding it. He could be dehydrated as you say he does not drink enough. If he has lost weight, that sometimes starts a vicious cycle in that the weight loss itself can lower his appetite. The best thing you can do to help is take him to his doctor and ask the doctor to help figure out why he is not eating. The treatment then is to deal with whatever is the problem causing him to feel and act as he does. 

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    Q:

    My Mom is 85 and in a nursing home. On Sunday she was very weak and lethargic. She was diagnosed with a urinary tract infection and started antibiotics on Monday. She is still weak, cannot walk by herself with her walker and needs assistance. Is this normal with a UTI? 


    Lil from CA
    A:

    It is very common for elderly people, particularly those in nursing homes or those who have dementia, to become weak with just a simple urinary tract infection. Usually there is improvement within 2-3 days after starting antibiotics, but sometimes there needs to be extra fluids given to help the improvement. There can be temporary worsening of kidney function with these infections and that can cause weakness with increased fluids being the main treatment. If you can make sure she is drinking or otherwise taking fluids well, and if she does not improve in a couple of days ask the doctor to look into it.

     

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    Q:

    While in rehab, my 93 year old mother was put in adult diapers with extra pads at night so she wouldn't have to get up in the middle of the night (she has mobility problems). We decided that was the safest thing for her and she is now used to wearing them every night. But one adult diaper with three extra pads (highest absorbency) aren’t enough and she still soaks her bed several nights a week. Besides using mattress protection, do you have any advice? 


    Sandy from AZ
    A:

    It is hard to give one answer without knowing all of the details. If she gets no sensation of needing to urinate and/or never wakes up at night, the only options are the extra mattress protection, or have someone wake her up in the middle of the night and help her urinate to keep dry or just change the pad. In addition, limit fluids after dinner, and if she takes any diuretics after noon see if they can be changed to earlier. If she does get a sensation of needing to go but the problem is mobility, can she use a bedside commode, and is there someone available to get up and help her to use that? If so, that would be the best option. In addition, if she is getting a sensation of needing to go, sometimes the medicines for urge incontinence, such as Detrol, might be beneficial, and you would need to talk with her doctor. 

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    Q:

    My friend's grandmother is having difficult swallowing food to the point that she is gagging and losing her appetite. She had been ill previously with a virus that has seriously affected her gag reflex. She is under the care of a doctor, but we are wondering what adult supplement drinks can she drink that are NOT thick. 


    Ann from WI
    A:

    That question can only be answered after she has had a swallow study. These tests are done by speech therapists to determine what consistency of foods are safe and what swallowing strategies are helpful in people who have trouble swallowing. In most cases actually thicker liquids are easier to swallow and often the recommendation is to thicken the liquids, but the only safe way to decide what is best for her is to have the swallow study done. You should ask her doctor to schedule on of these tests. 

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    Q:

    Is it possible for UTI symptoms to be caused by sitting on a non-leather or plastic chair? I have recently changed from a cloth office chair to a plastic type chair. I have noticed irritating symptoms near the anus. Occasionally, I have a sensation that I have to urinate (only when lying down). I go to the restroom and urinate only a little. Go back to bed and no problems. The doctor has checked a specimen with no infection detected. This has gone on for a couple of weeks. For now, I'm switching back to my OLD chair to see if it improves.  


    Marlys from IA
    A:

    Certainly types of chairs can cause irritation by the way they rub on your clothes, but would not cause a UTI. If the type of furniture makes you much more warm in your genital area than usual, you could get a yeast infection that might simulate a UTI. Although you can always switch chairs, you might ask your doctor to consider checking for a yeast infection if you think this is a possibility. Finally, feeling the need to urinate without much urine can be a sign of a UTI, which might be completely unrelated to the new chair, so you might need to check that possibility also. 

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    Q:

    My mother lives with my wife and I. She is 91 years old and of sound mind. She has never had the best hygiene habits. She always thought washing up was good enough. She has now gone over a year without a bath or shower. We have a nice shower at our northern home. Here in Florida for the winter, we have a shower, but it would be troublesome for her. Her brother has a shower and extra bedroom at his house, but of course she refuses that, too. Needless to say she is pretty ripe. I just don't know what to do. One day she is going to die and I don't want people saying it was my fault that I didn't do anything about this situation. Please advise.  


