Healthy Aging for Seniors Over Age 65

Getting older brings with it an abundance of emotional, physical and mental challenges. Aging can also bring with it a lot of anxiety. When we are in our 40’s we frequently talk about our parents, aunts and uncles getting older but seldom realize that at the very same time we are also aging.

The unexpected nature of the aging process often makes us feel nervous and scared. One in every eight Americans is over the age of 65. Preventing health problems is one of the few known ways you can remain independent for as long as possible and avoid the debility traditionally associated with aging.

Many organizations, agencies and health care providers are exploring and setting agendas for improvements in health across all life stages in an effort to improve our health and well being as we age.

Interim HealthCare staff are trained to assist you to take care of your body so you can feel more comfortable as you greet the changes that come with aging. Interim HealthCare is committed to assist you with information, education and resources that will help you manage many of the aspects of the aging process and improve your quality of life and help you enjoy yourself.

What the Flu is Costing Your Business.

When employees are sick, your company suffers, one employee sick day can cost your business up to $500 in lost production, replacement and related expenses. Additionally, healthy employees are forced to manage their sick coworker's workload, which leads to distraction and frustration. When sick employees do come to work, they can infect others, multiplying your losses. The Center for Disease Control (CDC) encourages all employees who want protection from the flu to get vaccinated for the seasonal flu.

One way to protect your employees is to set up a Worksite Flu Program. Worksite Flu Programs work by having a nurse or pharmacist come into the office to perform vaccinations at your workers convenience. They will also help organize and promote the program. By having a Worksite Flu Program your employees don't need to spend time out of the office for a doctor's visit and because it is convenient, staff members are likely to take advantage of the vaccination, which in the end means more healthy employees and a more productive company.

In the end Worksite Flu Programs save money by reducing the expense of employee sick days, maintain employee and company productivity, as well as demonstrate your commitment to your employees' well being.

UV Protection

Did you know that exposure to sunlight during the winter months puts you at the same risk as exposure during the summertime? There are a number of things you can do to prevent sun damage in any season. This is a short list of the things you can do to control sun damage to your skin:

1) Seek shade between 10 AM and 4 PM. This is the time of day that the sun’s rays are at their strongest and can do the most damage.

2) Cover up; don’t spend a lot of time in the sun with a bathing suit on. Cover up with towels, tee shirt or robe. Areas of your body that have not seen the sun in a long time are vulnerable to the sun’s damage.

3) Wear wrap-around sunglasses; use the kind that block as close to 100% of UVA rays as possible.

4) Use a hat with a wide brim to shade your face, head, ears and neck. If your hair is thin or you are bald or balding, the uncovered areas of your scalp can sustain a bad burn.

5) Use sunscreen with sun protective factor (SPF) 15 or higher on any skin areas that will “see” the sun.

Sun Damage to the Skin

We often link together a glowing complexion or sun-tanned skin with good health. If you are a “sun worshiper”, damage to your skin from days in the sun or a tanning booth may not become apparent until later in life.

Exposure to the sun causes a variety of conditions to occur; these are:

• Pre-cancerous and cancerous skin lesions caused by the loss of the skin’s ability to fight off disease

• Benign skin tumors

• Discoloration of the skin, including freckles

• Skin lines, including fine and course wrinkles

• Blood vessels that may raise closer to the surface and dilate under the skin

Senior Health & Fitness Day: Healthy Weight Management

Today is Senior Health and Fitness Day and in support we've posted one of our Here's to your Health presentations on Healthy Weight Management.

Obesity has doubled among the population aged 65 and older since 1987. A Task Force of the National Institutes of Health (NIH) estimates that more than 25% of American adults are obese and therefore at risk of heart disease, Type 2 diabetes, high blood pressure, stroke and some forms of cancer.

What is Obesity vs. Being Overweight?

Most people believe that obese is being very overweight, but it is not that simple. In fact, “overweight” is defined as an excess amount of body weight that includes muscle, bone, fat and water. “Obesity” is specifically an excess amount of fat. Bodybuilders, for example, with a lot of muscle can be overweight, but not obese.

A certain amount of body fat is necessary for heat insulation, shock absorption and other body functions. Women as a rule have more body fat than men, and so the proportion of fat considered “healthy” varies by gender. The current standard is that men with body fat more than 25% and women with more than 30% body fat are obese.

