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Expert Topics

Alzheimer's, Dementia, and Parkinson's Disease

- Douglas Scharre, MD

Asset Protection & Financial Management

- John Greener

Cancer Care

- Richy Agajanian, MD

Caregiver Challenges

- Sue Salach-Cutler

Communication Through The Generations

- David Solie, MS, PA

Diabetes

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Elder Care at Home

- Ethan Kassel, MSW, LCSW, C-ASWCM
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Elder Law

- Howard S. Krooks, JD, CELA, CAP
- Ellen Morris, Esq.
- Shana Siegel, Esq., CELA

End-of-Life Issues

- Vincent Dopulos, MA, LPC, RDT

Fitness

- Deborah Quilter

Geriatrics

- Robert A Murden, MD

Home Care Solutions

- Emma R. Dickison

Home Health Care & Palliative Care

- Pamela Fishman, LCSW

Home Health Modifications

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Senior Housing Solutions

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Incontinence Issues

- Brian Christine, MD

Integrative Medicine

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Live In Care

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Managing Medicare

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Memory Care

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Mobility Issues

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Nutrition Know-How

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Quality of Life

- Joan Garbow, MSW, LCSW, CCM

Safety and Hospitalization Concerns

- Martine Ehrenclou, M.A.

Senior Healthcare

- Archelle Georgiou, MD

Senior Medical Issues

- Chris Iliades, MD

Senior Transitions

- Mary Kay Buysse, MS

Senior Medical Issues

Chris Iliades, MD has many years of experience in clinician medicine, clinical research, and medical writing. After 15 years in private practice as a board-certified ear, nose, and throat specialist, he helped start a clinical research support company and served as its medical director.
Q:

I suffer badly from COPD. My wife bought a set of bedding, duvet and pillows filled with Goose feathers & down. I feel it interfers with my breathing. Is there any bedding recommended for COPD sufferers? 


Billy
A:

Your pillows and bedding could be a problem if you have allergies that are contributing to your COPD. If you are allergic to dust, dust mites, wool or feathers, the type of bedding you use could make your COPD worse. Another problem may be that your new pillows are too soft, and they may not be giving you enough support at night. Many people with COPD sleep better if their head and upper body is not too flat. If you have never been checked for allergies, talk to your doctor about getting an allergy evaluation. People who have allergies often benefit from plastic covers over their pillows and mattresses and from washing all their bedding weekly in hypoallergenic detergent and hot water.

 

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Q: Our elderly mother isn't sleeping well and keeping us up all night. What can we do?
Suzette from ID
A:

Dear Suzette,
The first thing to remember is that most people need less sleep and become lighter sleepers with age. This may mean that your mother is easily awakened by noises that you sleep through. Older people become less active and may nap during the day causing less sleep at night. There are also medical conditions that contribute to insomnia in the elderly. These include depression, chronic pain, urinary problems, breathing problems and digestive problems.

You might start by making sure your mom's sleeping environment is quiet and dark. If she tends to nap during the day, see if you can increase her activity level. Outside activity, even if it is just to sit outside for a while, is especially important because sunlight resets the "biological clock" which helps regulate sleep. Make sure your mom avoids caffeine in the afternoon, alcohol in the evening and any heavy eating after dinner. Over-the-counter sleep aids can have the opposite effect in the elderly and make sleep worse.

If these simple remedies are not helping, see her primary caregiver. Medical causes of insomnia should always be investigated. Ask the caregiver if any of your mom's medications may be contributing to the problem. Her caregiver should be able to rule out any medical problems that could be causing insomnia help you come up with the best treatment plan. 

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Q: Is it usual to have vertigo with a urine infection
A:

Vertigo is the sensation of spinning or movement when you are not really moving. It may feel as though the room is spinning while you are still. This is not a symptom that goes along with urinary tract infection (UTI). If you are having true vertigo, you need to see your doctor, and you may need a referral to an ear, nose, and throat specialist. You might have a sensation of dizziness, which is more like feeling lightheaded, if you have a severe urinary tract infection with a fever. Another possible link between dizziness and UTI could be the antibiotic Cipro. This medication may be used to treat UTI and one of the side effects is dizziness. In any case, talk to your doctor. Neither vertigo or dizziness is common with UTI, so it should be investigated.