    Virgil from FL
    A:

    There are two issues here. One, older people can have a hard time using a standard shower or bath and you might need to put in a seat or handrails to help her. If this is not the issue, however, and she just refuses to ever bathe, and her sponge baths are not adequate, this is considered self-neglect (the blame is on her, not you) and is actually considered a reportable form of elder abuse. You should take her to a doctor and see if the doctor can talk her into bathing. If that does not work, talk to the doctor about getting social services involved. There can even be a referral to an agency called Adult Protective Services that will investigate why she does not bathe and offer suggestions. 

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    Q:

    I have recently become incontinent and had several test done by a neurologist. My issue is do to an old c3/c4 injury, which has been over time restricting and/or pinching the nerves that control the proper bladder function. I was told after several tests that the nerves have been restricted, which in turn over time have not been feeding the nerve cells what they need to stay healthy, and they have died. The doctor cannot guarantee that the nerve cells will grow back once we deal with the restriction, so I may be incontinent for life. Do you think I should get another opinion? 


    Randy from MA
    A:

    In general, second opinions are worthwhile, if for some reason you do not feel confident in the first opinion (maybe the wrong type of physician, maybe not adequate training for the problem), or if the problem is severe, life-threatening or will be lifelong so that you really need the best answers. Many, if not most, insurances will pay for second opinions, but not third ones. With that in mind, I do usually tell people considering a second opinion, or coming to me for one, that there is no more than a 5 percent chance that the second opinion will give a different answer.

    In this case, if the prospect of lifelong incontinence is worrisome enough that you are willing to undergo the time and effort for a second opinion, it would be worthwhile to you, realizing that there is a low chance of getting a different answer.
     

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    Q:

    My Dad just turned 90 years old. He has emphysema and is on four different inhalers a day. He is on oxygen 24 hours a day. Now he has lost all taste—food has either no taste or, as he says, taste like dust. Is there anything he can do for this? 


    JoAnne from NJ
    A:

    The only ideas I have for this problem are as follows: First, Advair is an inhaler that is know to have a bad taste and sometimes cause people to lose taste for other foods. If this is one of his inhalers, maybe there is an alternative. Otherwise, all of the inhalers need to be rinsed out of the mouth after the inhalation or they can affect the taste. If that is not being done, he could rinse after every inhaler use. I hope one of these will give you the answer.
     

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    Q:

    My aunt moved into an assisted living facility after my uncle died. She has early dementia, but is able to function somewhat independently, in spite of being wheelchair-bound. She forgets to call for help though and falls transferring in and out of her wheelchair. Her falls have been occurring more frequently, lately 2 or 3 a month. The Assisted Living facility tells me that they can provide for her, but I am not so sure they have the staff to properly supervise her. She’s already fractured a hip, and minutes ago, got home from the ED with a fractured clavicle. Isn't the next step a nursing home? I'm not sure that would be any safer.... 


    Leslie from IN
    A:

    Frequent falls are a difficult issue. Even in a nursing home, there is not staff there every minute all day long, which is usually what is needed to prevent falls. She needs to be on a falls prevention program. If they do not have an aggressive falls prevention program where she is, another facility might be best. She might need things like a belt restraint, a geri-chair, or similar strategies to prevent falls, but again she needs to be in a strong “falls prevention” program.
     

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    Q:

     My 92-year-old mother has been diagnosed with ExtraMammary Pagets Disease. Her gynecologic oncologist recently said that the Paget’s has turned into full-blown skin cancer at the border of the Paget’s, and he wants to remove a small section to slow down the cancer growth. What type of skin cancer would this be? What is the future regarding metastisizing of the cancer? Mom is considering the surgery (as strongly encouraged by her oncologist) to remove this small section of tissue, but is very uncertain. She is terrified of not being able to walk because of the surgery, recuperation period, etc.


    Frances from NC
    A:

    Most Paget’s disease is essentially a skin-based form of breast cancer. Most people with Paget’s will also have a breast cancer in that breast, and treatment is primarily directed at the breast cancer. In the 15 percent of people who have Paget’s with no apparent underlying breast cancer, the usual treatment is removal of the skin containing the Paget’s, and radiation to that area to prevent metastases. That surgery is fairly mild and should have minimal complications. You have described this as ExtraMammary Paget’s. If that means it is not on the breast but rather elsewhere, that is exceedingly rare and I don’t think I could add anything to what the oncologist is saying. 