Measuring the exact amount of body fat is not easy. The US Preventive Services Task Force recommends using the body mass index (BMI), which is simply weight adjusted for height. As an example, go to the BMI table, and then find your height in the far left-hand column. Then find your weight to the right of your height, and look at your weight group and classification. Are you normal, overweight or obese?

If you are obese, you are more likely to suffer from: gallbladder disease and gallstones; liver disease; osteoarthritis-the result of excess weight on the joints; gout; pulmonary or lung problems-including sleep apnea; and, if a woman, you are at more at risk for cancer of the gallbladder, breast, cervix, uterus and ovaries.

Are You an Apple or a Pear?

Research tells us that not only how much fat a person has is a predictor of risk, but also where that fat is stored on the body. Women typically collect fat in their hip and buttocks, giving them a “pear” shape. Men usually build up fat around their bellies, giving them more of an “apple” shape. Of course men can become more pear-shaped as they age, and some women become more appleshaped after menopause. However, an apple shape is a predictor of heart disease. If you carry fat around your waist you are more likely to develop health problems. Among Asian Americans or persons of Asian descent a waist measurement is a better predictor of disease than using the BMI index.

Measure your waist:

• Women with a waist measurement of > 35 inches,

• Men with a waist measurement of >40 inches are at greater health risk, particularly for heart disease and stroke.

What Causes Obesity and Being Overweight?

Both obesity and being overweight occur when you consume more calories than you burn. However, genetic, environmental, psychological and other factors play a role.

Genetics: Obesity and being overweight does tend to run in families, suggesting a genetic cause. Remember that families do share diet and lifestyle habits that contribute to the problem. Research is beginning to show that heredity can be linked to obesity.

Environment: Lifestyle, such what a person eats and your level of physical activity strongly influences your weight - so genes need not to destine people to lifetimes of obesity. People can change eating habits and levels of activity.

Psychological: Many people respond to negative emotions such as anger, boredom or sadness by eating. Most overweight people have more psychological problems than people of average weight.

Other Causes: Some illnesses also lead to obesity as well as a tendency to gain weight. These include hypothyroidism, Cushing’s syndrome, depression and certain neurological problems. Drugs such as steroids and some antidepressants can also cause weight gain.

Who Should Lose Weight?

The standard in US healthcare is to lose weight if your BMI is 30 or more. If your BMI is between 25 and 29.9, prevention of weight gain is recommended unless your doctor recommends weight loss due to other health factors.

Fortunately, a weight loss of only 5-10% can improve health! The NIHrecommends if you are obese that you lose 10% of your baseline weight (the weight you are now that classifies you as “obese”) at a rate of 1-2 lbs/week. If you are overweight, reduce calories by 300-500/day and you should have a loss of .5 lbs per week.

What Happens 6 Months After You Start Losing Weight?

We now know that in general after 6 months of weight loss, the rate at which weight usually declines does plateau. If you need to lose more weight, it will take intense management and discipline on your part to watch your diet, sustain physical activity and behavior control. This is now the weight
management stage, and you are considered successful if you regain less than 6.6 pounds in the next 2 years and sustain a waist reduction of 1.6 inches from your waist measurement when you started.

Eating for Successful Aging-5 Simple Suggestions:

Loss of weight and sustaining weight is never easy, but the following are 5 suggestions that represent lifestyle changes that help you.

1. Eat plant-based foods: Healthy eating plans includes include foods with whole grains, fresh vegetables, fresh fruit and beans, nuts and seeds.

2. Drink water: Age increases your sense of thirst. By the time you feel thirsty, you are already slightly dehydrated. So drink until you have had enough, and then drink a little more. Although a common guideline says drink 8 glasses a day, a better individualized amount of how much water
you need is to divide your weight in half – this is the approximate amount of fluid ounces you need daily. Remember that drinks with alcohol or caffeine do not count – they only make you urinate more!

3. Watch fat, cholesterol and sodium: This guideline is particularly important for women. Women on average lose more muscle and gain fat more than men do. Therefore, women need to watch the intake of the following fats even more closely:

a. Saturated fat: butter, cheese, whole milk, meat, cream, poultry, chocolate, lard and solid shortening all have saturated fat and raise your cholesterol.

b. Polyunsaturated fat: while vegetable oil lowers polyunsaturated fats, it also promotes oxidation. Oxidation enables cells in your arteries to absorb fat and cholesterol. Over time oxidation builds up plaque, narrowing your arteries.

c. Monounsaturated fat: Olive oil, canola oil and nuts contain this fat that may help lower blood cholesterol. It is a good idea to control all types of fat, but when do you add fat to your diet,
choose monounsaturated fat.

d. Sodium: You need only a small amount of salt in your diet – less than one quarter teaspoon daily to help regulate fluid balance. Controlling sodium can be as easy as limiting processed foods, and carefully watching how much salt you add to foods when cooking and eating.