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Q: Why don't people take advantage of hearing aids? My dad refuses to get one, though it’s obvious he’s having a hard time hearing us.
A:

Despite the significant handicaps imposed by hearing loss in seniors, only about 20 percent ever buy a hearing aid and many of those are rarely used. If you know or are a senior struggling with hearing loss and resisting a hearing aid, you should know that many of the common reasons given for not trying or using a hearing aid don't make a lot of sense:

Association with age. It's hard to make any concession to age in a culture obsessed with youth. But do you really think having to constantly ask people to repeat themselves doesn't make you seem old?

Difficulty adapting. One of the most common reasons for rejecting a hearing aid is that it is just too complicated. "I'm too old for change—I can't be bothered" is a common complaint heard by audiologists. Remember when the remote control for your TV seemed complicated?

Cosmetics. Manufacturers of hearing aids are aware that their cosmetic appeal is an important factor. That's one reason why they keep making hearing aids smaller (even though smaller is not necessarily better). Today's hearing aids can hide inside your ear. But even if your hearing aid is visible, is it really such a big deal? Would you be worried about someone seeing your glasses?

Unrealistic expectations. You may have heard from friends that hearing aids just don't work. In many cases a bad hearing aid experience is due to a poor evaluation and fitting. But even in the best of circumstances your hearing will not go back to the way it used to be. Hearing aids do help, but they don't cure. That’s why they’re called aids.

Cost. Medicaid does not cover hearing aids and they are very expensive. For some people on a fixed income this is a real concern. Diagnostic evaluations are usually covered. A single hearing aid may cost around $2,500, but if properly fitted and worn, your hearing aid can be well worth the investment.

Once you get passed these arguments be to go about being fitted the right way. Start with the doctor. In most cases the patient should be referred to an ear, nose and throat specialist. Some causes of hearing loss in seniors can be corrected and the success of your hearing aid depends on getting a proper evaluation. If the specialist thinks a hearing evaluation is needed, it will be done by an audiologist. An audiologist is a hearing professional trained to measure hearing loss and fit you for a hearing aid. Expect the audiologist to custom fit the hearing aid and help the patient through the adjustment period. Just as you might expect from a car dealership, you should expect to be able to come back with any complaints or service issues. Here is what an audiologist should offer you: A thorough explanation of the type of hearing loss you have and what types of hearing aids will work best for you; an explanation of why one or two hearing aids is advisable; an explanation of all the charges, including dispensing fee, servicing, repairs and warranty—ask about a trial period; testing after the hearing aids have been fitted while wearing them; and instructions on using your hearing aid and on maintaining it.

Hearing aids are expensive, but in most cases they do work and they are the best solution for most cases of senior hearing loss. They key to getting the most out of a hearing aid is starting with a good medical exam and then finding a hearing professional that will work with you before, during and after your purchase.

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Q: What are the signs of a stroke?
A:

Blood supply to the brain can be cut off by a blood clot that travels to the brain or by the narrowing of an artery in the brain from arterial disease; this type of stoke is called an ischemic stroke. Blood supply can also be cut off if a blood vessel in the brain ruptures; this is called a hemorrhagic stroke. Regardless of the cause, as soon as blood supply is cut off, brain cells start to die. If part of the brain goes without its blood supply for just one minute, two million brain cells will die. That is why it is so important to recognize the symptoms of a stroke.


A stroke is a medical emergency and every minute is important. If you are a caregiver for someone who has any symptoms of a stroke, call 911. The National Stroke Association recommends that everyone learn the F.A.S.T. method for recognizing stroke symptoms:

F for face. Ask the person to smile or move their facial muscles and look for one sided weakness.

A for arms. Ask the person to lift their arms to see if one arm is weak or not moving.

S for speech. Ask the person to repeat a few words and listen for slurred or disordered speech.

T for time. Remember that time is of the essence. Call 9-1-1 and get the person to emergency treatment.
 

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Q: How much sleep do seniors really need? I’m not sure my parent is getting enough.
A:

A recent review article published in the journal Geriatrics and Gerontology International states that aging is associated with changing sleep patterns that lead to reduced stages of restful sleep as well as increasing periods of wakefulness. Sleep disorders such as restless leg syndrome and obstructive sleep apnea also increase with age. Identifying and managing sleep problems in the elderly is important because lack of sleep can contribute to depression, memory impairment and physical disease. "Americans need more sleep. We may be the most sleep deprived culture in history," says Alan Kominsky, MD, an otolaryngologist and sleep specialist at the Cleveland Clinic Sleep Disorders Center. "People sleep less as they get older and many seniors complain bitterly about lack of sleep."