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    Q:

    My mom is in the nursing home and has had frequent UTIs, which can be picked up on immediately. She makes no conversation at all and her eyes look as if they have a film over them. (Would this be a symptom of a UTI?) The doctor put her on a low dosage antibiotic, but she continues to have the UTIs. She is acting as if she has one now. When I contact the doctor, he had her tested, but said he most elderly patients will test positive for a bacteria infection in their urine, but he cannot continually keep her on antibiotics because she will eventually become immune to them and when she needs an antiobiotic for other ailments, it will do her no good. Could he change the type antibiotic for any other ailment? Also, if she is not going to be responsive with the UTI, wouldn't it be better for her to be on the antibiotic? I am not bashing her doctor—I feel as though he is saying in around about way there is nothing more he can do. 


    Cindy from LA
    A:

    One thing to discuss is the difference between a UTI, a urinary tract infection, and colonization of the urine, where there is always bacteria in the urine but it is not causing an infection. It is frequent in patients in a nursing home to have the colonization, and if that is the case it is more harmful to treat with antibiotics than to leave it alone. It is sometimes hard to tell if it is an infection or colonization. The urinalysis—looking at the urine under a microscope—can help because in an infection there are a lot of white blood cells because of inflammation from the infection, and in colonization there are not. The other way to tell is by symptoms. An acute change in mental function (including a glassy eyed look) can be one symptom of infection, but only if it is an acute change (if she has been like that for awhile, it would not likely be a symptom). Finally, if the doctor has taken a urine culture and has given her the right antibiotics based on the culture, and she has still not resolved the bacteria in her urine, it is likely a colonization. 

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    Q:

    My father is 96 and totally aware and able to take care of himself. He is in basically good health except that he has lost most of his hearing. He wears 2 hearing aids that may at times give him some help, but generally not. He reads papers, etc, and is on top of current events. My dilemma is how to help him with communications so he is more involved when in company. My last resort seems to get different sizes of dry erase boards so he can take them with him for people to write things and share with him. There MUST be something better. My father has not technical skills and therefore, an iPad type seems to not be quite appropriate. When we were kids, we used to have these little pads you wrote on, pull the top up and it erased...again, too simplistic. There must be something to help elderly with hearing loss so they can communicate without having to learn sign language, which is just too difficult at this point in his life and no one else knows it as well. Any help is greatly appreciated.  


    MaryAnn from MD
    A:

    We turned to Laura Feeney AuD, doctor of audiology at The Ohio State University Hearing Professionals in Columbus, OH for her expertise:

    The first step would be to visit your father’s audiologist to be sure that the hearing aids do not need any adjustment. If the hearing aids are set appropriately, then secondary assistive technology may be useful. One such assistive device is an FM system. The benefit of FM systems is that they improve the signal to noise ratio, elevating speech over background noise, and cut down on the distance between the speaker and the listener—the speech is directly sent to the hearing aids. FM systems consist of a receiver and a transmitter. The receiver would be attached to your father’s hearing aids, and the transmitter is a microphone that would pick up the speaker’s voice. The transmitter could be worn by one speaker, passed around to multiple speakers, or placed in the middle of a table. If the hearing aids are not FM compatible, there are FM systems that can be worn without hearing aids. Speak to your father’s Audiologist about the most appropriate options for him.

    To learn more, go to hearing.osu.edu

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    Q:

     Mom's personal hygiene is not attended to...how do I talk with her to allow someone to help her with showers?


    Terry from FL
    A:

    This is a problem we see often in elderly patients. The first thing you should do is acknowledge to her that activities are more difficult with aging and ask if you can arrange for someone to help her with some of her activities, such as bathing. If she declines, the next step depends on your relationship with your mother. If it is very good, just be frank with her and tell her that her hygiene is poor and needs improvement. If your relationship is not good enough that you would expect her to accept news like this, you could ask her primary care physician to suggest the need for bathing more often. 

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    Q:

    Is there anything out there to help regain eyesight after suffering a stroke?
     


    Tamra from IN
    A:

    Most loss of vision after a stroke is due to damage of the nerve pathways between the eye and the brain. Recovery of the vision depends on how severe the damage is. Up to 2/3 of people with a stroke will recover some or all of the vision loss eventually, particularly in cases of less severe damage, but it can take from 1-6 months. There is no good evidence that any vision therapy helps this process. There are some eye and neurologic centers that offer Vision Restoration Therapies after a stroke, however, the results are usually mild at best. You could ask the neurologist involved if this is a reasonable option to pursue if the stroke was a while ago. If the stroke was very recent, time is the best therapy.
     