4. Watch calories: As you age your metabolism slows and fat accounts for a greater proportion of weight. This reduces your need for calories. Don’t forget this fact. On average women gain a pound per year after age 35.

5. Consider supplements: Talk to your doctor about certain vitamin or mineral supplements. Especially important are calcium, Vitamin D, C and E, selenium and co-enzyme Q10-all antioxidants. Do NOT decide on your own about these supplements, as taking too much is dangerous.

These five simple suggestions and making a few adjustments for aging can make the issue of being an apple or a pear a discussion solely for produce section of the grocery store and not your doctor’s office!

References

“Obesity and Other Chronic Conditions Drive Medicare Spending Increases” Diabetes, Obesity and CVD American Diabetes Association November 2006

"Successful Aging" Mayo Clinic Health Information, 2000

"The Practical Guide-The Identification, Evaluation and Treatment of Overweight and Obesity in Adults" National Institutes of Health – National Heart, Lung and Blood Institute North American Association for the Study of Obesity October 2000

“USPSTF Recommends Obesity Screening for all Adults” Medscape Medical News 12/01/03

“Understanding Adult Obesity: Do You Know the Health Risks of Being Overweight?” Briefings on Patient Safety National Institutes of Health 2000

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Tips for Caring for Your Heart and Preventing Heart Disease

February is Heart Health Month, an entire month dedicated to caring for our hearts and preventing heart disease. Heart disease involves any disorder that affects the heart's ability to function normally. The most common cause of heart disease is narrowing or blockage of the coronary arteries, which supply blood to the heart. Other causes of heart disease include problems with the heart valves, abnormal electrical rhythm of the heart and weakening of the heart's pumping. As we age there are many diseases and conditions that affect our hearts and we want you to learn how to recognize if you are having problems with heart disease and how to help control any heart disease you may have. This information is tailored to an older adult who may possibly be living with heart disease, and in sharing this information; we hope to guide you on the path to preventing complications and managing heart disease and to living a happy, healthy life.

Some of the reasons that people get heart disease are not in their control, such as family history, age and race. However, there are many ways you can control the development and seriousness of heart disease. Because the disease is so common (it is the number one cause of death of men and women over 85) many older adults may already have heart disease and not even know it. It is also common not to have any signs while heart disease is developing, so it is extremely important to know your risk factors and ways to manage them. Lifestyle issues such as smoking, obesity (being overweight), high cholesterol, lack of exercise, high blood pressure and uncontrolled diabetes can all lead to problems with your heart. We know that making changes in your lifestyle is not an easy task, but no matter what your age, by making changes you can improve your health and reduce the chance that heart disease occurs or becomes more problematic.

There are many ways you can improve the health of your heart. The first change you will need to make is to quit smoking. Because people who smoke have more than twice the risk for heart attack, this is a powerful way to slow heart disease and reduce symptoms of existing heart disease. Secondly, you may need to improve your cholesterol levels and lower your blood pressure. Because the fat from cholesterol and damage from high blood pressure can lead to heart problems such as coronary artery disease and congestive heart failure, eating a diet low in fat and exercising is extremely important. To lose weight and improve your health you will need to eat foods such as fish, vegetables, fruits and whole grains. You can lower your chances of getting heart disease by carefully choosing the foods you eat. Be sure to speak with your health care professional before beginning any diet program. For a healthy heart eat:

Less Fat
Some fats (saturated) are more likely to cause heart disease.
Eat less of foods containing:
• Animal fats such as meat, milk, cheese and butter
• Palm and coconut oils
Eat more of foods containing polyunsaturated & monounsaturated fats:
• Olive, canola, safflower and corn oil
• Seafood

Less Sodium
This can help to lower some people’s blood pressure as well as reduce the risk of heart disease. Avoid adding salt to foods at the table; many already contain sodium, which was added during preparation.

Fewer Calories
If we eat more calories than our body needs then we gain weight. Being overweight can cause heart disease. In order to lose weight, eat fewer calories.