In addition to the natural changes in sleep patterns that occur with age, there are many other reasons for sleep problems in the elderly. "There are many factors," says Dr. Kominsky, "including arthritis pain, sleep apnea from loss of muscle tone and enlargement of the prostate gland that causes men to wake up to urinate frequently at night. Seniors in nursing homes may develop sleep disorders because they lose their normal schedule, don't get outside in the sunlight and nap more frequently."

In the past, other than daytime sleepiness, the health consequences of sleep deprivation were not appreciated. We now know that over 50 percent of all older adults complain of significant sleep disturbance and that these disturbances can have serious health consequences. "If you are a caregiver for a loved one who seems sleepy during the day or whose mental functioning seems to be declining, try observing them during sleep,” advises Dr. Kominsky. “Look for restless sleep, loud snoring or periods of interrupted breathing. These could be signs of sleep apnea, which is a condition that increases with age. Sleep apnea can be treated with a continuous positive airway pressure device, a treatment that is well tolerated by seniors." If you suspect a sleep disorder, ask the doctor for a sleep evaluation. Help for sleep problems in the elderly is available and effective.

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Q: How can falls be prevented?
A:

Feeling unsteady on your feet, lightheaded or a false sense of movement are all common complaints in seniors. These dizziness symptoms affect a majority of seniors over the age of 70. One-third of seniors between the ages of 65 and 75 report that feeling dizzy or unsteady is a major concern that diminishes their quality of life. According to the Centers for Disease Control and Prevention, more than one third of seniors over age 65 also fall each year. Falling is the leading cause of injury-related death for seniors and broken bones from falling can lead to a loss of independence. A recent study published in the journal Age and Ageing reports that dizziness is a common cause of falling, that seniors with vertigo are the most likely to fall and that many of these falls among seniors can be prevented by recognizing and treating vertigo. The first thing you need to know is that not all dizziness symptoms are the same. Vertigo is the term that doctors use to identify the type of dizziness that causes you to feel like you, or the room around you, is actually moving or spinning. This is important because vertigo is the most common type of dizziness that occurs with increasing age, the most likely to cause a fall and a type of dizziness that can often be treated. However, all types of dizziness can contribute to falls in seniors. The most important thing to know is that dizziness, vertigo and imbalance are not a normal part of aging and that treatment is available. You don’t need to live in fear of falling.


Some symptoms that may be seen with dizziness demand immediate attention. If you are a senior’s caregiver and you note any of the following symptoms along with dizziness, you need to treat it as a medical emergency: high fever, severe headache or stiff neck; convulsions or vomiting; head trauma; loss of consciousness; sudden weakness or inability to move an arm or leg; and chest pain or shortness of breath.

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Q: I’m concerned about my father’s emotional health and worry that he’s drinking too much.
A:

Abuse of alcohol among adults over the age of 65 has been estimated to be as high as 17 percent. Although seniors make up about 14 percent of the US population, they account for about 25 percent of yearly prescription drugs. As many of these prescriptions are for chronic pain, insomnia, and anxiety, this can be a dangerous cocktail for seniors. As the baby boomer generation continues to age, the number of cases of substance abuse in the elderly is predicted to double by the year 2020.

More seniors are living alone and studies show that living alone is a risk factor for substance abuse. It is also harder to detect substance abuse in the elderly if the senior lives alone, and seniors are unlikely to admit to this problem. So if you are a caregiver, you need to be aware of these substance abuse warning signs: Depression, sadness or loss of interest in activities, friends and family; memory loss, confusion or irritability; loss of coordination, falls or unexplained bruising; changes in sleeping habits, eating habits or weight loss; wanting to be alone most of the time; and failure to keep up with physical hygiene or household chores.

If you suspect alcohol abuse, let your senior’s health care provider know you are concerned. If you suspect drug abuse, get a shopping bag and collect all the prescription and over-the-counter medications in the house. Take them to your senior’s heath care provider. Health care providers have screening tests they can use to detect alcohol or drug abuse in seniors. They can adjust medications, change doses or eliminate unnecessary prescriptions. The good news is that if substance abuse treatment is required, seniors respond just as well or even better than younger people.

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