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    Q:

    My friend's husband is in a nursing home. He is paralyzed on one side and was recently started on Klonopin for anxiety. The nursing home won’t use a bedrail with him (they took them away from all the patients). They said the "government" made them stop because a study showed the bedrails were dangerous. My friend's husband has fallen out of bed twice since they took away the bedrail and has had to be hospitalized for one fall. He has returned to the nursing home and they still won't use a bedrail. What should we expect as far as use of a bedrail? They said there was no waiver she could sign to allow it.
     


    Debra from AR
    A:

    This is unfortunately a very difficult situation. There are many opinions about how to prevent falls from beds in hospitals and nursing homes, but not great conclusive evidence. The best way to prevent serious falls seems to be to have the bed very low to the ground and have a safety mat on the ground so if the person does fall out of bed there is little danger of serious injury. The issue with bedrails is that with bedrails up there are fewer falls out of bed, but the falls that do happen are more serious because they result from people climbing over the bedrail and falling from a greater height. Most specialists in falls suggest not using bedrails for that reason. Another safety feature sometimes used is a bed alarm that sounds when someone is climbing out of bed, but those have been shown to not help reduce falls because by the time a staff member responds to the alarm the person has usually gotten out of the bed (and fallen if it is a fall situation). People on Klonopin are at greater danger of falling.

    The best solution would be to ask if there can be a low bed with a mat next to it. I do not know of any regulation preventing bedrail use, just the worries that are mentioned above. Places that use bedrails usually make sure to inform the family of the dangers associated with them, which includes not only the more severe falls when they do happen, but also people
    getting tangled in the rail and injuring arms or legs by the tangling.
     

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    Q:

    A recent EKG taken to give clearance for me for cataract surgery revealed, according to the on-call doctor, that I had had two previous heart attacks. No time in my 81 year history have I experienced anything like a heart attack. I have survived rectal cancer and the surgery, chemo and radiation. I get a little out of breath when I walk too far. I take yoga, live alone, drive, and thought I was in good health. How could I have experienced a heart attack and not known it. I know about silent heart attacks in diabetics, but I am not diabetic. I have had stress tests and cat scans. 


    Joanne from VA
    A:

    There are two important considerations in your question. First, in addition to diabetics, women and older people may have silent heart attacks. Heart attacks are much more common in people with risk factors for heart disease, which include hypertension, high cholesterol, diabetes, smoking, obesity, lack of exercise and family history of heart problems, but people with little to none of these risk factors can have heart attacks also.

     

    The second, and possibly more important consideration, is that the EKG may have been interpreted incorrectly. Most EKGs these days have an automated interpretation by a computer, and those are often incorrect. I have seen this computer interpretation often diagnose a prior heart attack, that on more expert review of the EKG is not suggested. I would ask the doctor if a cardiologist overread (meaning also reviewed the EKG) it and if the cardiologist also thinks an old heart attack or two old ones are suggested. It might also be helpful for a doctor to look at an old EKG of yours, if one is available, to see if there are changes from before. A lack of new findings on the EKG, particularly if any available prior EKG was from a while ago, also makes a heart attack less likely.
     

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    Q:

    I visit a 93 year old woman every week. Over the last six months I have seen a decline in her mental state. We use to sit and talk for an hour. Now we cannot have a conversation because she will not stay seated. She gets up constantly and walks, with her walker, in circles in the room. She does this all day long. It is exhausting for her and her caregivers. Any advice on why she wanders and what we can do to help her? 


    Melissa from CA
    A:

    There are two issues to discuss for your problem. In terms of the wandering, it is believed that people who have abnormal mental function often wander because they are looking for something, but due to their trouble thinking they are not sure what it is. Medications do not help this, and in fact in facilities that specialize in dementia the wandering is often encouraged because stopping or preventing it can be frustrating to people with dementia.

    The bigger issue for her may be to figure out why she has had the decline in her mental state. She may have developed dementia, which is a term for mental deterioration that has several causes, the most common of which is Alzheimer’s disease. However, there are often correctable causes for mental status deterioration such as side effects from medications, other new medical conditions, abnormalities in blood tests such as low sodium and psychiatric issues such as depression. She should be evaluated for the cause of the decline in mental function. If it is correctable, the wandering may stop.
     