More Fiber
To lower your chances of getting heart disease eat more foods containing fiber such as:
• Fruits
• Vegetables
Grain

Exercise not only helps you lose weight but also strengthens the heart and improves blood flow. It is safe for most adults over the age of 65 to exercise. Even people with chronic conditions such as heart disease, high blood pressure, diabetes and arthritis can exercise safely; in fact, many of these conditions are improved with exercise. Even leisure-time activities such as gardening, walking and dancing are good for our hearts. If you are not sure if exercise is safe for you, please ask your health care provider. Exercise can be fun and helps to reduce stress, which can be a common problem for people with heart disease. Managing stress can help to reduce heart disease symptoms as well as help prevent feelings of depression, another common complication for those diagnosed with heart disease. Be sure to speak with your healthcare provider if you are experiencing signs of depression such as feeling sad, trouble sleeping, wanting to be alone, or feeling worthless or helpless.

Normally blood flows freely inside your heart’s arteries, which are like hollow tubes. As you grow older, fat and other substances build up along the walls of these tubes, causing narrowing and hardening; this build up is called plaque. Coronary artery disease is the clogging or narrowing of the blood vessels that bring blood to our hearts; if the heart doesn’t get enough blood it becomes starved for oxygen and cannot work properly. Lack of oxygen causes the heart to cramp during activities such as exercise, eating and excitement, when your heart needs extra oxygen. The most common symptom of coronary artery disease and lack of oxygen is angina, which most people say feels like bad heartburn. Angina causes the sensation of pressure in your chest, but it is also common to feel aching, burning, fullness and pain. Angina discomforts may also be felt in the left shoulder, arm, throat and jaw or in your back. If you have angina pain for the first time or if you are already taking medication for angina and it does not relieve your pain, you should seek help immediately.

Another serious condition that can affect your heart is called congestive heart failure. Heart failure is when your heart can no longer pump enough blood to your body, or, when the heart cannot stop blood from “backing up” in your lungs. In most cases heart failure occurs over time and can have many different causes. One of the most common causes of heart failure is an abnormal heartbeat called an arrhythmia. Patients sometimes describe an arrhythmia as their heart beating too fast, fluttering or skipping a beat. Although it is important to see your doctor if you have had any of these symptoms, it is common as you age to have arrhythmias. Other causes of heart failure include: high blood pressure, abnormal heart valves, alcohol or drug abuse, damaged heart muscle or damage to the lungs. Symptoms of heart failure include feeling tired, an irregular heartbeat, loss of appetite, confusion, nausea, coughing or wheezing that doesn’t go away, shortness of breath and swelling of the feet, legs or stomach. Again, it is very important to see your doctor if you experience any of these problems. With congestive heart failure your doctor may recommend limiting your fluid intake in order to reduce the stress on your heart. Weighing yourself daily will also be an important tool in managing congestive heart failure.

One more complication we would like to mention is vascular disease or disease of the blood vessels. Vascular disease is included in the discussion on heart disease because it can eventually lead to heart failure or even a heart attack. There are many different types of vascular disease, each with separate causes and symptoms, but what is important to remember is that any condition that affects your arteries, veins, lymph vessels or blood can affect your heart. Blockage of arteries in your body, abnormal bulges in your vessel walls (aneurysm), certain diseases, varicose veins and blood clots or clotting disorders all place you at a higher risk for heart disease.

After studying the results of your tests your doctor may prescribe medications to help treat or prevent heart disease. There are many different kinds of medications, some are used to lower blood pressure and cholesterol while others rid your body of excess fluids, which put stress on your heart. Each person is unique as is the treatment of his or her heart disease. Although we cannot possibly describe every medication and how it works, we do have some simple suggestions to help you safely use the medications prescribed to you. Keep a list of your medications and how much you are taking with you at all times, this is important in case you experience complications or illness and need to go to the hospital. It is also important to tell your health care team about additional medications you are taking, such as: vitamins, herbals and dietary supplements. If you have allergies to any medications or have had a problem when taking a particular medication in the past, this is also important information to share. If cost is a concern, there may be another medication that costs less, yet works the same. Ask questions about every new prescription medication and be sure to get the answers you need before taking the medication. Know what your edication is for. It is also important that you take your medication when scheduled and at the same time every day. Some medications are more effective when taken at a certain time of day, so scheduling is key. Also, some medications may work better if taken with food and others may react with certain types of foods or with other medications so be sure you follow instructions. Do not skip doses or stop taking your medication unless you speak with your doctor first. Filling a pillbox is a great way to keep medications organized and help you to remember times and dosages. It is also not safe to take over-the-counter or herbal remedies unless approved by your doctor. Before having surgery be sure to let the doctor or dentist know what medications you are taking, because some heart medications may cause excess bleeding. Also, some medications may cause dizziness, so be sure to stand up slowly, especially when getting out of bed. In sharing these tips we hope to help you prevent complications from medication errors, and live a healthier life.