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    Q:

    My 93-year old father spends many hours a day in bed and has(sometimes) several bowel movements a day. He doesn't eat much, but what he eats is normal fare–toast, meat, some vegetables, etc. He also drinks orange juice and Coca-Cola. Is it normal to have several messy movements? What might cause this? His only medications are Omaprazole, Ranitidine and Sucralfate.
     


    M from GA
    A:

    One thing that can cause this is termed fecal impaction, which means that there is severe constipation and the only stool that can get out must be loose stool that leaks around the area of the constipation, often several times a day. The only way to find out if this is the cause is for someone to do a rectal exam and feel for a mass of hard stool. If this is not found, then his medicines, particularly the Omeprazole and maybe the Sulcrafate, could be the cause.

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    Q:

    My stepfather has gone from being very active to dragging his feet and falling within a short period of time—he has no dizziness, extensive scans and bloodwork are all negative and only normal shrinkage of brain for 72 years of age. Any ideas?
     


    Brian from FL
    A:

    He needs an extensive neurologic examination. With normal scans the likely causes focus on nerve damage, with multilple possibilities such as Guillian-Barre syndrome, which do not show up on lab testing or scans. Sometimes a neurologist will do an EMG test that can also help diagnose the cause.
     

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    Q:

    I have severe neuropathy of the feet. The pain is almost unbearable at times. I take 300mg of Lyrica a day. I also use an electric stimulator called the Rebuilder 300 once a day. I use a topical cream with capsaicin twice a day. All of these seem to help some. Is there anything else I should be doing to ease or stop the pain? My last A1c was 6.8. When I test after a big meal my usual range is 150. My fasting is about 90. Please help. Thank you.  


    Jack from NC
    A:

    Unfortunately I do not have any additional suggestions for the neuropathy. You are on the maximal dose of those medications and those are the recommended treatments for diabetic neuropathy. Getting your diabetes under control also can help but your A1C is at recommended levels. 

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    Q:

    My 86 year old dad has had some health problems for the past 8 years, namely prostate and bladder cancers, also, very serious sepsis and frequent UTIs. He was depressed and his dpctor prescribed lexapro, which was intolerable for him. Next was xanax, also intolerable. During this time it was discovered that the levequin he was given was also not agreeing with him. So he was taken off those, prescribed ativan and has been on it for several months. We cannot however manage the dosing. We've tried everything and cannot get it right and his primary doctor doesn't really help. Now he's taking 1 mg every 4 hours, which I think is too much. He's lethargic, tremoring, depressed, cannot walk without help, speech is mumbled, sleeps most of the time and sometimes he sees things that aren't there. He does not have dementia, knows everyone, knows what's going on and has said “I don't know what's wrong with me.” He is able to answer if you ask him a question, knows the year, day, etc. We just don't know where to turn to get him better. I believe it's the ativan causing all of these symptoms but family members disagree. I know there must be a doctor who can help, but not sure which specialty. Can you advise? 


    Ro from NY
    A:

    There are several issues here to address for you. First, yes the Ativan can be causing all of your Dad’s symptoms. Your father is on a very high dose even for a young person, and particularly for someone of his age. There are other possibilities of what could be causing his symptoms, however, and he should see someone with knowledge in this area as suggested below. Unfortunately, also, Ativan is very addicting and has severe withdrawal effects. He really should get off it, but that requires a very slow withdrawal over several weeks at least. The preferable drugs for depression with anxiety component for an older person are celexa (citalopram) or Zoloft (sertraline). As for what doctor could help him, the options are a geriatrics specialist preferably or if not available a neurologist, general internist, or even a psychiatrist. 

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    Q:

    In an older adult, what can be the number one cause of hypotension--is it low sodium diet, gastrointestinal bleeding, antihypertensive agents or early urosepsis?


    Chloe from CA
    A:

    It would be difficult to say that there is a number one cause. The most common causes would be related to medications, dehydration, poor heart function or due to aging of the nervous system. The most common medications to cause this are blood pressure or heart medications, with pain, anxiety, depression and prostrate medications also capable of this. Dehydration causing low blood pressure is most commonly from diarrhea, vomiting, or being too sick to take in fluids. Systolic heart failure, if severe, can cause the heart muscle to pump poorly and lower blood pressure. Finally, up to 20 percent of elderly people will have orthostatic hypotension (low blood pressure only when sitting or standing) due to a change in autonomic nervous system function with aging. While sepsis frequently causes low blood pressure, it is fortunately uncommon. Merely having a diet low in salt can cause low blood pressure, but this is also rare.

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