The prevention of infection is of utmost importance to people who have heart disease. By getting vaccinations that protect against flu and pneumonia you can lower your risk of infection related complications that could further damage your heart. Protecting yourself against infections such as the common cold is as simple as washing your hands. Be sure to use soap and warm water and lather up for at least 15 seconds and a great tip for anyone during cold and flu season is to avoid others who appear sick. Knowing the symptoms of the common cold and the flu will allow you to know when there is a problem and when it is time to notify your doctor. A high fever, accompanied by a headache, body aches and pains, fatigue and chest discomfort such as coughing may be the flu. The flu can produce many severe complications, such as pneumonia, so be sure to call your doctor if you experience these symptoms.

The final topic is cardiac emergencies. There are different types of emergencies, but we are going to focus on heart attack. A heart attack occurs when the heart does not get enough oxygen due to blocked arteries; remember that plaque that caused narrowing? Due to the lack of oxygen some of the heart muscle dies, and if too much of the heart is damaged, it can cause sudden death. A heart attack requires immediate attention! For most people symptoms of a heart attack include severe chest pain that may also be felt in the back, jaw, throat or arm. Other symptoms include heartburn-like sensation, sweating, nausea and vomiting, problems with breathing, feeling dizzy, weak or anxious. If you are having chest pain and have been diagnosed with angina, it is important to take your nitroglycerin as prescribed. If you think you are having a heart attack call 911 or emergency services right away. If your heart stops beating, or is quivering instead of beating, you will need to receive defibrillation. Defibrillation assesses your heart rhythm and delivers an electric shock in order to correct it. If a defibrillator or AED device is not available, CPR is another method to help someone whose heart has stopped. CPR does not “restart” the heart, but it helps to deliver oxygen and circulate blood until help arrives. Once you arrive at the emergency room doctors will perform an ECG and do several blood and other tests. Quick treatment is important to save the heart from permanent damage. Treatment may include any of the various medications, procedures, surgeries and/or devices that we have mentioned throughout our discussion and there are also many more options available that we didn’t discuss. If you have already had a heart attack you may be able to prevent having another one; this is where the lifestyle changes we discussed are so important. We at Interim HealthCare are available.

References
Allender, J., & Spradley, B. (2005). Community Health Nursing (6th ed.). Philadelphia:
Lippincott Williams & Wilkins.
American Heart Association. (2005). Diseases and Conditions. Retrieved November 3,
2005, from http://www.americanheart.org
Black, J., Hawks, J., & Keene, A. (2001). Medical-Surgical Nursing (6th ed.).
Philadelphia: W.B. Saunders Company. Allender and Spradley.
Cardiology Channel. Congestive Heart Failure. Retrieved November 8, 2005, from
http://www.cardiologychannel.com
Cass, P., Luckmann, J., Nigro, C., Schlapman, N., & Timby, B. (2002). Content Mastery
Series Registered Nurse Medical-Surgical Review Module (4.1 ed.). United States:
Assessment Technologies, LLC.
Cleveland Clinic. (2005, July). Recovery after heart surgery. Retrieved November 10,
2005, from http://www.clevelandcling.org/heartcenter
Jarvis, C. (2000). Physical Examination and Health Assessment (3rd ed.). Philadelphia:
W.B. Saunders Company.
Porth, C. (2002). Pathophysiology Concepts of Altered Health States (6th ed.).
Philadelphia: Lippincott Williams & Wilkins.
WebMD. (2005, October). Heart Disease: Your Guide to Heart Disease. Retrieved
October 27, 2005, from http://mywebmd.com
MedlinePlus. (2004, February 1). Nitroglycerin Tablets, Capsules, and Sprays. Retrieved
November 10, 2005, from National Institutes of Health Web Site:
http://nlm.nih.gov
Additional resources include JCAHO.org and FDA.gov